Geographic variability in rural patient internet connectivity when accessing telehealth services from home: A retrospective analysis during the COVID-19 pandemic

J Rural Health. 2023 Jan;39(1):55-60. doi: 10.1111/jrh.12695. Epub 2022 Jul 11.


Purpose: Telehealth at home (TAH) is a means of providing patient care that is increasingly utilized by health care organizations. It is crucial to identify factors, such as internet accessibility, that might impact the ability of patients to make use of such services.

Methods: A retrospective analysis was conducted using real-time data from audio-visual telehealth encounters conducted using the Cisco Webex Meetings platform from April 22, 2020 to May 26, 2020, and originating from a single rural health care system in the state of Wisconsin. Quality scores were determined for each encounter, and comparative call qualities were mapped to demonstrate zones of poor and unacceptable quality throughout the service area.

Findings: Of 3,962 encounters meeting the study criteria, 746 (18.8%) had poor or unacceptable quality, with 116 of poor or unacceptable encounters failing to connect, and greater than 1 in 20 encounters (5.8%) requiring conversion to a telephone-only visit. Geographic mapping of encounters with poor to unacceptable quality highlights numerous locations throughout the service area that suffer from connectivity issues.

Conclusions: In our study, there is wide and unpredictable variability in the quality of TAH encounters throughout the service area, which impacts the ability of patients living in rural areas to access timely and effective care. Our study supports the need for further infrastructure changes to improve internet connection quality in rural areas, with implications that extend beyond the current COVID-19 pandemic.

Keywords: accessibility; connectivity; rural; telehealth; telemedicine.

MeSH terms

  • COVID-19* / epidemiology
  • Humans
  • Internet
  • Pandemics
  • Retrospective Studies
  • Telemedicine*