Telemedicine services leverage information and communication technologies toward innovating and enabling the delivery of healthcare. We propose and empirically analyze a framework for understanding the impact of telemedicine services on health outcomes at scale across communities in the United States. Our analysis of county-level panel data reveals that increased availability of telemedicine services improves community health that is central to the well-being of a community. We evaluate the benefits of telemedicine services in aggregate—that is, overall health outcomes—and along specific dimensions of reductions in premature death rate, low birthweight rate, preventable hospital stays, smoking rate, and the need for diabetes monitoring. In addition, we find that greater availability of telemedicine services is associated with decreased COVID-19-related mortality. Heterogeneity analyses further show that lower socioeconomic status reduces the effectiveness of telemedicine services while superior digital infrastructure and greater innovation capacity enhance its effectiveness. Demographics by way of higher proportions of Black and female community members enhance the effectiveness of telemedicine services, whereas a higher proportion of older adults reduces its effectiveness. Taken together, the proposed framework and the findings underscore the potential of telemedicine services to improve community health while recognizing the moderating effects of contextual factors. This study makes a significant contribution toward advancing the literature on seamless coordination of digital service innovations to drive community-wide health benefits.
AljafariR.SohF.SetiaP.AgarwalR. (2024), “The Local Environment Matters: Evidence from Digital Healthcare Services for Patient Engagement.” Journal of the Academy of Marketing Science, 52 (5), 1343-65.
2.
AndersonL.OstromA. L. (2015), “Transformative Service Research: Advancing Our Knowledge about Service and Well-Being.” Journal of Service Research, 18 (3), 243-49.
3.
AndersonL.OstromA. L.CorusC.FiskR. P.GallanA. S.GiraldoM.MendeM.MulderM.RayburnS. W.RosenbaumM. S.ShirahadaK.WilliamsJ. D. (2013), “Transformative Service Research: An Agenda for the Future.” Journal of Business Research, 66 (8), 1203-10.
4.
AngstC. M.DevarajS.QueenanC. C.GreenwoodB. (2011), “Performance Effects Related to the Sequence of Integration of Healthcare Technologies.” Production and Operations Management, 20 (3), 319-33.
5.
AntonsD.BreidbachC. F. (2018), “Big Data, Big Insights? Advancing Service Innovation and Design with Machine Learning.” Journal of Service Research, 21 (1), 17-39.
6.
AtheyS.ImbensG. W. (2019), “Machine Learning Methods That Economists Should Know About.” Annual Review of Economics, 11 (1), 685-725.
7.
BarnettM. L.RayK. N.SouzaJ.MehrotraA. (2018), “Trends in Telemedicine Use in a Large Commercially Insured Population, 2005-2017.” JAMA, 320 (20), 2147-49.
8.
BarrettM.DavidsonE.PrabhuJ.VargoS. L. (2015), “Service Innovation in the Digital Age: Key Contributions and Future Directions.” MIS Quarterly, 39 (1), 135-54.
9.
BavafaH.HittL. M.TerwieschC. (2018), “The Impact of E-Visits on Visit Frequencies and Patient Health: Evidence from Primary Care.” Management Science, 64 (12), 5461-80.
10.
BellJ. J.LeeS.GrucaT. S. (2024), “Bringing the Doctor to the Patients: Cardiology Outreach to Rural Areas.” Journal of Marketing, 88 (1), 31-52.
11.
BerryL. L.AttaiD. J.ScammonD. L.AwdishR. L. A. (2022), “When the Aims and the Ends of Health Care Misalign.” Journal of Service Research, 25 (1), 160-84.
12.
BerryL. L.YadavM. S.HoleM. K. (2024), “Reclaiming Healthcare’s Healing Mission for a Sustainable Future.” Journal of Service Research, 27 (1), 6-27.
BlockerC. P.BarriosA. (2015), “The Transformative Value of a Service Experience.” Journal of Service Research, 18 (3), 265-83.
15.
BlockerC. P.DavisB.AndersonL. (2022), “Unintended Consequences in Transformative Service Research: Helping without Harming.” Journal of Service Research, 25 (1), 3-8.
16.
BreidbachC. F.AntonsD.SalgeT. O. (2016), “Seamless Service? On the Role and Impact of Service Orchestrators in Human-Centered Service Systems.” Journal of Service Research, 19 (4), 458-76.
BrockJ. K.-U.von WangenheimF. (2019), “Demystifying AI: What Digital Transformation Leaders Can Teach You about Realistic Artificial Intelligence.” California Management Review, 61 (4), 110-34.
19.
ČaićM.Odekerken-SchröderG.MahrD. (2018), “Service Robots: Value Co-Creation and Co-Destruction in Elderly Care Networks.” Journal of Service Management, 29 (2), 178-205.
CoffeyJ. D.ChristophersonL. A.WilliamsR. D.GathjeS. R.BellS. J.PahlD. F.MankaL.BlegenR. N.ManiaciM. J.OmmenS. R.HaddadT. C. (2022), “Development and Implementation of a Nurse-Based Remote Patient Monitoring Program for Ambulatory Disease Management.” Frontiers in Digital Health4 (December), 1052408.
25.
CohenW. M.LevinthalD. A. (1990), “Absorptive Capacity: A New Perspective on Learning and Innovation.” Administrative Science Quarterly, 35 (1), 128-52.
26.
DanaherT. S.BerryL. L.HowardC.MooreS. G.AttaiD. J. (2023), “Improving How Clinicians Communicate with Patients: An Integrative Review and Framework.” Journal of Service Research, 26 (4), 493-510.
27.
DanaherT. S.DanaherP. J.SweeneyJ. C.McColl-KennedyJ. R. (2024), “Dynamic Customer Value Cocreation in Healthcare.” Journal of Service Research, 27 (2), 177-93.
28.
DanaherT. S.GallanA. S. (2016), “Service Research in Health Care: Positively Impacting Lives.” Journal of Service Research, 19 (4), 433-37.
29.
DanielH.SulmasyL. S. (2015), “Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings: An American College of Physicians Position Paper.” Annals of Internal Medicine, 163 (10), 787-89.
30.
DelanaK.DeoS.RamdasK.SubburamanG.-B. B.RavillaT. (2023), “Multichannel Delivery in Healthcare: The Impact of Telemedicine Centers in Southern India.” Management Science, 69 (5), 2568-86.
31.
DemekeH. B.MeraliS.MarksS.PaoL. Z.RomeroL.SandhuP.ClarkH.ClaraA.McDowK. B.TindallE. (2021), “Trends in Use of Telehealth among Health Centers during the COVID-19 Pandemic—United States, June 26–November 6, 2020.” Morbidity and Mortality Weekly Report70 (7), 240.
32.
DragoC.GattoA.RuggeriM. (2023), “Telemedicine as Technoinnovation to Tackle COVID-19: A Bibliometric Analysis.” Technovation, 120, 102417.
33.
DudleyM. D. J.Sunglyue (2020), What Patients Like — and Dislike — About Telemedicine. Harvard Business Review, December8, 2020.
FarmerP.LéandreF.MukherjeeJ. S.ClaudeM. S.NevilP.Smith-FawziM. C.KoenigS. P.CastroA.BecerraM. C.SachsJ.AttaranA.KimJ. Y. (2001), “Community-Based Approaches to HIV Treatment in Resource-Poor Settings.” The Lancet, 358 (9279), 404-9.
36.
FiskR. P.GallanA. S.JoubertA. M.BeekhuyzenJ.CheungL.Russell-BennettR. (2023), “Healing the Digital Divide with Digital Inclusion: Enabling Human Capabilities.” Journal of Service Research, 26 (4), 542-59.
37.
ForjazM. J.AyalaA.SchutteL.WissingM. P.TemaneQ. M.CampbellT. C. H.CarrollM. T. C. (2025), “Rasch and Confirmatory Factor Analysis of the Community Wellbeing Index: A Multicountry Validation Study.” Social Indicators Research, 179 (1), 47-66.
38.
FreemanR. E. (1984), Strategic Management: A Stakeholder Approach. New York: Cambridge University Press.
39.
GanjuK. K.AtasoyH.McCulloughJ.GreenwoodB. (2020), “The Role of Decision Support Systems in Attenuating Racial Biases in Healthcare Delivery.” Management Science, 66 (11), 5171-81.
40.
Go JefferiesJ.BishopS.HibbertS. (2021), “Service Innovation through Resource Integration: An Empirical Examination of Co-Created Value Using Telehealth Services.” Public Policy and Administration, 36 (1), 69-88.
41.
GreenT.HartleyN.GillespieN. (2016), “Service Provider’s Experiences of Service Separation: The Case of Telehealth.” Journal of Service Research, 19 (4), 477-94.
42.
GuanX.LiK.WuH. (2025), “A Blessing or a Curse? Teletriage Service in Healthcare.” Management Science Forthcoming (March).
43.
GuoT.SriramS.ManchandaP. (2021), “The Effect of Information Disclosure on Industry Payments to Physicians.” Journal of Marketing Research, 58 (1), 115-40.
44.
HaimiM. (2023), “The Tragic Paradoxical Effect of Telemedicine on Healthcare Disparities- a Time for Redemption: A Narrative Review.” BMC Medical Informatics and Decision Making23 (1), 95.
45.
HarrisonM. (2019), “Telehealth Is Improving Health Care in Rural Areas.” Harvard Business Review, 2019.
46.
HarveyJ.PoorrezaeiM.WoodallT.Nica-AvramG.SmithG.AjiboyeT.KholodovaK.ZhuK. (2020), “The Smart Home: How Consumers Craft New Service Networks by Combining Heterogeneous Smart Domestic Products.” Journal of Service Research, 23 (4), 504-26.
47.
HollanderJ. E.CarrB. G. (2020), “Virtually Perfect? Telemedicine for Covid-19.” New England Journal of Medicine, 382 (18), 1679-81.
48.
HuangM.-H.MalthouseE.NobleS.WetzelsM. (2021), “Moving Service Research Forward.” Journal of Service Research, 24 (4), 459-61.
49.
HuangM.-H.RustR. T. (2017), “Technology-Driven Service Strategy.” Journal of the Academy of Marketing Science, 45 (6), 906-24.
50.
HuangM.-H.RustR. T. (2018), “Artificial Intelligence in Service.” Journal of Service Research, 21 (2), 155-72.
51.
HweiL. R. Y.OctaviusG. S. (2021), “Potential Advantages and Disadvantages of Telemedicine: A Literature Review from the Perspectives of Patients, Medical Personnel, and Hospitals.” Journal of Community Empowerment for Health, 4 (3), 180-86.
52.
ImbensG. W.RubinD. B. (2015), Causal Inference in Statistics, Social, and Biomedical Sciences. New York: Cambridge University Press.
53.
IshfaqR.RajaU. (2015), “Bridging the Healthcare Access Divide: A Strategic Planning Model for Rural Telemedicine Network.” Decision Sciences, 46 (4), 755-90.
54.
JacobsonJ. O. (2023), “Commentary: The Bumpy Road to Achieving High-Quality Cancer Conversations.” Journal of Service Research, 26 (4), 511-13.
55.
JankeA. T.MeiH.RothenbergC.BecherR. D.LinZ.VenkateshA. K. (2021), “Analysis of Hospital Resource Availability and COVID-19 Mortality across the United States.” Journal of Hospital Medicine, 16 (4), 211-14.
56.
KeininghamT.AksoyL.MalthouseE. (2024), “Sustainable Service.” Journal of Service Research, 27 (1), 3-5.
57.
MakridisC. A.MishraS. (2022), “Artificial Intelligence as a Service, Economic Growth, and Well-Being.” Journal of Service Research, 25 (4), 505-20.
58.
MDH (2020), Minnesota E-Health Initiative - Minnesota Department of Health (MDH). Minnesota Department of Health.
59.
MDH (2024), Minnesota Study of Telehealth Publications - Final Report Publications. Minnesota Department of Health.
60.
MilesI. (2010), “Service Innovation.” in Handbook of Service Science, MaglioPaul P.KieliszewskiCheryl A.SpohrerJames C., eds. Service Science: Research and Innovations in the Service Economy. Boston, MA: Springer US, 511-33.
61.
Minnesota Statutes (2017), 2017 Minnesota Statutes Sec. 147.033 - Practice of Telemedicine. 2017 Minnesota Statutes.
MitkaM. (2003), “Telemedicine Eyed for Mental Health Services: Approach Could Widen Access for Older Patients.” The Journal of the American Medical Association, 290 (14), 1842-43.
64.
MN Department of Health (2024), Study of Telehealth Expansion and Payment Parity – Final Report to the Minnesota Legislature 2024. MN Department of Health.
65.
NarcisseM.-R.AndersenJ. A.FelixH. C.HayesC. J.EswaranH.McElfishP. A. (2022), “Factors Associated with Telehealth Use among Adults in the United States: Findings from the 2020 National Health Interview Survey.” Journal of Telemedicine and Telecare, 30, 993-1004.
NilsenP. (2006), “The Theory of Community Based Health and Safety Programs: A Critical Examination.” Injury Prevention, 12 (3), 140-45.
69.
OllierJ.SuryapalliP.FleischE.von WangenheimF.MairJ. L.Salamanca-SanabriaA.KowatschT. (2023), “Can Digital Health Researchers Make a Difference during the Pandemic? Results of the Single-Arm, Chatbot-Led Elena+: Care for COVID-19 Interventional Study.” Frontiers in Public Health, 11, 1185702.
70.
OsmundsenT. C.Andreassen JaatunE. A.HeggemG. F.KulsengB. E. (2015), “Service Innovation from the Edges: Enhanced by Telemedicine Decision Support.” Personal and Ubiquitous Computing, 19 (3), 699-708.
71.
OstromA. L.FieldJ. M.FotheringhamD.SubramonyM.GustafssonA.LemonK. N.HuangM.-H.McColl-KennedyJ. R. (2021), “Service Research Priorities: Managing and Delivering Service in Turbulent Times.” Journal of Service Research, 24 (3), 329-53.
72.
OstromA. L.ParasuramanA.BowenD. E.PatrícioL.VossC. A. (2015), “Service Research Priorities in a Rapidly Changing Context.” Journal of Service Research, 18 (2), 127-59.
73.
PannuJ.SanghaviD.SheleyT.SchroederD. R.KashyapR.MarquezA.DanielsC. E.BrownD. R.CaplesS. M. (2017), “Impact of Telemedicine Monitoring of Community ICUs on Interhospital Transfers.” Critical Care Medicine, 45 (8), 1344-51.
74.
ParasuramanA.ColbyC. L. (2015), “An Updated and Streamlined Technology Readiness Index: TRI 2.0.” Journal of Service Research, 18 (1), 59-74.
75.
PatelS. Y.MehrotraA.HuskampH. A.Uscher-PinesL.GanguliI.BarnettM. L. (2021), “Variation in Telemedicine Use and Outpatient Care during the COVID-19 Pandemic in the United States.” Health Affairs, 40 (2), 349-58.
76.
PearlR.WaylingB. (2022), “The Telehealth Era Is Just Beginning.” Harvard Business Review.
77.
PerrinA.AtskeS. (2021), “7% of Americans Don’t Use the Internet. Who Are They?” Pew Research Center.
78.
PolonskyM. J.WeberV.OzanneL.RobertsonN. (2024), “A Framework of Foreseen and Unforeseen Harms in Transformative Service Systems.” Journal of Service Research, September, 10946705241287833.
79.
PorterM. E. (1998), “Clusters and Competition: New Agendas for Companies, Governments, and Institutions.” Harvard Business Publishing.
80.
QueenanC.CameronK.SnellA.SmalleyJ.JoglekarN. (2019), “Patient Heal Thyself: Reducing Hospital Readmissions with Technology-Enabled Continuity of Care and Patient Activation.” Production and Operations Management, 28 (11), 2841-53.
81.
RabbaniM. (2024), “Internet Price, Speed, and Disparity: The Case of Rural Healthcare Providers in the United States.” Telecommunications Policy48 (2), 102674.
82.
RajanB.TezcanT.SeidmannA. (2019), “Service Systems with Heterogeneous Customers: Investigating the Effect of Telemedicine on Chronic Care.” Management Science, 65 (3), 1236-67.
83.
RamdasK.SwaminathanS. (2021), “Patients Could Share Virtual Medical Appointments for Better Access to Telemedicine.” Nature Medicine, 27 (1), 14-16.
84.
RandhawaK.ScerriM. (2015), “Service Innovation: A Review of the Literature.” in The Handbook of Service Innovation, AgarwalRenuSelenWillemRoosGöranGreenRoy, eds. London: Springer, 27–51.
85.
RavalD.RosenbaumT. (2021), “Why Is Distance Important for Hospital Choice? Separating Home Bias from Transport Costs.” The Journal of Industrial Economics, 69 (2), 338-68.
86.
RotensteinL. S.FriedmanL. S. (2020), “The Pitfalls of Telehealth — and How to Avoid Them.” Harvard Business Review, November20, 2020.
87.
SaghafianS.HoppW. J.IravaniS. M. R.ChengY.DiermeierD. (2018), “Workload Management in Telemedical Physician Triage and Other Knowledge-Based Service Systems.” Management Science, 64 (11), 5180-97.
88.
SaljoughianM. (2021), “The Benefits and Limitations of Telehealth.” US Pharm, 46 (8), 5-8.
89.
ShacharC.EngelJ.ElwynG. (2020), “Implications for Telehealth in a Postpandemic Future: Regulatory and Privacy Issues.” JAMA, 323 (23), 2375-76.
90.
SmithA. C.ThomasE.SnoswellC. L.HaydonH.MehrotraA.ClemensenJ.CafferyL. J. (2020), “Telehealth for Global Emergencies: Implications for Coronavirus Disease 2019 (COVID-19).” Journal of Telemedicine and Telecare, 26 (5), 309-13.
SoderbergK. (2014), Minnesota Department of Health: Minnesota e-Health Assessment Reports, Factsheets and Briefs. Minnesota Department of Health, (accessed Auguest 2, 2014), (available at: http://www.health.state.mn.us/e-health/assessment.html#profile)
93.
SrivastavaS. C.ShaineshG. (2015), “Bridging the Service Divide through Digitally Enabled Service Innovations: Evidence from Indian Healthcare Service Providers.” MIS Quarterly, 39 (1), 245-A19.
94.
SunS.LuS. F.RuiH. (2020), “Does Telemedicine Reduce Emergency Room Congestion? Evidence from New York State.” Information Systems Research, 31 (3), 972-86.
95.
SunarN.StaatsB. R. (2022), “Telemedicine for Inclusive Care: Remedy for Socioeconomic Health Disparities?” SSRN Scholarly Paper 4103887. Rochester, NY.
96.
TangY.SinhaK. K.MoenA.ErtekinN. (2024), “Towards Achieving Mental Health Equity for the Underserved Population: Evaluating the Potential of Mobile Apps.” Production and Operations Management, 33 (1), 87-107.
97.
The New York Times (2023), “Tracking Coronavirus in Minnesota: Latest Map and Case Count.” The New York Times, March23, 2023, sec. U.S.
98.
VargoS. L.LuschR. F. (2008), “Service-Dominant Logic: Continuing the Evolution.” Journal of the Academy of Marketing Science, 36 (1), 1-10.
99.
van DoornJ. vanMendeM.NobleS. M.HullandJ.OstromA. L.GrewalD.PetersenJ. A. (2017), “Domo Arigato Mr. Roboto: Emergence of Automated Social Presence in Organizational Frontlines and Customers’ Service Experiences.” Journal of Service Research, 20 (1), 43-58.
100.
WagerS.AtheyS. (2018), “Estimation and Inference of Heterogeneous Treatment Effects Using Random Forests.” Journal of the American Statistical Association, 113 (523), 1228-42.
101.
WHO (2010), Telemedicine - Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth. Global Observatory for eHealth Series 2. Geneva, Switzerland: World Health Organization.
102.
YancyC. W. (2020), “COVID-19 and African Americans.” JAMA, 323 (19), 1891-92.
103.
ZepedaD. E.SinhaK. K. (2016), “Towards an Effective Design of Behavioral Health Care Delivery: An Empirical Analysis of Care for Depression.” Production and Operations Management, 25 (5), 952-67.
