Telehealth is the delivery of health services at a distance. It has considerable
potential to have either positive or negative impacts on access to and delivery
of rural health services. This policy statement provides the participants, funders
and planners of rural health services with guidelines for the introduction of
telehealth services to rural communities.
Rural communities have been early adopters of technology where these technologies
can reduce their isolation and disadvantage in access to services. Low level,
and relatively low cost, technologies have the potential to offer access to
useful telehealth services for many rural communities, especially Internet based
services. If a rural community has access to basic telephony services and a
computer, then the community has access to e-mail as a basic Internet service.
At this basic level, there are many opportunities to use e-mail to reduce the
professional isolation of rural health workers.
Telehealth planners and designers must recognise the economic impact of telehealth
services on a rural community when specifying components and performance criteria
for telehealth. Many rural communities will not be able to sustain telehealth
services without significant subsidies from central funders. Funders of rural
telehealth services must also allocate sufficient levels of recurrent funding
for rural health workers to have access to ongoing technical support and training,
and for capital replacement, upgrade and depreciation costs of information and
technology equipment
Critical factors in the planning and implementation that will determine the
success and sustainability of telehealth services include:
* an appropriate needs survey of rural communities for planned telehealth services
* a partnership involving funders and planners with the rural communities that
acknowledges, respects and responds to the views and needs of local health workers
at all stages in the planning and implementation of these services
* sufficient levels of funding for rural health to support a policy commitment
to rural health, including telehealth
* the potential for local, national, regional and global partnerships that may
enhance the level of services provided and/or spread the cost of providing communications
and information technology infrastructure, and
* consideration as to whether any regulatory barriers exist to telehealth (especially
for reimbursement of health care providers), and initiatives to ensure that
these are addressed prior to the introduction of telehealth services
The introduction of telehealth services should not have an adverse impact on
access to health services by rural communities. Planning for telehealth services
must never be intended to replace local health care services delivered by rural
health workers to their community at the local level.
Any service delivery based on telehealth must acknowledge existing referral
and access patterns between rural communities and secondary/tertiary providers
of health care. If not, then both the community and the health workers may bypass
the telehealth services, which would have a significant impact on the viability
of the telehealth service. The installation of information and communication
technologies to support telehealth also provides rural health workers with the
opportunity to access a wide range of continuing education services remotely.
There is little evidence to date to support the effectiveness of telehealth,
and any future programs must incorporate data collection and analysis of the
process, impact and outcomes of telehealth as a core component of the planning
process. Evaluation must be an integral part of any telehealth services.