For all the reports regarding how much telehealth has advanced during the COVID-19 pandemic, it may have gone without notice that robust telehealth capabilities still are not deployed on a large scale in the United States. Some regions and states are much better equipped and experienced in this arena than others.1

Investigators from Florida Atlantic University (FAU) scoured through 2017 data from the American Hospital Association, Area Health Resource Files, and Medicare cost reports. They wanted to identify factors that predicted telehealth and e-ICU capabilities at U.S. hospitals. They found that larger hospitals and facilities that are part of a system are more likely to possess telehealth and e-ICU capabilities than their smaller and independent counterparts.

Beyond those factors, region seems to play an outsize role. Hospitals in the West North Central region tended to be well-equipped with telehealth capabilities. Meanwhile, facilities in the East South Central region and West South Central region were less likely to possess these capabilities. In particular, the researchers found coastal areas that were hit hardest by the initial wave of COVID-19 had the lowest prevalence of rural telehealth capability.

Overall, only 27.4% of hospitals had telehealth capabilities and just 14% had e-ICU capabilities, showing considerable room for improvement in this area. However, multiple barriers to adoption remain, with cost at the top of the list.

“It takes millions of dollars to actually install telehealth capabilities. To not get any payment out of it, why would any hospital invest in these capabilities?” observes Neeraj Puro, PhD, lead study author and assistant professor of management programs and health administration at FAU. “Until [the pandemic], the internal enlistment for telehealth capability was not enough because insurance would not pay for telehealth or a telemedicine consultation.”

Scott Feyereisen, PhD, study co-author and assistant professor of management programs and health administration at FAU, adds there is a general impression that telemedicine is more widely available in hospitals than it is. However, the funding and motivation for adoption have not been there.

“Different states are more involved in terms of providing the funding and the incentives [to provide telemedicine], but [adoption] has been very low,” he says. “We did have some of the data from 2018 that was most recent. We didn’t really see any trend toward additional diffusion [of telemedicine] at that point. I think it is really just coming to the surface now just because of the pandemic and people realizing ... this is a really valuable tool.”

Puro and Feyereisen note states like Minnesota, Iowa, South Dakota, North Dakota, Nebraska, Missouri, and Kansas lead the way in telemedicine use, while New York, Florida, California, and Washington lag. However, both investigators are hopeful there is impetus now to enact the regulatory changes needed to make telemedicine more widely available.


  1. Puro NA, Feyereisen S. Telehealth availability in US hospitals in the face of the COVID-19 pandemic. J Rural Health 2020; Jun 30;10.1111/jrh.12482. doi: 10.1111/jrh.12482. [Online ahead of print].