Rural Telehealth Use during the COVID-19 Pandemic: How Long-term Infrastructure Commitment May Support Rural Health Care Systems Resilience.

Amid concerns of inadequate medical supplies and staffing anticipated from a surge in COVID-19 cases, many health care systems across the United States (U.S.) began shutting down non-essential patient services in March 2020. These sudden shifts bring up questions about the long-term effects of COVID-19 on already fragile rural health care systems and the ability of rural populations, including farmers and farm workers, to meet their health care needs. To provide alternative and safe access to health care, the Federal government relaxed telehealth regulations, which effectively removed some of the largest regulatory barriers that had limited the adoption of telehealth in the U.S. In this commentary, we draw on the example of the Marshfield Clinic Health System (MCHS), a large rural health care system in Wisconsin and provide an early assessment of how it adjusted its telehealth services during the early months of COVID-19. While the long-term effects of the pandemic on rural health care systems will not be known for some time, the example of MCHS points to the importance of on-going and sustained investments to support the resilience of health care systems and their ability to weather crises. With early evidence that MCHS patients and practitioners are interested in continuing to use telehealth post-COVID-19, we conclude our commentary by offering three recommendations to remove hurdles and improve quality of telehealth care.