Telehealth in the trenches: reporting back from the frontlines in rural America.

Access to appropriate healthcare services continues to be a major challenge in rural America. Telehealth technologies offer an opportunity to bridge gaps in health services in rural and remote areas and possibly support rural economic development. Lack of access to healthcare services to a growing population may create barriers to recruitment of businesses and economic growth. Several rural-oriented programs have attempted to leverage these emerging distance technologies, but success has varied despite the application of considerable federal, state governmental, and private resources. Barriers to adoption and sustainability of rural telehealth embody several factors that must be considered when planning, developing, implementing, and evaluating a rural telehealth program. New Mexico, the fifth largest state in the United States, represents many of the issues related to the potential benefits and challenges in developing a telehealth system to serve its rural communities. The Center for Telehealth at the University of New Mexico Health Sciences Center has been supported in large part by state and federal funding. Through our experiences, successes, failures, and lessons learned, we have developed approaches to overcoming barriers to adoption and sustainment of telehealth applications, including the establishment of partnerships with economic development projects in the state. This article describes these experiences and identifies and provides strategies for planning, development, implementation, and sustainment of telehealth in a rural program.