Posted: April 29th, 2018

Barriers to Implementation of Telemedicine in Rural Emergency Departments

Barriers to Implementation of Telemedicine in Rural Emergency Departments

Telemedicine is the use of information and communication technologies to provide health care services remotely. It has the potential to improve access, quality, and efficiency of care for rural populations, especially in emergency situations. However, telemedicine adoption and utilization in rural emergency departments (EDs) remains low, despite the growing demand and need for such services.

In this blog post, we will discuss some of the barriers that hinder the implementation of telemedicine in rural EDs, and suggest some possible solutions to overcome them.

Cost

One of the major barriers to telemedicine implementation in rural EDs is the high cost of acquiring, maintaining, and upgrading the necessary equipment and infrastructure. According to a study by Zachrison et al. (2020), cost was the most commonly cited reason for lack of adoption among rural EDs that did not use telemedicine in 2016. The study found that implementing a telemedicine program can cost anywhere from $17,000 to $50,000 for equipment and internet connectivity. Moreover, rural EDs may face additional costs related to staff training, technical support, and legal and regulatory compliance.

To reduce the cost barrier, rural EDs may seek external funding sources, such as grants, subsidies, or donations, to support their telemedicine initiatives. They may also collaborate with other health care organizations, such as academic medical centers or regional networks, to share resources and expertise. Furthermore, they may adopt low-cost or open-source telemedicine platforms that are compatible with existing devices and systems.

Reimbursement

Another barrier to telemedicine implementation in rural EDs is the lack of adequate and consistent reimbursement policies for telemedicine services. Reimbursement policies vary by state, payer, and service type, and often do not cover the full cost of providing telemedicine care. For instance, some payers may only reimburse for certain types of telemedicine encounters, such as video consultations or store-and-forward transmissions, but not for others, such as remote patient monitoring or asynchronous communication. Some payers may also impose restrictions on the location, specialty, or licensure of the telemedicine provider or the patient.

To overcome the reimbursement barrier, rural EDs may advocate for more favorable and uniform reimbursement policies at the state and federal levels. They may also negotiate with payers for alternative payment models, such as bundled payments or value-based contracts, that reward quality and outcomes rather than volume and service type. Additionally, they may demonstrate the value and cost-effectiveness of telemedicine services through data collection and analysis.

Acceptance

A third barrier to telemedicine implementation in rural EDs is the lack of acceptance and adoption by clinicians, patients, and administrators. Clinicians may be reluctant to use telemedicine due to concerns about technical issues, liability risks, workflow disruptions, or loss of autonomy. Patients may be hesitant to use telemedicine due to privacy fears, cultural preferences, or lack of trust or familiarity with the technology. Administrators may be resistant to use telemedicine due to organizational inertia, competing priorities, or insufficient leadership support.

To increase the acceptance and adoption of telemedicine in rural EDs, it is important to involve all stakeholders in the planning, implementation, and evaluation of telemedicine programs. Stakeholders should be educated about the benefits and challenges of telemedicine, as well as their roles and responsibilities in using it. They should also be provided with adequate training, feedback, and incentives to facilitate their use of telemedicine. Moreover, they should be encouraged to participate in quality improvement activities and best practice sharing to enhance their telemedicine skills and performance.

Conclusion

Telemedicine is a promising tool to improve emergency care delivery in rural areas. However, there are several barriers that prevent its widespread implementation in rural EDs. These barriers include cost, reimbursement,
and acceptance issues that need to be addressed through various strategies. By overcoming these barriers,
rural EDs can leverage telemedicine to enhance their capacity,
quality,
and efficiency
of care for their patients.

References

: Zachrison KS et al., Understanding Barriers to Telemedicine Implementation in Rural Emergency Departments. Ann Emerg Med 2020;75:392-399.
: Telehealth Reimbursement a Barrier for Rural Hospital EDs. MHealth Intelligence 2021.
: Physicians’ Perspectives of Telemedicine During the COVID-19 Pandemic: A Systematic Review. JMIR Med Inform 2021;9(6):e27176.
: Understanding Barriers to Telemedicine Implementation in Rural Emergency Departments.
: Patient Perceptions of Telehealth Visits Before and After COVID-19: A Systematic Review
and Thematic Analysis. J Gen Intern Med 2021;36:2598–2607.

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