Telehealth and Health Information Technology in Rural Healthcare – Models and Innovations

These stories feature model programs and successful rural projects that can serve as a source of ideas and provide lessons others have learned. Some of the projects or programs may no longer be active. Read about the criteria and evidence-base for programs included.

Evidence-Based Examples

Telepsychology-Service Delivery for Depressed Elderly Veterans

Updated/reviewed April 2024

• Need: To provide evidence-based psychotherapy for depression in elderly veterans who are unable to seek mental health treatment due to distance or stigma.
• Intervention: Telepsychology-Service Delivery for Depressed Elderly Veterans compared providing behavioral activation therapy via home-based telehealth and the same treatment delivered in a traditional office-based format.
• Results: A 2015 study and two 2016 studies show that providing treatment via home-based telehealth to elderly veterans in South Carolina resulted in the same improved health outcomes, quality of life, satisfaction with care, and cost of healthcare compared to those receiving face-to-face treatment.

Project ECHO® – Extension for Community Healthcare Outcomes

Updated/reviewed February 2024

• Need: Increase medical management knowledge for New Mexico primary care providers in order to provide care for the thousands of rural and underserved patients with hepatitis C, a chronic, complex condition that has high personal and public health costs when left untreated.
• Intervention: Project leveraging an audiovisual platform to accomplish "moving knowledge, not patients" that used a "knowledge network learning loop" of disease-specific consultants and rural healthcare teams learning from each other and learning by providing direct patient care.
• Results: In 18 months, the urban specialist appointment wait list decreased from 8 months to 2 weeks due to Hepatitis C patients receiving care from the project's participating primary care providers. Improved disease outcomes were demonstrated along with cost savings, including those associated with travel. The project model, now known as Project ECHO® – Extension for Community Healthcare Outcomes — has evolved into a telementoring model used world-wide.

Project ENABLE (Educate, Nurture, Advise, Before Life Ends)

Updated/reviewed February 2024

• Need: To enhance palliative care access to rural patients with advanced cancer or heart failure and their family caregivers.
• Intervention: Project ENABLE consists of: 1) an initial in-person palliative care consultation with a specialty-trained provider and 2) a semi-structured series of weekly, phone-delivered, nurse-led or palliative care coach/navigator sessions designed to help patients and their caregivers enhance their problem-solving, symptom management, and coping skills.
• Results: Patients and caregivers report higher quality of life and lower rates of depression and (caregiver) burden.

UAMS IDHI High-Risk Pregnancy Program

Updated/reviewed January 2024

• Need: Arkansas had high rates of low birthweight babies, and pregnant individuals in rural areas had difficulty accessing specialty obstetric care.
• Intervention: The University of Arkansas for Medical Sciences (UAMS) created the Institute for Digital Health & Innovation (IDHI) High-Risk Pregnancy Program to increase access to care for pregnant individuals in an effort to improve outcomes for high-risk pregnancies.
• Results: The program has increased access to care and improved neonatal outcomes for rural Arkansas individuals through a variety of programs and has been recognized by various organizations as a model program.

Effective Examples

STAIR (Skills Training in Affective and Interpersonal Regulation)

Updated/reviewed March 2024

• Need: To increase access to telemental health services for rural veterans, especially women, with a history of trauma.
• Intervention: STAIR (Skills Training in Affective and Interpersonal Regulation) is a 10-week program designed to reduce PTSD and depression symptoms and increase emotional regulation and social functioning in clients.
• Results: Therapists reported that clients attended more sessions when offered via teleconferencing, and clients reported satisfaction with the program.

Wyoming Trauma Telehealth Treatment Clinic

Updated/reviewed February 2024

• Need: To provide psychotherapy to survivors of domestic violence and sexual assault.
• Intervention: University of Wyoming psychology doctoral students provide psychotherapy via videoconferencing to crisis center clients in two rural locations.
• Results: Clients, student therapists, and crisis center staff were satisfied with the quality of services, and clients reported reduced symptoms of depression and PTSD.

University of Vermont Medical Center's Nursing Home Telepsychiatry Service

Updated/reviewed December 2023

• Need: To improve the health status and access for rural nursing home patients in need of mental health services.
• Intervention: The University of Vermont Medical Center provides telepsychiatry care and education to nursing homes in communities that face shortages of mental health professionals.
• Results: These telepsychiatry consultations have eased the burden on nursing home residents by saving travel time, distance, and money it takes to travel to the nearest tertiary facility.

New Mexico Mobile Screening Program for Miners

Updated/reviewed December 2022

• Need: To increase access to medical screening for miners in New Mexico.
• Intervention: A mobile screening clinic with telemedicine capability screens miners for respiratory and other conditions.
• Results: In a survey, 92% of miners reported their care as very good, while the other 8% reported it as good. The program has expanded to three other states.

Promising Examples

TelePrEP

Updated/reviewed March 2024

• Need: To prevent new cases of HIV in rural Iowa.
• Intervention: TelePrEP provides preventive care via telehealth and prescription delivery.
• Results: Between February 2017 and August 2020, TelePrEP received 456 referrals, with 403 patients completing an initial visit.

SD eResidential Facilities Healthcare Services Access Project

Updated/reviewed August 2020

• Need: To increase local health services to rural elderly populations in long-term care facilities located in four Midwest states near a tertiary care organization.
• Intervention: A non-profit healthcare organization implemented telehealth services to provide acute care evaluations for long-term residents in their home facilities.
• Results: The program increased local care as evidenced by improved year-over-year provider-determined available transfer data: 33%, 50%, 63% program years 1 through 3, respectively. From the success of the initial pilot implementation, the program has further matured into a long-term care offering that now reaches many other rural facilities located in 10 states across the nation.

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