JMIR Publications

ABSTRACT

Artificial intelligence (AI) is increasingly integrated into telehealth platforms that function as public health infrastructure, supporting disease surveillance, population-level screening, and healthcare access in underserved communities. In the United States, telehealth regulation is largely determined at the state level, creating a patchwork of frameworks with inconsistent oversight of AI-enabled systems. This variation has consequences extending beyond clinical care into the equity of public health protections and the reliability of informatics infrastructure on which population health monitoring depends. This article argues that fragmented state regulation creates governance gaps in AI-enabled telehealth. Drawing on a comparative assessment across all 50 states and informed by Salamon’s New Governance framework, the analysis evaluates variation in telehealth statutory frameworks, licensure models, transparency expectations, liability structures, and data governance protections. The analysis finds that no U.S. state has established a comprehensive governance framework for AI-enabled telehealth. Of the 50 states, only 17 have implemented partial provisions related to AI, such as transparency requirements, algorithmic auditing, or liability considerations. However, most of these provisions remain vague and inconsistent. The remaining 33 states regulate telehealth without addressing the role of AI at all. This governance vacuum disproportionately affects the communities most dependent on AI-enabled telehealth, and it compromises population health data quality flowing into public health surveillance systems. The article proposes targeted reforms including standardized disclosure requirements through model state legislation, distributed liability frameworks, mandatory algorithmic auditing, strengthened data governance standards, and an AI-Telehealth Interstate Compact. These reforms aim to ensure AI-enabled telehealth serves as reliable, equitable public health infrastructure rather than a source of uneven protections across populations.