Telemedicine

There is strong evidence that telemedicine increases access to care (Saragih 2021, Dorsey 2016, Molini-Avejonas 2015, Penate 2012, Kehle 2011), particularly among rural populations (Quayson 2024, Rush 2022, Harkey 2020) and other groups who experience challenges in access (Tilhou 2024a), such as mobility (Shaver 2022, Dorsey 2016). It also increases patients’ direct access to providers, services, and medication for women’s reproductive health care (Cochrane-Cleeve 2025, Aiken 2021, Endler 2019, DeNicola 2020). Telemedicine also reduces carbon emissions by reducing vehicle miles traveled to appointments (Purohit 2021, Shaver 2022).

Telemedicine provides care equivalent to in person care for some health conditions (Shaver 2022, Shigekawa 2018, Bashshur 2016, Cochrane-Flodgren 2015), but more rigorous research is needed evaluating whether telemedicine improves health outcomes among individuals when used to treat acute conditions or more complex or chronic diseases, compared to solely in-person care (Bashshur 2016, Shaver 2022, Dorsey 2016), especially as the focus of telemedicine services shifts to increasing patient convenience and reducing costs (Shigekawa 2018).

Reproductive health care. Telemedicine can provide early access to medical abortion services (DeNicola 2020, Aiken 2021) and appears comparable to in-clinic services in its safety, effectiveness, and acceptability to patients and providers (Cochrane-Cleeve 2025, Endler 2019, DeNicola 2020). A British study suggests a telemedicine/in-person hybrid model for providing remote medical abortions could lead to significantly shorter wait times from referral to treatment, increasing the number of abortions provided at 6 weeks or less gestation (Aiken 2021). There is demand for self-managed abortion care, where medication is received through the mail and patients are supported via telemedicine (Skuster 2022). A recent U.S.-based study suggests telemedicine appointments for abortion care increase timely access to such care (Koenig 2023). However, in the U.S. legal and policy challenges to telemedicine-supported abortion care continue and are increasing (Skuster 2022).

Telemedicine interventions for reproductive health can impact some pregnancy and birth-related health outcomes, including increasing perinatal smoking cessation and breastfeeding (DeNicola 2020), reducing postpartum depression (Hanach 2021), and are a comparable alternative to in-person office visits to monitor patients for high-risk obstetric conditions (DeNicola 2020). However, it may not significantly improve maternal and fetal outcomes related to pregestational and gestational diabetes compared to usual care, although that may be because pregnant individuals are often already closely monitored for some conditions, limiting telemedicine’s effect (Laursen 2022). Additionally, telemedicine interventions designed for adolescent sexual health may improve self-efficacy and condom use and increase screening and testing for sexually transmitted infections (Saragih 2021).

Chronic disease. Telemedicine may improve chronic disease management in some cases, including reducing Hba1c in diabetic patients (Timpel 2020) and modestly improving disease control in patients with multiple morbidities when interventions focus on a specific risk factor (Kraef 2020). Post-hospital discharge medication-focused telehealth interventions can decrease hospital readmission rates, particularly as part of a multicomponent intervention, in older populations with chronic conditions, particularly heart failure (Emadi 2025). Pharmacist-delivered telemedicine care, especially interventions delivered at predetermined times, may improve disease management, self-management, and treatment adherence for chronic diseases, as much as or more than in-person visits (Niznik 2018). A variety of telemedicine interventions appear to modestly improve blood pressure in patients with cardiovascular disease and hypertension, particularly if the interventions last 6 months or longer; experts recommend telemedicine interventions include monitoring devices which report data automatically (Gao 2020). Asynchronous patient-physician messaging may decrease emergency department and hospital utilization among patients with multiple chronic conditions (Reed 2019). Conditions that have been shown to be sensitive to telemedicine include hypertension, diabetes (Timpel 2020, Cochrane-Flodgren 2015, Huang 2015, Greenwood 2014), anticoagulation, hyperlipidemia, asthma, heart failure, HIV, chronic kidney disease, stroke, and COPD, as well as depression and posttraumatic stress disorder (Niznik 2018, Wootton 2012). Experts caution, however, that the type and intensity of interventions vary widely and more rigorous research is needed on whether telemedicine improves clinical outcomes for chronic diseases and overall health status among patients with multiple morbidities (Shaver 2022, Kraef 2020, Timpel 2020).

Acute conditions. Telemedicine may be an appropriate alternative, or first step in triage, for low-risk acute conditions for which people commonly seek treatment at an in-person appointment, such as conjunctivitis, emergency contraception, urinary tract infection (UTI), upper respiratory tract infections (URI), and sore throat (pharyngitis) (Reed 2021a); such e-visits do not appear to increase emergency department use, and may be cost effective due to their short length (often only two or three minutes) (Reed 2021a). Evidence is mixed, with some studies suggesting telemedicine leads to similar or better care outcomes such as appropriate prescribing of antibiotics or ordering of medical imaging (Bashshur 2016) while other studies suggest patients may be more likely to receive inappropriate antibiotics or that clinicians may not order appropriate tests. Telemedicine may reduce physician-related medication errors among seriously ill or injured children in rural emergency departments (Dharmar 2013). Experts suggest telemedicine may be more likely to produce beneficial outcomes, such as appropriate prescribing and expected rates of follow-up care, when providers and patients have an established relationship, the patient’s medical record is available, and on-site testing and follow-up care are accessible (Shaver 2022). More research is needed about difficult-to-assess conditions and among patients with communication barriers (Shaver 2022).

Other specialties. Telerehabilitation services may improve motor function following total knee replacement (Agostini 2015) and reduce short-term disability and symptoms for patients with multiple sclerosis (Cochrane-Khan 2015). Telerehabilitation also appears to produce similar outcomes to center-based cardiac rehabilitation for low to moderate risk coronary artery disease patients (Huang 2015a). Teleglaucoma screening detects more cases of glaucoma than in-person screening in remote and underserved communities (Thomas 2014b), and, overall, telemedicine appears to increase access to care for speech, language, and hearing services (Molini-Avejonas 2015). Telemedicine is also used globally for routine dermatologic care, but more research is needed which compares tele-dermatology with in-person consultation; experts suggest it may be well-suited for initial evaluations and follow-up visits (Shaver 2022).

Environmental benefits. Telemedicine has the potential to reduce the carbon footprint of the health care industry, primarily by reducing vehicle miles traveled (VMT) and greenhouse gas emissions from patients driving to appointments. Telemedicine does generate some carbon emissions and those amounts vary, for example, with the length of the appointment, type of teleconferencing platform used, energy used to support the virtual connection, and different broadband capacities. In general, telemedicine appointments that replace a car trip of a few kilometers or more reduce carbon emissions (Delarmente 2025, Purohit 2021, Dacones 2021, Holmner 2014). Experts also suggest that telemedicine can reduce traffic, wear on medical facilities, and reduce staff and patients’ exposure to infectious disease (Shaver 2022).

Challenges. Providers and patients may encounter challenges in using telemedicine, including inconsistent reimbursement policies, inadequate reimbursement amounts, restrictions on which technologies can be used, and from what settings, and privacy regulations that can increase costs to ensure exchanges are secure (Shaver 2022). Patients who are traveling may be excluded from care due to states’ different medical licensing systems, and certain prescription, visit, and patient types may also be excluded (Shaver 2022). Telemedicine can also be challenging to evaluate because telemedicine visits can be simple or intensive and complex. Providers may prefer in-patient visits for high-risk patients or those with complex conditions when there is no disincentive for using in-person visits (Shaver 2022). More research is also needed on diagnostic accuracy and timing in telemedicine, as well as delayed diagnosis legal claims in telemedicine compared to standard care (Shaver 2022). A multi-institution study suggests providers want to continue using telemedicine but describe common challenges in receiving high-quality training, determining which patients are well-served by telehealth, and obtaining adequate physical exams (deMayo 2022).

Recommendations. Overall, experts recommend telemedicine alongside standard care, not as a replacement (Shaver 2022, Dorsey 2016). More research is needed on the effects of telemedicine on patient-provider trust and rapport; the ability to pick up on less easily observed symptoms and non-verbal communication remotely; the unavailability of therapeutic touch; and patients’ treatment adherence (Shaver 2022, Dorsey 2016). Experts suggest that video appointments may allow providers to check on a patient’s home environment, perform a partial physical exam, observe some non-verbal communication, and may enhance the patient-provider relationship compared to audio only appointments (US DHHS-Karimi 2022). Recommended operational support for providers conducting telemedicine appointments can include intake, scheduling, translation, and technical support coordinated between the patient and additional staff, which experts note may be easier to implement with video appointments (Patt 2024). Experts suggest asynchronous messaging may be well-suited for hospitals’ busiest times, such as flu seasons or during disasters, but recommend measures to manage potential burden on outpatient clinicians handling a high message volume, which could contribute to fatigue or burnout over time if not addressed (Shaver 2022).

Telemedicine is a suggested strategy to decrease geographic disparities in access to health care between rural and urban areas (Shaver 2022) by improving access for rural populations and in areas with medical provider shortages (Quayson 2024, Harkey 2020, Shigekawa 2018). Telemedicine appears to improve access to care for populations experiencing transportation barriers (Shigekawa 2018), such as among rural veterans (Quayson 2024) and older adults (Rush 2022), including those with limited mobility outside the home (Dorsey 2016). Telemedicine-supported abortion care may increase access for women who live in states that prohibit or restrict abortion (Skuster 2022). In general, more rigorous research is needed to understand persistent disparities in usage and acceptance, with interventions focused on ensuring telemedicine is available to those who desire to use it.

Telemedicine appears to be a viable option to treat rural veterans, including those with complex conditions, reducing the need for travel, improving health outcomes, and providing significant savings on transportation costs (Quayson 2024). Experts suggest telemedicine can improve access for those experiencing barriers related to vehicle ownership, income, geographic isolation, and limited access to specialists (Quayson 2024). Telemedicine increases access to telerehabilitation services in rural communities and can improve patient satisfaction with occupational, physical, and speech-language therapy services (Harkey 2020). Telemedicine also appears promising for increasing access and continuity of care in rural areas among older adults with dementia, per studies in which patients accessed telemedicine centers (Sekhon 2021).

Prior to the public health emergency, telemedicine use for prenatal care was low (Bodas 2026). A study of Medicaid patients who are pregnant which compared rural and urban uptake suggests that increased use by rural patients in this group was sustained following the public health emergency (Bodas 2026). Experts caution that if states reduce Medicaid provider reimbursement in response to possible or actual federal budget cuts, this could affect telehealth access and usage, especially in rural areas where there are already fewer Medicaid-accepting providers (Bodas 2026).

A recent U.S.-based study suggests telemedicine appointments for abortion care increase timely access to care (Koenig 2023), especially for patients who live in rural areas, those who would have to drive over 100 miles to a providing facility, those experiencing food insecurity, and among patients younger than 25 (Koenig 2023). As access to abortion care is increasingly restricted, experts suggest telemedicine may reduce disparities in access to this care more than other health services (Koenig 2023).

Two U.S.-based studies looking at the telemedicine expansion (2021-2022), suggest disparities in use may have decreased compared to the beginning of the COVID-19 pandemic, finding similar usage rates by age, race, ethnicity, income, urban/rural location (Spaulding 2024) and education (Chang 2024). Disparities persist in video-enabled compared with audio-only visits as well as health care online portal use (Sheon 2026), even with significant increases in use in 2020 and 2021 when barriers were removed due to the COVID-19 pandemic (Shaver 2022, US DHHS-Karimi 2022). Video-enabled visits in particular appear to be used more by younger, higher income, urban, white adults – and less by those with lower incomes, adults with less than a high school degree, individuals who identify as Black, Latino/a, or Asian, and adults over age 65 (US DHHS-Karimi 2022). Video visits may be used more often by individuals who identify as transgender compared with other groups (US DHHS-Karimi 2022).

Health insurance coverage and internet access and technology literacy are still well-recognized barriers to telemedicine use (US DHHS-Karimi 2022). A Wisconsin-based study of the COVID-19 public health emergency finds telehealth expansion helped maintain access to primary care among Medicaid beneficiaries, especially among those with less education and lower incomes, though these groups were more likely to use audio-only (Tilhou 2024a). Notably, usage in this study only increased among Hispanic and non-Hispanic Black individuals with high-speed internet, and there was greater completion of audio-only visits among Black, Hispanic or Latino, and Asian relative to white individuals (Tilhou 2024a). Audio-only visits may be more likely among those older than 65 and those without health insurance (Chang 2024); those without insurance are least likely to use telemedicine overall (US DHHS-Karimi 2022). More research is needed regarding what contributes to higher rates of audio-only visits, including how patients are triaged (Tilhou 2024a, Ojinnaka 2024).

A study of telemedicine visits from March 2020 through December 2022 suggests telemedicine appointments reduce no-shows for appointments compared with missed in-person appointments, particularly among historically marginalized and underserved populations, such as Native American, non-Hispanic Black, Medicaid-insured, and self-pay patients (Ojinnaka 2024). Experts suggest telemedicine availability may reduce the impacts of factors affecting appointment attendance, such as lack of transportation or child care, or work schedule conflicts (Ojinnaka 2024). Telehealth expansion alone will not close gaps in primary care utilization by race/ethnicity (Tilhou 2024a).

Early advocates for telemedicine pointed to its potential to improve access, quality, and affordability of care, reducing disparities between populations in health care receipt (Bashshur 1995). Telemedicine was initially used for acute conditions, such as strokes or traumatic injuries, to connect specialist providers with clinicians treating patients in emergency departments. Telemedicine programs have also historically focused on rural populations, as well as those in the military and individuals who are incarcerated (Dorsey 2016). Before March 2020 and the onset of the COVID-19 pandemic in the U.S., provider-patient telemedicine use was increasing but was a tiny proportion of overall care (Shaver 2022), especially video-enabled visits (Dorsey 2016). Most patients in the U.S. who used telemedicine did so through large academic medical centers, the Veterans Administration (VA) health systems, or purchased access if their healthcare provider offered direct-to-consumer services. Barriers to internet access and use prevented patients in rural areas, those with lower household incomes, disabilities (Shaver 2022), and older adults from accessing care via telemedicine (Dorsey 2016). Legal barriers and differing state rules, such as whether medication could be prescribed over the internet also restricted use (Dorsey 2016). For example, prior to the legal decision to reverse Roe v. Wade in 2022, 19 states had banned or restricted use of telehealth for medication abortion (KFF-Anderson 2021).

In March 2020, to support access to care and financial solvency for health care systems, Congress adjusted telemedicine restrictions for Medicare, including removing some restrictions for reimbursement, geography, and platform, as well as including telephone-only visits, and addressing interstate barriers to practice and privacy related to states’ differing rules, with state and private health insurance payors following this example (Shaver 2022). A study of private and Medicare health care claims estimates that telehealth claims increased from 0.1% in 2019 to 5% of overall claims, as of 2021 (Shaver 2022).

Telemedicine-supported abortion care has also been affected by recent changes in state and federal law and regulation. Medication abortion in early pregnancy has been available since 2000, when mifeprestone was approved by the U.S. Food and Drug Administration (FDA) for this use. As of 2023, medication abortion comprised 63% of all clinician-provided abortions in the U.S., an increase from 53% in 2020 and 39% in 2017 (Guttmacher-Medication abortion 2025).

• How widely available and used is telemedicine in your community or state – between providers, as well as providers and patients?
• Who is choosing which types of telemedicine interventions to offer patients and how are those decisions being reached? Which health needs are the focus? Which patient groups?
• How are health care providers, as well as community members, engaged in efforts to expand telemedicine use? What local or state laws and regulations restrict its use?
• What barriers might people experience at the local or state level in accessing telemedicine (e.g., health insurance coverage, internet access)? To using telemedicine meaningfully (e.g., digital literacy)?

As of September 2025, all 50 states, Washington, D.C., and Puerto Rico provide Medicaid and Medicare reimbursement for live video telehealth services, while 46 states and Washington D.C.’s programs also provide reimbursement for audio-only telehealth; in both cases, what is reimbursed varies (CCHP-Telehealth policy maps). Similarly, 44 states and Washington, D.C. have telehealth private payer laws (CCHP-Telehealth policy maps). After the onset of the COVID-19 pandemic in March 2020, telemedicine visits increased among all patient types (Shaver 2022). As of 2025, telehealth does not appear to increase health care utilization, and so cost, per the American Hospital Association (AHA-Telehealth 2025).

A number of telemedicine and telehealth programs exist in the United States (HRSA-Telehealth). The federal website Telehealth.HHS.gov has updates on state and federal policy and project examples from across the U.S. (HRSA-Telehealth). The National Rural Health Association (NRHA) advocates for telehealth to increase rural access to health care and tracks related legislation (NRHA Telehealth Broadband). The University of Missouri hosts the National Center for Telehealth Research and Policy, C-TRaP, founded in 2025 (MU-CTRAP) and the Missouri Telehealth Network (MTN), aimed at enhancing access to care in rural and underserved areas of Missouri (MU-MTN). The Children’s National Medical Center in Washington, D.C. has a telemedicine program that serves community hospitals, suburban health centers, inner-city health clinics, national hospitals, and international partners (CNHS-Telehealth).

To access health care today, people need reliable high-speed internet (HRSA-HHS Telehealth). The Telehealth Broadband Project was a HRSA-funded pilot program which studied how to improve rural broadband access, including for healthcare, with partnerships in Alaska, Michigan, Texas, and West Virginia (Telehealth Broadband Project). The Veterans Administration (VA) health system recognizes not all veterans have access to high-speed internet or internet-connected devices and so established Digital Divide Consult in 2020, a consulting system to connect veterans with social workers to troubleshoot and connect them with discounts and devices (Cruise 2025). The VA also loans remote health monitoring devices and maintains centers with health technology experts to support veterans, their families and caregivers, and VA staff in using VA telehealth tools and technology (Cruise 2025). The VA’s Anywhere to Anywhere initiative, (ATLAS – Accessing Telehealth through Local Area Stations) connects veterans living far from the VA with a location set up for private telehealth so that home internet is not a barrier (Cruise 2025).

U.S. regulations on abortion care are changing quickly, complicating telemedicine-supported care. The U.S. Food and Drug Administration (FDA) removed restrictions on dispensing medication for abortions in 2023, making it possible for individuals to obtain medication abortion pills from retail pharmacies except in states with a near-total ban on abortion. Other states limit prescribing power to physicians, despite guidance from the World Health Organization (WHO) and others which says it is safe for advanced practice clinicians, such as physician assistants, to provide medication abortion (Guttmacher-Medication abortion 2025).

‡ Resources with a focus on equity.

ATA - American Telemedicine Association (ATA).

CCHP-Telehealth Fall 2024^‡ - Center for Connected Health Policy (CCHP). State Telehealth Laws and Reimbursement Policies Report, Fall 2024. November 2024.

CCHP-Telehealth policy maps - Center for Connected Health Policy (CCHP). (n.d.). Telehealth policy trend maps. Retrieved June 25, 2025.

HRSA-HHS Telehealth^‡ - Health Resources & Services Administration (HRSA). Telehealth.HHS.gov.

HRSA-Telehealth - Health Resources and Services Administration (HRSA), Office for the Advancement of Telehealth. Telehealth active programs.

RHIhub-Telehealth - Rural Health Information Hub (RHIhub). Telehealth use in rural healthcare.

* Journal subscription may be required for access.

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Guttmacher-Medication abortion 2025 - Guttmacher Institute. State Laws and Policies: Medication abortion. New York: Guttmacher Institute; April 23, 2025.

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HRSA-HHS Telehealth - Health Resources & Services Administration (HRSA). Telehealth.HHS.gov.

HRSA-Telehealth - Health Resources and Services Administration (HRSA), Office for the Advancement of Telehealth. Telehealth active programs.

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Marshfield-Telehealth - Marshfield Clinic. Telehealth.

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