Telemedicine in Rural EDs

by | Aug 13, 2021

Telemedicine (the provision of remote clinical services) has expanded considerably in America in the past decade, and exponentially further since March 2020. Authors of a paper published in International Journal of Environmental Research and Public Health tell us that telemedicine has in fact been in existence since the late 1960s, “beginning…with projects such as those launched by the National Aeronautics and Space Administration (NASA).”1

Since its origin, telemedicine has advanced in both relevance and technological capability, and has been integral to a number of government initiatives focused on improving overall healthcare, such as President Obama’s proposal “Connecting America: The National Broadband Plan” from March 2010. 2

Continuing to expand the availability of telemedicine is widely regarded as beneficial to the modern American healthcare system, especially in rural areas where access to board-certified physician specialists can be more difficult than at large urban hospitals. According to the Rural Emergency Care Task Force Summary, despite a more than 25% increase in the number of emergency medicine residency slots since 2008, there has actually been a decrease in the number of emergency physicians practicing in rural EDs, particularly at low volume EDs (see another EMCT article “Do You Know What You Don’t Know?” for more details on this topic).

A paper published in a December 2018 issue of Health Affairs by Marcia M. Ward et. al states that while hospitals had previously been required to have a physician either on site or on call for their EDs 24 hours a day if staffed by NPs or PAs, “in 2013, the Centers for Medicare & Medicaid Services adjusted that requirement to allow rural hospitals to use advanced practice providers, such as physician assistants and nurse practitioners, as long as physicians could be summoned via telemedicine in an emergency.” 3

While the practical application of this change in regulation has had varied results (complicating factors include access to telemedicine equipment and EM-boarded physician availability), increasing the use of telemedicine in rural EDs can only help improve the quality of care provided. Additionally, studies show that the implementation of telemedicine lowers costs for hospitals over time, which is especially important for locations with limited resources.

The Rural Emergency Care Task Force Summary recommends that rural EDs utilize telemedicine with supervision by EM board-certified EPs for initial onboarding and ongoing supervision of PAs and NPs working solo. It is the fifth and final pillar of ACEP’s Rural Task Force recommendations for bolstering care of patients presenting to rural EDs. While staffing with board-certified emergency physicians for 24 hours a day is not always an option for Critical Access and other small rural hospitals, telemedicine offers an avenue for having that expertise consistently available, which helps to improve the quality of care in emergency departments across the country.


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Have the U.S. barriers to widespread adoption of telemedicine been significantly

reduced? Retrieved from

  1. Gruessner, V. (2015, November 06). The History of Remote Monitoring, Telemedicine

Technology. Retrieved from

  1. Ward, M. M. et. al (2018, December 01). Use Of Telemedicine For ED Physician

Coverage In Critical Access Hospitals Increased After CMS Policy Clarification:

Health Affairs Journal. Retrieved from