Telehealth Needs Assessment Content: Ashley Cram and Amgad Farah
Developer & Designer: Madoc Alder July 2025

Background

What Is the Telehealth Survey?

The Association of State and Territorial Health Officials (ASTHO) supports states and territories in leading policies and programs that expand access to health services through telehealth.

In February 2025, ASTHO fielded the annual telehealth needs assessment to members to identify areas of interest and technical assistance related to telehealth and to assess how health agencies use telehealth for clinical care and service delivery nationally. The report’s findings will help inform ASTHO programming and provide ASTHO member agencies with relevant subject matter expertise and resources to advance telehealth in their jurisdictions.

Why Is Telehealth Important?

Telehealth increases access to care, addresses workforce shortages, and facilitates the maintenance of public health services and programs.

“Overall, telehealth allows for flexibility in program implementation and increases access to services during disruptions such as the pandemic or for populations with barriers to care”

- survey respondent

“We are a very rural state and access is a challenge. Telehealth is impactful.”

- survey respondent

Who Responded to the Survey?

Twenty-eight respondents who work for a state or territorial public health agency from 24 jurisdictions, including three U.S. territories, participated in the survey.

Four additional respondents indicated that their health agency does not lead telehealth activities and, in some cases, telehealth is led by another state agency such as Medicaid

How Is Telehealth Structured?

Telehealth spans multiple programs without central coordination.

Nineteen out of 28 respondents (67.9%) reported telehealth activities occur across various agency programs and departments without a central coordinating entity.

Where Does Telehealth Fit?

Telehealth operations vary in capacity, authority, and structure.

Eight respondents (29.6%, N=27) indicated that their health agencies have regulations that authorize telehealth use, with five respondents indicating that their health agencies have been involved in discussions and/or expressed interest in expanding telehealth flexibilities.
In addition to the operational structures shared earlier, participants shared the following:

“Currently restructuring to bring telehealth under the Office of Provider Resources as one of several programs within that office.” - survey respondent

“[T]ypically, individual programs and units manage their specific telehealth work related to their programs. Another state agency, the Office of eHealth Innovation, is a separate agency from the Department of Public Health, and it also works on expanding telehealth efforts across the state.” - survey respondent

How Do Telehealth Teams Collaborate?

Five respondents (19.2%, N=26) indicated that their health agency’s telehealth and informatics teams collaborate on shared data modernization activities.

Collaboration on these activities included:

• “Integrating telehealth solutions into our healthcare systems”
• “Ensuring seamless technology implementation, data sharing, and user support to enhance patient care”
• “Optimizing clinical workflows and improving collection of clinical data (including telehealth)”
• “Engaging with various information systems, including our work with state Medicaid and the state all-payer claims database”
• “Unifying our various data sources through integrated telehealth solutions”

Telehealth for
Healthcare Delivery

How Are Agencies Using Telehealth?

Public health agencies mostly use telehealth to educate healthcare personnel ¹ and provide direct clinical services to patients.
Other telehealth-related uses reported by respondents include guidance or recommendations for the provision of telehealth services in various formats, including guides, reports, and policy documents.

What Services Are Provided via Telehealth?

Agencies that responded to the telehealth survey deliver the following clinical services via telehealth² within their jurisdiction:

Behavioral Health
Assessment, counseling, and prescribing for substance use disorder and mental health.

Family and Child Health
Prescribing for family planning, prenatal care visits, maternal and child health, early intervention services for children with special healthcare needs, breastfeeding and lactation consultation, and nutritionist consultation.

Communicable Disease Programs
HIV/AIDS prevention (e.g., tele-PrEP), TB, and other STI screening and treatment.

Chronic Disease
Cardiovascular disease treatment, diabetes and hypertension screening, risk assessment and treatment.

Who Provides Clinical Services via Telehealth?

Of the agencies delivering direct clinical services to patients, eleven respondents indicated that their public health agencies employed or contracted a provider to deliver services via telehealth.

Which Populations Engage with Telehealth?

Eleven respondents highlighted the populations served via telehealth by their public health agency, which are most frequently Medicaid, Medicare, dual eligible, and uninsured populations.

What Telehealth Modalities Are Used?

Real time telemedicine³ was the most reported telehealth modality used by respondent public health agencies.

Others included remote patient monitoring⁴ and asynchronous store-and-forward⁵.

How Do Agencies Track Telehealth Data?

Respondents reported a variety of sources for data collection related to telehealth.
challenges for telehealth data collection include lack of funding to support data systems and analytics, electronic data, data sharing restrictions, and data user agreements, insufficient data collected, non-standardized data collection, or indirect sources of data collection, etc.

Health Agency
Telehealth Goals

What Are Agencies’ Telehealth Goals?

91.7% of responding agencies seek to expand access to clinical services. Other reported goals related to telehealth include effective policy and appropriate utilization of telehealth services; reduction of chronic absenteeism as related to students accessing care during school hours; and supporting the building of infrastructure.

What Are Agencies’ Telehealth Goals?

Respondents who indicated their agency’s telehealth goal is to expand access to services reported prioritizing access among rural communities (85.7%), the Medicaid-enrolled population (66.7%), and the uninsured population (57.1%).

Approaches being implemented by agencies to prioritize expansion of telehealth services for the aforementioned communities include:

• Telementoring program to train LTC staff for outbreak responses, prioritizing rural and uninsured populations.

• Reducing barriers for patient access and providing reimbursements for providers.

• Expanding access to rural areas, children with special health care needs, veterans, and offering provider training.

• Expanding telehealth services across multiple specialties within the Medicaid program.

• Piloting data exchange systems for continuity of care.

Who Are Agencies’ Telehealth Partners?

Public health agencies rely on partnerships to advance their telehealth goals.

Public health agencies partner with state Medicaid agencies and health systems to advance shared goals related to telehealth. Partnerships with other entities and ways respondents work with partner agencies include: critical access hospitals, Division of Substance Abuse and Mental Health & Department of Correction, and requests for coverage from entities/providers outside the [state] DHHS.

What Are Barriers to Telehealth?

Various barriers, most frequently insufficient funding and staff and patient broadband access, hinder agencies from achieving their agency or program telehealth goals.

What Do Agencies Need for Telehealth?

Identifying funding opportunities is the top technical assistance need for public health agencies to advance telehealth goals.
Respondents also reported technical assistance needs of identifying resources available to build infrastructure that supports telehealth and understanding state policy trends related to telehealth.

Let’s Support These Needs, Together

For Agencies:

Join ASTHO’s Telehealth Peer Network. For more information, please contact an ASTHO staff member at ask@astho.org.

Conduct a landscape assessment of telehealth policies and programs happening across your health agency and jurisdiction. See great examples from NC Division of Public Health and Washington State Department of Health.

Develop and advocate for statutory and/or regulatory policies that enable broad telehealth use (e.g., audio-only services, licensure compacts, etc.).

Footnotes

1. e.g., virtual learning sessions, distant learning, and Project ECHO

2. In some cases, aspects of the service may be delivered via telehealth in combination with in-person delivery.

3. Live video/Real-time telemedicine: Healthcare workers converse with patients in real-time from any location, privately, using a two-way communication medium - telephone, videoconferencing platform, or messaging service. Medical history reviews, checkups, evaluations, and providing some types of treatment are typically conducted during these visits

4. Remote patient monitoring: Healthcare providers use technology to monitor patients’ progress during their treatment plan without visiting a physician’s office for a face-to-face consultation.

5. Asynchronous store-and-forward: Electronic storage of medical information such as images, test results, vital signs, lab reports, and medical documentation, which can easily be shared with the appropriate people. The sender and receiver do not need to be available simultaneously. A caregiver can gather, upload, and share the data for review by a different provider whenever they are available, without any information loss.