Despite the rapid expansion of telehealth services over recent years, new research reveals that significant barriers persist for rural populations in the United States when it comes to accessing virtual care. A study published in the Journal of Medical Internet Research sheds light on the ongoing digital divide and highlights the complex challenges rural patients face in utilizing video and telephone telehealth, as well as web-based patient portals. These findings underscore the urgent need for multifaceted policy interventions and targeted infrastructure improvements to bridge the telehealth accessibility gap.
The study, conducted by Meghan Rowe Ferrara and Susan Chapman at the University of California, San Francisco, analyzed electronic medical records from over 9,300 adults residing in rural California zip codes. Through retrospective data analysis, the researchers evaluated patterns of telehealth use, focusing specifically on differences in modality—video versus telephone—and web portal activation. By dissecting these patterns alongside demographic variables, the study delivers a nuanced understanding of who is most disenfranchised and why.
One of the striking findings is that the rural cohort tends to skew older and predominantly White compared to their less rural counterparts. This demographic trend is crucial, considering that older adults showed significantly lower engagement with video-based telehealth—considered superior for clinical assessment given its visual cues—compared to telephone consultations. This suggests that age-related factors such as technology literacy, cognitive barriers, or physical impairments may substantially inhibit the adoption of more advanced telehealth formats.
Moreover, the study highlights racial and ethnic disparities. Spanish-speaking patients, in particular, were less likely to utilize video telehealth or activate patient portals. This points to language barriers, lack of culturally sensitive resources, and perhaps limited bilingual technical support within health systems as ongoing obstacles. Medicaid and Medicare beneficiaries, whose insurance plans often cover these patients, also exhibited lower uptake. This finding raises questions about the adequacy of current reimbursement policies and whether they sufficiently incentivize providers to offer video telehealth options or support portal engagement for these vulnerable populations.
Web-based patient portal activation—a key component of digital health infrastructure that allows patients to access medical information, communicate with providers, and manage appointments—also showed troubling disparities. Rural patients, especially those from low-income backgrounds or minority groups, were less likely to activate and engage with these portals. This digital exclusion limits their ability to benefit from the increasingly integrated and patient-centered digital healthcare ecosystem.
These gaps underscore that telehealth is not a one-size-fits-all solution. Infrastructure readiness alone—like broadband availability—is necessary but insufficient. Patient-level barriers including digital literacy, language access, and economic constraints must be addressed to make virtual healthcare equitable. The authors advocate for evidence-based interventions, including culturally tailored telehealth education programs, multilingual outreach campaigns, and policies that lower the financial burden for low-income patients to obtain necessary digital devices and internet services.
On the provider side, reimbursement policies for telehealth services require reform. Without adequate incentives to adopt and support video visits, especially for traditionally underserved rural patients, providers may default to telephone visits, potentially compromising the quality of care. Additionally, the lack of standardized metrics and feedback loops regarding telehealth use among vulnerable groups may stunt continuous quality improvement efforts.
Beyond these patient and provider considerations, the study signals the need for more granular data collection and analysis concerning rural telehealth engagement. Understanding the heterogeneity within rural populations—ranging from remote farming communities to small-town clusters—is critical to designing scalable and sustainable digital health programs. For example, local cultural norms, technological infrastructure, and health literacy levels may all modulate telehealth utilization differently, requiring tailored strategies.
From a technological standpoint, video telehealth holds distinct advantages. The visual component allows clinicians to observe nonverbal cues, perform rudimentary physical assessments, and build rapport with patients more effectively than audio-only calls. However, video visits demand higher bandwidth and more advanced devices, which may be prohibitive in rural regions where internet service is unreliable or prohibitively expensive. Expanding broadband infrastructure is thus as essential as patient education to leveling the telehealth playing field.
The findings are particularly timely given the post-pandemic climate, where telehealth has become a foundational modality in healthcare delivery. Many stakeholders herald telehealth as a means to improve access, reduce travel burden, and address provider shortages in rural areas. Yet, this study reveals the sobering reality: without intentional strategies targeting equity and inclusion, telehealth risks reinforcing existing disparities rather than ameliorating them.
Meghan Rowe Ferrara, a lead author of the study, emphasizes the complexity of digital health adoption among rural populations. She highlights the importance of deepening our understanding of usage patterns and patient preferences to craft solutions that truly meet their needs. This includes investing in digital literacy programs, developing user-friendly platforms in multiple languages, and ensuring that telehealth reimbursement models do not inadvertently marginalize vulnerable communities.
Ultimately, this body of research calls for a comprehensive approach that integrates infrastructure enhancement, patient empowerment, culturally competent care, and supportive policy frameworks. Telehealth holds great promise to transform rural health care delivery, but realizing this vision demands coordinated efforts from healthcare systems, policymakers, technology developers, and communities themselves.
As telehealth continues to evolve, future research must explore innovative approaches, such as hybrid models blending in-person and virtual visits, and the role of community health workers or digital navigators in closing the access gap. Additionally, monitoring outcomes in terms of health disparities and patient satisfaction will be essential to ensure that the digital revolution in medicine benefits all segments of society equitably.
This study adds a vital dimension to the discourse on health equity in the digital age. By scrutinizing the challenges faced by rural patients in accessing telehealth services and digital tools, it reframes the narrative to not only celebrate technological advancements but also confront real-world barriers. It is a clarion call to move beyond assumptions of universal accessibility toward intentional, equity-focused innovation in healthcare delivery.
Subject of Research: People
Article Title: Video and Telephone Telehealth Use and Web-Based Patient Portal Activation Among Rural-Dwelling Patients: Retrospective Medical Record Review and Policy Implications
News Publication Date: 29-Aug-2025
References:
Rowe Ferrara M, Intinarelli-Shuler G, Chapman S. Video and Telephone Telehealth Use and Web-Based Patient Portal Activation Among Rural-Dwelling Patients: Retrospective Medical Record Review and Policy Implications. J Med Internet Res 2025;27:e67226. DOI: 10.2196/67226.
Image Credits: JMIR Publications
Keywords: Health care delivery, Health disparity, Health equity, Health counseling, Health care, Telephones, Video cameras
