Background
Geographic access to healthcare is a barrier experienced
by many New York State residents, as 86.6% of New York State land is considered
rural [1].
Individuals living in rural communities may need to travel long distances to
access specialty healthcare services, and may incur additional financial and
practical costs in doing so [1].
Telemedicine is a potential solution to overcome these barriers. The World
Health Organization defines telemedicine as the delivery of healthcare services
using technological means to overcome access barriers related to distance, with
the goal of diagnosing, treating, preventing, educating about, and researching
disease and injuries [2].
Telehealth appointments, a form of telemedicine, became especially popular
during the COVID-19 pandemic in 2020. With mandatory isolation, telehealth
healthcare visits became an essential way to deliver care without the risk of
spreading COVID-19, and were reimbursed at the same level as in-person visits [3,
4].
Even as mandatory isolation policies eased, many
healthcare systems have found that telehealth has the potential to improve
access to healthcare services, reduce healthcare costs, and increase patient
satisfaction [5-8]. Using telehealth, providers can deliver remote healthcare
services, such as virtual consultations and health literacy programs, to
geographically remote rural communities [9].
In this manuscript, we use the US Census Bureau definition of “rural,” meaning
areas that are neither urbanized (with more than 50,000 residents) nor urban
clusters (with between 50,000 and 2,500 residents). Despite its benefits, the
implementation of telehealth in rural areas faces several challenges, including
limited access to broadband infrastructure and technological resources, lack of
knowledge and acceptance of telehealth services [10-13].
To fully harness the potential of telehealth in rural settings, it will be
necessary to address these challenges through the development of appropriate
technological infrastructure, increasing awareness and acceptance of telehealth
services among healthcare providers and patients, and developing sustainable
reimbursement models [14, 15].
Prior research has examined potential solutions to the
issue of telehealth infrastructure in rural areas [16,
17]. Libraries, often considered trusted community centers, can be ideal
locations to deploy telehealth services [18].
By establishing such community sites, rural residents can access reliable
high-speed internet connectivity and technological resources necessary for
telehealth services like private telehealth booths, computers, webcams, and
even telehealth-related software. Libraries can also play an essential role in
promoting awareness, accessibility, and acceptance of telehealth services by
providing education, training, and advertising to patients and providers [19, 20]. Given that many vulnerable communities find libraries to be accessible and
trustworthy, researchers and community partners have called on practitioners
and policy makers to implement more public health services in libraries [21-24]. Librarians and library partners have already implemented a variety of programs
to increase access to their communities for a variety of direct healthcare
services, health resources, and linkage to services [22,
24, 25]. Some of these programs include supplying Narcan to manage opioid
overdose in their community or staffing a COVID-19 help hotline [24,
25]. With many libraries already offering other healthcare services, this
positions them well to effectively provide telehealth services. One recent
study queried whether public libraries could be a potential access point for
telehealth visits [19].
Fifteen librarians from nine states participated in semi-structured interviews
that asked about the communities where the libraries were located, the types of
patrons typically frequenting the libraries, and the librarians’ views on
barriers and benefits of public libraries as access locations for telehealth.
This study indicated that librarians support libraries as telehealth access
locations, that libraries face financial barriers to telehealth implementation,
and that rural public health nurses can be a key component in collaborative
efforts between regional libraries and healthcare networks. These results
indicate the need for further research focused specifically on telehealth
implementation in rural public libraries.
We sought to understand the
perspectives of rural library staff and rural community members on implementing
a telehealth hub in a library. To that end, we conducted a survey of staff at
public libraries across the University of Rochester Wilmot Cancer Institute
(WCI)’s catchment area to assess the knowledge, interest, and capacity of these
libraries to provide access to telehealth services. We then chose a rural
library in Macedon, NY from among the survey respondents to serve as a pilot
location for providing telehealth access. We surveyed library staff and patrons
about their perspectives on telehealth and what next steps would be needed to
implement a telehealth hub at the selected library.
Study Design and Procedure
This study was led by a community-academic partnership
between the University of Rochester WCI and the Community Cancer Action Council
(CCAC), a group of 29 community stakeholders. The partnership identified the
need for increased access to healthcare in rural areas within WCI’s catchment
area. The WCI’s catchment area consists of a 27-county area of Western and
Central New York that includes more than 3 million people in the Finger Lakes,
Southern Tier, Central, and Mohawk Valley regions. The study aimed to provide a
holistic understanding of the possibility of providing telehealth access within
a public library. A series of surveys were developed and disseminated in four
phases. Phases were completed between August 2021 and December 2022. There were
no incentives for completing any of the surveys across phases. The University
of Rochester Research Subjects Review Board approved all phases.
Phase 1: NYS libraries & telehealth
survey (library survey)
The community-academic team developed the survey and
circulated it to libraries within the WCI’s catchment area to identify
telehealth capacity and determine a pilot location for this project. The survey
was sent to the libraries through email addresses available on the New York
State Public Library System email directory listserv, and direct outreach via
email addresses available on the library website. All libraries within the
WCI’s catchment area received an email from the study team explaining the purpose
of the study and including a link to the REDCap survey. These emails were sent
directly from the REDCap system. A total of 273 libraries were invited to
participate in the survey, with 53 completing the survey (a 19.4% response
rate).
Phase 2: Community patron survey
(community survey):
Three respondents to the library survey indicated that
they were in the process of implementing a telehealth hub using grant funding
from New York State. A member of the study team contacted the director of each
of these libraries to determine whether any would be willing to conduct
additional surveys to assess their telehealth implementation process. The
director of the Macedon Public Library expressed interest in participating as a
pilot site for telehealth hub implementation. Macedon is a rural town in Wayne
County, New York, with a population of approximately 9,000 people. The Macedon
Public Library had recently constructed a “digital equity booth” with grant
funding from New York State (see Figure 1 and Supplemental Materials). This
booth was located in the foyer of the library; it included a computer, headset,
and camera; it had space for two people to sit comfortably; and it was
soundproof and opaque from the outside, ensuring privacy. In partnership with
the library director, the study
Figure 1 Digital equity booth at the Macedon Public Library, including
materials from the community-academic partnership with University of Rochester.
team developed a community survey to assess Macedon
community members’ and Macedon Public Library patrons’ perspectives on
telehealth and the use of the digital equity booth to enhance access to
telehealth.
To disseminate the community survey, the study team
attended two community events in collaboration with the Macedon Public Library:
the Macedon Heritage Festival and the Macedon Senior Luncheon.
Participants at each event were residents of Macedon and the surrounding area
who are either existing or potential Macedon Public Library patrons.
Participants completed a paper version of the survey, which the study team
entered into REDCap. A total of 48 community participants completed the survey.
Phase 3: Library staff survey (library
staff survey)
The community-academic team developed the third survey
using the ORIC Readiness for Implementing Change (ORIC) scale [26].
This survey targeted Macedon Public Library staff to assess their readiness to
implement a telehealth hub. Participants were recruited at an employee meeting
by the study team. Participants completed a paper version of the survey, and
the survey team entered the data into REDCap. All three
full-time library staff and six of the nine part-time library staff completed
the survey. All responding staff were responsible for scheduling visits at
the hub, answering patron questions about the hub, and participating in
promotion of the hub, and so were able to respond to the ORIC questions.
Phase 4: Vendor feedback survey (vendor
survey)
The study team organized a health fair at the Macedon
library to improve awareness of the telehealth hub. The study team invited
local community organizations that utilize telehealth or digital health
services within their work to join the event and display their services. The
study team also developed a vendor feedback survey to assess the event's
effectiveness at promoting telehealth at the
library. The vendor survey included three closed-ended, multiple choice (YES or
NO) questions. Thirteen community organization vendors attended the event, and
seven completed the survey.
Participants
As surveys were anonymous and multi-level,
sociodemographic characteristics of each participant were not collected for
this study. Participants eligible to participate in this study were required to
be at least 18 years old, possess English language proficiency, and either
live, work or volunteer within the WCI’s catchment area. Specifically, the
library survey required participants to volunteer or be employed at a NYS
library within the WCI’s catchment area. The library staff survey required
participants to volunteer or be employed at Macedon Public Library. The vendor
survey required attendance at the Macedon Public Library health fair event.
Participants for all surveys were given an information
sheet outlining research objectives, study procedures and contact information
for both the principal investigator and the study coordinator if questions
arose. Those willing to participate in the library and vendor surveys selected
“Accept” at the conclusion of the information sheet on REDCap, before being
redirected to complete the survey. Those willing to participate in the
community and library staff surveys completed paper versions of these surveys after
receiving the information sheet.
Capability and infrastructure of libraries to host
telehealth (Phase 1)
From the library survey, data on the utilization of
telehealth sites, existing infrastructure, and possibilities of community
engagement with telehealth services was compiled in Table 1. Notably,
while the vast majority of responding libraries reported that a telehealth site
in a community setting would be beneficial and that they would be willing to
promote health initiatives and digital health services through the library, a
much smaller percentage reported that they would be interested in leading the
implementation of a telehealth site in their organization, and a small minority
of respondents stated that they had an established partnership with a local
health system or doctors (see Table 1).
Community members’ perspectives on telehealth
utilization at the Macedon Public Library (Phase 2)
From the community survey, community members’ prior
experiences with telehealth, comfort levels in utilizing the booth, potential
concerns and overall satisfaction with the booth were measured by a Likert
scale and compiled in Table 2. Existing experience with telehealth was
limited, with the minority of respondents stating that they had a
telehealth appointment via computer or phone, and nearly
half (45.8%) stating that they never used telehealth before. However, the
majority of patients stated that they would feel comfortable going to the
Macedon Public Library for a telehealth appointment and that they had no
concerns about using a telehealth booth in the Macedon library (see Table 2).
|
Table 2
Assessing patrons’
perspectives on telehealth utilization at the Macedon Library (n*)
|
|
Have you ever had a telehealth appointment?
Yes, on the computer
Yes, on the phone
No
|
Total n = 48 (100%)
13 (27.1)
13 (27.1)
22 (45.8)
|
|
Would you feel comfortable going to a telehealth
appointment at the Macedon library?
Yes
No
|
Total n = 47 (100%)
29 (61.7)
18 (38.3)
|
|
Do you have concerns about using a telehealth booth in
the Macedon library?
Yes
No
|
Total n = 45 (100%)
8 (17.8)
37 (82.2)
|
|
How satisfied are you with the telehealth booth at the
Macedon library?
Very Dissatisfied
Somewhat Dissatisfied
Neither Satisfied nor
Dissatisfied
Somewhat Satisfied
Very Satisfied
|
Total n = 19 (100%)
0 (0.0)
0 (0.0)
5 (26.3)
1 (5.3)
13 (68.4)
|
Readiness to implement a telehealth booth (Phase
3)
Macedon Public Library staff (n=9) were given the library
staff survey during their routine shifts to assess their readiness to
implement a telehealth booth at the library (see Table 3). In total,
55.5% agreed or somewhat agreed that the organization could get people invested
in implementing a telehealth booth; 88.9% agreed or somewhat agreed that they
want to implement telehealth booth; 88.9% agreed or somewhat agreed that they
were committed to implementing a telehealth booth; and 66.6% agreed or somewhat
agreed that they could handle the challenges that might arise in implementing a
telehealth booth. Moreover, the vast majority (88.9%) of the participants
agreed or somewhat agreed that they could coordinate tasks so that
implementation goes smoothly and 77.7% agreed or somewhat agreed that they were
motivated to implement a telehealth booth.
Library as a venue for promoting telehealth (Phase
4)
Of the 13 vendors at the Macedon Public Library health
fair, 7 completed the vendor survey. In total, 71% of vendors reported that the
fair was successful in promoting telehealth, 43% received referrals to their
programs or services, and 100% of vendors would attend another community event
at the Macedon Public Library, signifying the event was constructive and
beneficial.
Discussion
Our study assessed the capability of libraries in the
WCI’s catchment area and the perspectives and readiness of library staff and
the local community to implement telehealth at a pilot library, Macedon Public
Library. Among the libraries that participated in the survey, the majority of
them reported that they have the capacity and infrastructure to host telehealth
within their respective libraries. Local community residents (who are potential
users of the telehealth) surrounding the Macedon Library reported that they
support the idea of implementing telehealth within the library. Moreover, the
staff at Macedon Library (who oversee the library) expressed their readiness to
implement a telehealth booth within Macedon Public Library.
Infrastructure is a critical component of implementing
telehealth hubs in rural communities. Assessing the availability and robustness
of community infrastructure is crucial for the successful implementation and
delivery of telehealth services, as the lack of infrastructure is a global
challenge that healthcare organizations are facing as they attempt to integrate
telehealth into their workflows [27].
Most libraries in the WCI’s catchment area, however, have critical components
of telehealth infrastructure that could enable them to implement telehealth
hubs within their libraries. Specifically, in addition to broadband internet,
availability of private space and presence of a staff champion are essential
components of infrastructure for telehealth [28].
The pilot library chosen, Macedon Public Library, reported these important
infrastructure features, including a private telehealth booth and a conference
room where training for library staff and community members about utilization
of telehealth could be held. In addition, two other libraries in the WCI’s
catchment area reported the capacity to construct a private booth to serve as a
telehealth hub, indicating that this infrastructure exists across multiple
libraries. Healthcare organizations could leverage the immense potential of
public libraries to extend their service delivery coverage to a wider range of
communities, particularly to rural communities who may experience limited
access to healthcare facilities, barriers to transportation, and lack of broadband
internet at their homes.
Various stakeholders are involved in telehealth
implementation and utilization including patients, medical providers, insurance
payors, and policymakers [29]. Although each of these stakeholders plays their respective
role, the perspectives of the local communities (i.e., the ultimate users of
the services) are the prime determinant of telehealth uptake. Hence, assessing
the
perspectives of the local community regarding
implementing telehealth hubs is crucial before starting the services. Among the
local community participants surrounding the Macedon Public Library who
participated in the survey, close to three-quarters of them reported their
interest in using telehealth at Macedon Library. They also reported that they
felt comfortable having a telehealth appointment at Macedon library. Finally,
successful implementation of telehealth hubs within public libraries requires sustained
engagement of library staff. The library staff members at the Macedon Public
Library expressed a strong commitment and readiness to implement telehealth hub
within the library. Again, this indicates that healthcare organizations could
leverage the readiness of these communities and staff members when strategizing
around telehealth implementation.
Integrating telehealth into public libraries requires
cooperation between multiple stakeholders, including health systems,
community-based organizations, and libraries, to provide culturally tailored
and holistic care [20, 28]. It is notable from our results that while 87% of
libraries reported that they had space to host a telehealth hub, 82% did not
have an existing relationship with healthcare organizations or providers.
Developing these relationships may further enhance telehealth referral
pipelines into community-based hubs. Offering targeted telehealth training
within libraries, using locally-familiar doctors, and marketing the presence of
library-based telehealth hubs to both doctors and patients could bolster
utilization of these hubs. Other ways to engage diverse stakeholders in
implementing telehealth could include focusing on particular segments of the
population (ex: economically disadvantaged, elderly, chronically ill) to ensure
they are aware of and able to access community telehealth hubs, and training
patients and community members on the use of online healthcare accounts (e.g.,
patient portals). As a community-academic partnership hosted by a cancer
center, the CCAC was particularly interested in the potential for rural
telehealth hub to promote access to cancer care. Promoting telehealth access to
cancer care would involve developing specific relationships with oncology
providers and specific education for the community about use of telehealth
across the continuum of cancer care services.
Our study, while providing insight into the feasibility
and perspectives of rural libraries as telehealth hubs, is not without
limitations. The response rate from the initial statewide library survey was
low, with only 51 out of 274 libraries responding. Though this matches rates in
other online surveys, it potentially introduces a selection bias where
libraries with either a pre-existing inclination or familiarity towards
telehealth might have been overrepresented. The use of self-reported data
raises the risk of either recall bias or social desirability biases, especially
when highlighting the potential benefits of telehealth. Further, individual
respondents may have been more interested in the idea of telehealth than those
who opted not to respond. Though our community survey included a definition of
telehealth, individuals with low health literacy may not have fully understood
the uses of telehealth. The sample from the Macedon Public Library, which
included both patrons and staff, was relatively small, potentially not
capturing all of the perspectives in the larger community and limiting the
generalizability of the results. To expand on this point, it is unclear whether
the results from a single pilot location at the Macedon Library can be applied
to other rural libraries, both within and outside New York State. This study
did not thoroughly assess the telehealth hub’s long-term feasibility and
sustainability. Additionally, for certain measures, we encountered limited
responses, and notably, the vendor feedback from the health far did not yield
many substantive insights for our analysis. We did not collect demographics
from respondents to preserve their anonymity, thus further limiting our ability
to assess generalizability of results. In order to ensure a long-lasting and
successful integration of telehealth hub’s in rural libraries, future
initiatives should aim for more comprehensive study of these factors. Despite
these limitations, our sampling of libraries was robust, our response rate was
acceptable, and our community-academic partnership proved both feasible and
effective in conducting the project.
In conclusion, public libraries have the capacity (i.e.,
private rooms and other important infrastructure factors) to serve as
telehealth sites. Moreover, the local community and the staff members at our
pilot public library, Macedon Public Library, support telehealth implementation
within the library. Healthcare organizations should harness such great
resources of public libraries (particularly in rural areas) to address
disparities in healthcare service coverage.
CONFLICT OF INTEREST
All authors report that they have no conflicts of
interest to disclose.
DATA AVAILABILITY STATEMENT
All data from surveys conducted as part of this article
are available in the Open Science Framework at DOI 10.17605/OSF.IO/TD3GA.
ACKNOWLEDGEMENTS AND FUNDING
This research was supported by NIH grants UG1 CA189961.
References
1. Aubertine
DJ. Rural New York. 2018 January 16, 2018. Report No.
2. WHO
Global Observatory for eHealth. Telemedicine: opportunities and developments in
Member States: report on the second global survey on eHealth. 2010.
3. Bashshur
R, Doarn CR, Frenk JM, Kvedar JC, Woolliscroft JO. Telemedicine and the
COVID-19 Pandemic, Lessons for the Future. Telemed J E Health. 2020
May;26(5):571-3. https://www.ncbi.nlm.nih.gov/pubmed/32275485.
4. Bashshur
RL, Howell JD, Krupinski EA, Harms KM, Bashshur N, Doarn CR. The Empirical
Foundations of Telemedicine Interventions in Primary Care. Telemed J E Health.
2016 May;22(5):342-75. https://www.ncbi.nlm.nih.gov/pubmed/27128779.
5. Fortney
JC, Pyne JM, Mouden SB, Mittal D, Hudson TJ, Schroeder GW, Williams DK, Bynum
CA, Mattox R, Rost KM. Practice-Based Versus Telemedicine-Based Collaborative
Care for Depression in Rural Federally Qualified Health Centers: A Pragmatic
Randomized Comparative Effectiveness Trial. Focus (Am Psychiatr Publ). 2017
Jul;15(3):361-72. https://www.ncbi.nlm.nih.gov/pubmed/32015700.
6. Graves
JM, Abshire DA, Amiri S, Mackelprang JL. Disparities in Technology and
Broadband Internet Access Across Rurality: Implications for Health and
Education. Family & community health. 2021 Oct-Dec 01;44(4):257-65. https://www.ncbi.nlm.nih.gov/pubmed/34269696.
7. Hunter
I, Lockhart C, Rao V, Tootell B, Wong S. Enabling Rural Telehealth for Older
Adults in Underserved Rural Communities: Focus Group Study. JMIR Form Res. 2022
Nov 4;6(11):e35864. https://www.ncbi.nlm.nih.gov/pubmed/36331533.
8. Hudson
HE. Rural telemedicine: lessons from Alaska for developing regions. Telemed J E
Health. 2005 Aug;11(4):460-7. https://www.ncbi.nlm.nih.gov/pubmed/16149892.
9. Doraiswamy
S, Abraham A, Mamtani R, Cheema S. Use of Telehealth During the COVID-19
Pandemic: Scoping Review. J Med Internet Res. 2020 Dec 1;22(12):e24087. https://www.ncbi.nlm.nih.gov/pubmed/33147166.
10. Caffery
LA, Muurlink OT, Taylor-Robinson AW. Survival of rural telehealth services
post-pandemic in Australia: A call to retain the gains in the 'new normal'. The
Australian journal of rural health. 2022 Aug;30(4):544-9. https://www.ncbi.nlm.nih.gov/pubmed/35612267.
11. Arcury
TA, Gesler WM, Preisser JS, Sherman J, Spencer J, Perin J. The effects of
geography and spatial behavior on health care utilization among the residents
of a rural region. Health Serv Res. 2005 Feb;40(1):135-55. https://www.ncbi.nlm.nih.gov/pubmed/15663706.
12. Harkey
LC, Jung SM, Newton ER, Patterson A. Patient Satisfaction with Telehealth in
Rural Settings: A Systematic Review. Int J Telerehabil. 2020 Dec 8;12(2):53-64.
https://www.ncbi.nlm.nih.gov/pubmed/33520095.
13. Call
VR, Erickson LD, Dailey NK, Hicken BL, Rupper R, Yorgason JB, Bair B. Attitudes
Toward Telemedicine in Urban, Rural, and Highly Rural Communities. Telemed J E
Health. 2015 Aug;21(8):644-51. https://www.ncbi.nlm.nih.gov/pubmed/25839334.
14. Bashshur
R, Shannon G, Krupinski E, Grigsby J. The taxonomy of telemedicine. Telemed J E
Health. 2011 Jul-Aug;17(6):484-94. https://www.ncbi.nlm.nih.gov/pubmed/21718114.
15. Dorsey
ER, Topol EJ. State of Telehealth. N Engl J Med. 2016 Oct 6;375(14):1400. https://www.ncbi.nlm.nih.gov/pubmed/27705257.
16. Kvedar
J, Coye MJ, Everett W. Connected health: a review of technologies and
strategies to improve patient care with telemedicine and telehealth. Health
affairs. 2014 Feb;33(2):194-9. https://www.ncbi.nlm.nih.gov/pubmed/24493760.
17. Brems
C, Johnson ME, Warner TD, Roberts LW. Barriers to healthcare as reported by
rural and urban interprofessional providers. J Interprof Care. 2006
Mar;20(2):105-18. https://www.ncbi.nlm.nih.gov/pubmed/16608714.
18. Marcin
JP, Shaikh U, Steinhorn RH. Addressing health disparities in rural communities
using telehealth. Pediatr Res. 2016 Jan;79(1-2):169-76. https://www.ncbi.nlm.nih.gov/pubmed/26466080.
19. DeGuzman
PB, Abooali S, Jain N, Scicchitano A, Siegfried ZC. Improving equitable access
to care via telemedicine in rural public libraries. Public health nursing. 2022
Mar;39(2):431-7. https://www.ncbi.nlm.nih.gov/pubmed/34614251.
20. DeGuzman
PB, Garth JL, Sanjay K, Compton RM. Extending health care access via
telemedicine in public libraries. J Am Assoc Nurse Pract. 2023 Mar
1;35(3):208-15. https://www.ncbi.nlm.nih.gov/pubmed/36538416.
21. Morgan
AU, Dupuis R, D’Alonzo B, Johnson A, Graves A, Brooks KL, McClintock A,
Klusaritz H, Bogner H, Long JA, Grande D, Cannuscio CC. Beyond Books: Public
Libraries As Partners For Population Health. Health Affairs. 2016
35(11):2030-6. https://dx.doi.org/10.1377/hlthaff.2016.0724.
22. Philbin
MM, Parker CM, Flaherty MG, Hirsch JS. Public Libraries: A Community-Level
Resource to Advance Population Health. Journal of Community Health. 2019
44(1):192-9. https://dx.doi.org/10.1007/s10900-018-0547-4.
23. Simon
MA, O’Brian CA, Nava M, Dahdouh R, Wafford QE, Mack S, Holmes KL. Public
libraries as key partners for advancing health equity. American Public Health
Association; 2021. p. 40-2.
24. Lenstra
PMN, Flaherty PMMMG. Closing the Gap. Delaware Journal of Public Health. 2020
6(4):40-5. https://dx.doi.org/10.32481/djph.2020.09.013.
25. Ford
A. Saving lives in the stacks. American Libraries. 2017 48(9-10):44-9.
26. Shea
CM, Jacobs SR, Esserman DA, Bruce K, Weiner BJ. Organizational readiness for
implementing change: a psychometric assessment of a new measure. Implement Sci.
2014 Jan 10;9:7. https://www.ncbi.nlm.nih.gov/pubmed/24410955.
27. Kobeissi
MM. Telehealth policy guide for nurse practitioners: A compliance checklist. J
Am Assoc Nurse Pract. 2023 Oct 1;35(10):602-4. https://www.ncbi.nlm.nih.gov/pubmed/37141436.
28. Chiricuzio
S. Public Libraries Tackle Telehealth Challenges. Telehealth can bridge
healthcare accessibility issues, but that leaves out the many who still don’t
have reliable broadband access at home. Some libraries are stepping up to fill
that gap. 2022.
29. Jiang
CY, El-Kouri NT, Elliot D, Shields J, Caram MEV, Frankel TL, Ramnath N, Passero
VA. Telehealth for Cancer Care in Veterans: Opportunities and Challenges
Revealed by COVID. JCO oncology practice. 2021 Jan;17(1):22-9. https://www.ncbi.nlm.nih.gov/pubmed/32970512.
Supplemental Files
Appendix A
Appendix B
Authors’ Affiliations
Abdi T. Gudina, abdi_gudina@urmc.rochester.edu, University of Rochester, Rochester, NY
Sarah Merritt, sarah_merritt@urmc.rochester.edu, University
of Rochester, Rochester, NY
Rohan Dhawan, rdhawan@u.rochester.edu, University of Rochester, Rochester, NY
Milena E. Insalaco, University of Rochester, Rochester, NY
Joanne Kochanek, jfk@rochester.rr.com, University of Rochester, Rochester, NY
Mitzi Sackett, mitzi.sackett@bassett.org, Bassett Healthcare, NY
Stacey Wicksall, swicksall@owwl.org, Macedon Public Library, Macedon, NY
Lynae Wyckoff, lwyckoff@nycamh.org, Bassett
Healthcare, NY
Diana Huussen, diana_huussen@urmc.rochester.edu,
University of Rochester, Rochester, NY
Francisco Cartujano-Barrera,
francisco_cartujano@urmc.rochester.edu,
University of Rochester, Rochester, NY
Ana Paula Cupertino, paula_cupertino@urmc.rochester.edu,
University of Rochester, Rochester, NY
Michele Foster, michele.foster@s2aynetwork.org,
Pivital Public Health Partnership, New York, NY
Jason Coleman, jason.coleman@cancer.org, American Cancer Society, New York, NY
Charles S. Kamen, PhD, MPH, charles_kamen@urmc.rochester.edu,
Associate Professor, University of Rochester, Rochester, NY
Received December 2024; accepted April 2025
