Telemedicine and Rural Health Open Access

Tchamako Djonkam, Jimica (Spring 2019)

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In the United States (U.S.), health disparities are a complex and multi-factorial construct that exist across race, ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location (rural and urban).[i] The National Institutes of Health defines health disparities as “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States."[ii] Ultimately, health disparities present both moral and ethical dilemmas for the U.S. healthcare system.[iii] This thesis presents a technical recommendation for addressing a population group that experiences significant health disparities, rural Americans.

The Federal Office of Rural Health Policy (FORHP) provides guidance to the U.S. Department of Health and Human Services (HHS) on health care issues that impact rural communities, including: access to quality health care and health professionals; the viability of rural hospitals; and the effect of proposed rules and regulations on access to and financing of health care in rural areas.[iv] FORHP is currently funding grants to support the development and deployment of telemedicine solutions to address health disparities in rural populations. As an emerging field, telemedicine seeks to enhance and in some respects replace the traditional approach to clinical care to address practical and ethical concerns within the existing U.S. healthcare model. To address both the clinical care opportunities and ethical dilemmas faced by rural populations, we must develop a clear set of principles and recommendations for virtual care platforms and continue educating the public about the opportunities afforded in telemedicine.

Telemedicine is necessary to provide better access to care for isolated populations, reduce the burden and costs of onsite patient visits, and improve the efficiency and effectiveness of care provided. Telemedicine combines the strengths of information technology, telecommunications, and medicine to provide clinical care to individuals and populations from a distance. “Telemedicine is the practice of assessing patients remotely using videoconference, digital photography, instant messaging or other technology. This saves time and money, and enables patients and physicians to meet no matter where they are located.”[v]  Telemedicine solutions that are HIPPA (Health Information Portability and Privacy Act) compliant, such as online video sessions, can significantly decrease hospital admissions without diminishing, and often improving medical outcomes.

To address both the clinical care opportunities and ethical dilemmas faced by rural populations, we must have a clear set of recommended solution requirements to support and promote the delivery of telemedicine in our communities. This project is limited to the development of a telemedicine prototype for the purpose of proof of concept only.


[i] U.S. Department of Health and Human Services. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Phase I report: Recommendations for the framework and format of Healthy People 2020 [Internet]. Section IV: Advisory Committee findings and recommendations [cited 2010 January 6]. Available from:

[ii] National Institutes of Health. (2002). Strategic Research Plan and Budget to Reduce and Ultimately Eliminate Health Disparities Volume I Fiscal Years 2002-2006.

[iii] Riley, Wayne J. "Health disparities: gaps in access, quality, and affordability of medical care." Transactions of the American Clinical and Climatological Association vol. 123 (2012): 167-72; discussion 172-4.

[iv] “About FORHP.” Health Resources & Services Administration, 1 Nov. 2015,

[v] “The Benefits and Risks of Telemedicine,” Found Here:

Table of Contents

Background Information. 1

Problem Statement & Recommendation. 2

Problem: 2

Recommendation: 2

Risks. 3

Mitigations. 3

Project Constraints. 3

Project Assumptions. 3

Approach. 4

Business Process Analysis and Redesign. 4

Requirements Gathering. 5

Solution Recommendations for a telemedicine system.. 5

Proposed High-Level Activities. 5

Detailed Project Plan. 6

Business Analysis and Requirements Gathering. 8

Business Analysis of the Current State of Traditional Management of Patient Visits. 9

Business Process Redesign for Future State Adoption of a Telemedicine System Prototype. 9

Key Facts and Assumptions about Telemedicine as an emerging technology. 10

Key Functional System Requirements for Adoption of a Telemedicine System Prototype. 10

Alternatives to the usage and adoption of a Telemedicine platform.. 12

Evaluation Criteria of Vendors for a Telemedicine System.. 12

Evaluation of Top Three Telemedicine Platforms using Key Requirements for Telemedicine. 12

Evaluation of Top Three Telemedicine Platforms using Major Deliverables for Telemedicine: 13

Analysis of Alternatives. 14

Final Recommendation of a Vendor for a Telemedicine System Prototype. 15

Conclusion. 15

Measuring Success. 15

The Big Picture 16

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