Telehealth has become a central part of healthcare delivery in the United States, especially after the COVID-19 pandemic sped up its use. For medical practice leaders, owners, and IT managers, it is important to know the challenges of starting telehealth in different places and among people with different incomes. This article talks about those challenges using data and expert information, focusing on places like California and others with similar situations. It also looks at how artificial intelligence (AI) and workflow automation can help telehealth work better.
Digital health technologies, including telehealth, grew quickly during the COVID-19 pandemic. Telehealth has clear benefits. It can lower healthcare costs, help people in faraway or poor areas get care, and fix healthcare worker shortages. The California Telehealth Resource Center (CTRC), a federally recognized group, has helped expand telehealth across California. They offer free tools and training to healthcare providers. Since 2017, CTRC has helped every county in California, changing their resources to fit what each area needs, from big city hospitals to small rural clinics.
Even with these efforts and laws like the American Relief Act of 2025, which keeps Medicare paying for telehealth, many problems still stop equal use of telehealth for everyone.
Geography creates big challenges for telehealth in the U.S., especially in states like California where big rural and mountain areas exist alongside crowded cities. In rural areas, it is hard to find specialty doctors because most specialists work in cities. Taking patients to special hospitals can take a long time, cost a lot, and might not be possible in emergencies or natural disasters.
The CTRC tries to fix this by giving tools to improve telehealth for specialty care. But many places, especially rural and tribal areas, do not have good internet. Internet service (broadband) is missing or weak in many of these places. Without steady internet, video doctor visits and quick communication are very hard. This problem mostly affects rural patients, older adults, and those with disabilities.
People’s income and education affect how well they can use digital health tools. Things like how much money someone makes, their education, language problems, and insurance affect whether they can use telehealth fully. Research shows that groups such as Black, American Indian or Alaska Native (AIAN), Hispanic, and Native Hawaiian or Pacific Islander (NHPI) have higher rates of infant death, chronic illness, and lower life expectancy than White groups. These groups also often have no insurance, which limits access to regular and digital healthcare.
The conditions where people live, work, and age affect their health and ability to use technology. People who are homeless or very poor often do not have the devices, internet, or skills needed for telehealth.
Digital health tools can make inequalities worse if they mainly help people with good internet, tech skills, and money. Studies show digital inequalities match factors like race, income, and education, leaving some groups behind. As telehealth grows, healthcare groups must think about fair ways to include all populations.
Janine Badr and others suggest using an equity approach to building digital health. This means working across fields and making policies that match local situations to lower access gaps. For medical leaders and IT managers, this means designing telehealth programs carefully to fix problems like poor internet, language needs, and tech training.
The American Relief Act of 2025 helps telehealth grow in the U.S., especially by keeping Medicare coverage. This law allows telehealth services to be flexible under government programs. It helps older adults and disabled people who depend on Medicare.
Federal groups like the Centers for Medicare and Medicaid Services (CMS) have changed their equity plans to reduce gaps in coverage and care across Medicare, Medicaid, and other insurance. The Biden Administration has also issued orders about health equity, telling agencies to make full plans to fix access and outcome gaps.
These federal efforts match special programs like the California Telehealth Resource Center, which gives education, tech help, and tools to keep programs running even after short-term funding ends.
Access to specialty care is still a big problem in many areas, especially in California, which can show what other parts of the country face. Sylvia Trujillo, CTRC’s Executive Director, says that flexible telehealth solutions are needed to meet specialty care needs, especially after natural disasters that disrupt normal care.
Doctors like James P. Marcin from UC Davis Health praise CTRC for helping providers understand the clinical, billing, and rule-related parts of telehealth. This help is important for medical practices that want to expand telehealth while following changing rules.
Telehealth can reduce geographic problems by letting patients see specialists remotely. But making telehealth fair and lasting depends on good internet, digital skills for patients, and care that respects different cultures.
Artificial intelligence (AI) and workflow automation help improve telehealth access and make work easier for healthcare providers. AI can do simple front-office jobs like setting appointments, checking patients in, and answering phones. This reduces work for medical staff.
Simbo AI is a company that makes phone answering services using AI. Their tools let healthcare providers automate patient phone calls in a way that is fast, reliable, and works after hours. This helps practices with many patients or small staff.
AI phone systems can sort patient requests, send appointment reminders, answer common questions, and forward calls when needed, all without people. This gives patients faster responses and helps them book visits easily. For managers, this means fewer staff needed, fewer missed calls, and happier patients.
AI also helps with clinical work by making documentation easier and supporting billing. As telehealth grows, using AI well lowers delays and mistakes caused by manual work.
Beyond simple tasks, new AI tools include chatbots that help with mental health care, check symptoms, and watch patients remotely, making telehealth programs wider.
Experience from areas like heart care teaches useful lessons. Researchers Alex Hoagland and Sarah Kipping show that new technologies, while helpful, can disrupt current care if not used carefully. Vulnerable people may have worse health if access to new tools is not equal.
The mix of new technology and old care services must be managed well to keep fairness. Telehealth should not just add digital tools but also support traditional care without making extra barriers.
Policy makers and healthcare groups must remember that social conditions greatly affect how people accept new healthcare methods. Funding, sharing, and outreach should be made to include and help those at risk.
Assess Infrastructure Needs: Check internet access and technology availability where your patients live. Push for or help provide broadband and devices if needed.
Provide Patient Education: Create educational materials in multiple languages and easy formats to improve digital skills. Teach patients how to use telehealth tools.
Collaborate with Resource Centers: Use groups like the California Telehealth Resource Center for technical help, educational tools, and guidance on telehealth rules.
Use AI-Powered Automation: Add AI tools like Simbo AI’s phone answering system to make front-office work easier, reduce mistakes, and improve patient communication.
Focus on Equity: Design telehealth programs that consider cultural, language, and income barriers. Work with community organizations to reach people who are underserved.
Monitor Outcomes: Watch telehealth use and patient satisfaction in different groups. Find gaps and change programs to reduce them.
Stay Informed on Policy Changes: Keep up with federal, state, and local rules about telehealth coverage and payments, including changes from the American Relief Act of 2025 and others.
For healthcare providers in the U.S., using telehealth well across different places and income groups needs careful planning and ongoing changes. Telehealth can help more people get care, especially specialty care, but problems like bad internet, social factors, and unequal use of technology must be fixed.
Support from the federal government, help from groups like CTRC, and new AI and automation tools offer ways to solve these problems. Medical leaders, owners, and IT managers play key roles in building telehealth systems that work well, cost less, and are fair for all patients.
The CTRC serves as a federally designated telehealth resource center, offering unbiased, no-cost tools and services based on proven digital health practices to support telehealth providers and patients in California.
The CTRC addresses the challenge of access to specialty care in California by providing resources and support to expand digital health services, facilitating connections between patients and specialty providers.
The CTRC provides a comprehensive library of resources, including sustainability calculators and equipment selection tools, to help telehealth programs grow and thrive, especially in underinvested areas.
The CTRC hosts virtual and in-person events, including trainings and workshops, aimed at keeping healthcare professionals updated on telehealth insights and advances.
The American Relief Act of 2025 helps maintain Medicare coverage for telehealth services, ensuring continued access and flexibility in telehealth practices across the U.S.
AI is expected to play a crucial role in scaling telehealth solutions, improving efficiency, and enhancing patient outcomes, as discussed in policy considerations and upcoming legislation.
California faces geographical and socioeconomic challenges in accessing healthcare, particularly specialty care, which the CTRC aims to mitigate through digital health solutions.
The CTRC includes specialized expertise in supporting diverse patient populations, such as older adults and those experiencing homelessness, to ensure equitable access to telehealth.
CTRC’s resources include a digital health payment guide, online courses, and a telehealth course finder, designed to educate providers and enhance telehealth practices.
Organizations can obtain guidance on clinical connections, billing questions, regulations, and technical support, helping them navigate telehealth complexities effectively.
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