The North State Development and Planning Collective (NSDPC) at the California State University (CSU), Chico, and the California Telehealth Network (CTN) have collaborated for around ten years addressing issues of rural broadband connectivity in rural Northern California through identifying geographic areas that lack broadband services and supporting expansion of these services to rural health care providers (i.e., rural hospitals and health clinics). As part of these efforts, and in response to the lack of health care options, limited access to specializations, and the number of uninsured in rural Northern California, the NSDPC’ Northeastern and Upstate California Connect Consortia (NECCC & UCCC) and the CSU, Chico, School of Social Work partnered to create a survey to assess the status of telehealth services and challenges that prevent rural healthcare facilities from adopting and implementing these services.
The NSDPC’s Geographical Information Center (GIC) and Center for Economic Development (CED) partnered to identify and map rural health care facilities in ten counties in rural Northern California and reached out to them to conduct the survey. The sample size consisted of 40 respondents representing 76 health care facilities. Although the sample size did not provide an adequate number for any statistical significance, or generalizations, the data do create an initial assessment of potential issues and barriers associated with delivering broadband and telehealth services to rural and isolated communities. This survey is the first step in a larger investigation of telehealth service delivery in Northern California.
Survey respondents indicate that a majority of on-site providers have ‘presenting site video conferencing’, utilize psychiatric, mental/behavioral services for diagnosing and treatment or as follow-up care. Off-site providers use their telehealth for clinical labs, experience connectivity barriers, and purchase their equipment through public grants or through general operating funds. The on-site only facilities identified ‘inability to connect at the needed bandwidth’ as one of the largest barriers; while off-site providers stated major barriers were ‘inability to connect at the needed bandwidth’ and ‘lack of community/patient acceptance of telehealth’.
A number of challenges are presented when using telehealth and technology; however, there is an opportunity to address the promise of telehealth improving access and increasing quality of care. Increased awareness of California Telehealth Resource Center (CTRC) can be provided through public service announcements, workshops, trainings, and education on the telehealth services designed specifically for each rural area. Along with education, technical support is critical for rural providers to become comfortable implementing a new form of health care delivery. With CTRC involvement, there can be support with technical concerns, funding resources, grants, private funding, and political advocacy. Additionally, legislation can be implemented to support telehealth usage, for example Assembly Bill 1264, Petrie-Norris. Medical Practice Act: dangerous drugs: appropriate prior examination (2019) can reinforce the use of a telehealth delivery system. This bill specifically indicates telehealth as a means for receiving approval for this type of medication. The political support and policy development regarding key issues of telehealth is an essential element needed for telehealth to evolve.
Finally, telehealth is at a critical juncture as it advances from a tool used intermittently to an integrated tool on a routine basis. The overall findings of this inventory confirm that more research is needed on telehealth services and implementation models. Further investigation into the effectiveness, cost savings, and quality of telehealth is needed.
Celeste A. Jones, David Espinoza, Abigail R. Whittaker and Tyler J. Boyle