The evolution of telehealth and telemedicine has made its mark over the last decades, but not without difficulties. The coronavirus pandemic, on its end, has not only grown the need for such technology, but also highlighted even further the issues surrounding its potential for growth and expansion in the healthcare industry.
The terms telehealth and telemedicine, although both widely used, do not have the same meaning or significance. In fact, telehealth is a broader term that refers more to the use of information technology and telecommunications for diagnoses, consultations, interventions and sharing of information from a distance. On the other hand, telemedicine, according to the Centers for Medicare and Medicaid Services (CMS), can be defined as:
“A service that seeks to improve a patient’s health by permitting two-way, real-time interactive communication between the patient and the physician at a distant site.” – CMS
Over the years, despite technological improvements, telemedicine and its use has been met with regulation and reimbursement issues that have hindered its complete implementation into hospitals and clinics across the country. With the onset of COVID-19 at the beginning of 2020, the lack of telemedicine use, especially in rural areas where broadband access is limited, greatly affected many populations and the availability of quality care.
Payment structures and heavy regulatory laws have also negatively contributed to the widespread use of telemedicine in the United States. According to The Office of the United Nations High Commissioner for Human Rights, there are six key aspects to a person’s right to health:
- Good Quality
Each state has its own laws and regulations that govern five of the six key aspects, all of which are individually managed by state. Acceptability is the only one that is transient across all states, with telemedicine being deemed an acceptable alternative to in-office visits by Medicaid.
On top of this, many states have different regulatory laws that cover various aspects of telemedicine, including payment, licensure, online prescribing, coverage, and security. Even so, the novel coronavirus has made great strides in breaking down many barriers for both providers and patients when it comes to virtual care.
Growing Telemedicine Use Since Coronavirus Break Out
Due to the growing number of cases across the country and the need for patients to stay home and not catch or spread the virus in a clinical setting, CMS has allowed cross-state licensing for telemedicine purposes. It has also added 135 services that can be paid when delivered by telehealth. These include visits such as:
- Initial inpatient
- Nursing facility
- Emergency department
- Discharge day management services
With CMS expanding access to telemedicine services during the COVID-19 pandemic, the advantages of telemedicine have been highlighted for many. Increased access to care and specialty services as well as being a cost-effective service have allowed patients to stay home and physicians to continue seeing their patients and documenting encounters.
Of course, the use of telemedicine has also presented challenges, including privacy and security issues, lack of technological resources and difficulties performing certain exams virtually.
Even so, telemedicine was still being used pre-COVID-19 in certain medical specialties. In fact, according to a 2019 AMA study, specialties that utilized telemedicine the most were:
- Radiology; 39.5%
- Psychiatry; 27.8%
- Cardiology; 24.1%
The need and use of telemedicine go beyond general practitioners needing to see their patients virtually rather than in the office. It stretches to all specialties across the United States.
There has even been a significant consumer shift when it comes to Americans seeking medical care virtually, according to a McKinsey report. Consumers have gone from 11% using telehealth means for medical purposes to 76% being interested in seeking virtual care going forward due to the coronavirus.
On the provider side, health systems, independent practices and others have scaled telehealth use during the pandemic. Rather than cancelling in-person care, they have filled the gap through telemedicine and are reporting 50 to 175 times the number of virtual visits than they did pre-coronavirus.
Thankfully, with regulatory changes regarding telemedicine and the adoption of technology by many providers and specialties, more and more patients are receiving quality care from the safety of their home.
Expanding Telehealth Care
The onset of the COVID-19 pandemic and the quarantine and shutdown of many establishments that ensued led to many seeking healthcare virtually. This boom in telemedicine finally allowed performance evaluations of virtual visits.
An analysis conducted by Press Ganey surveyed over 30,000 patients who took part in telemedicine visits between March and April of 2020, administered over 3.5 million telemedicine surveys. The results showed that “virtual visits can achieve similar ratings for patient experience as in-person visits, with some specific differences on methods of care delivery.”
As patients are increasingly keen on using telemedicine means to contact their doctor and continue their care, virtual visits are becoming an essential care delivery mode. Not only is this true for patients, but for healthcare personnel as well. Transitioning to virtual means reduces the risk of staff exposure to illnesses, minimizes the impact of patient influxes on facilities as well as contributes to conserving personal protective equipment.
Methods of Virtual Communication
The expansion of telemedicine and telehealth modalities includes four methods of communication. The first, real-time communication, permits patients to connect with their providers through phone, chat or video means. The second, store-and-forward, allows for the transmission of images, data, sound or video for evaluation purposes across care sites.
The third form of communication is remote patient monitoring. This is the collection of patient data through digital or phone means while keeping patients at home and transferring health data to remote providers. These providers can then monitor their patient from a distance and contact them when needed.
The fourth method, although emerging, is mobile health. This involves services delivered to patients including health education and information through mobile devices.
The first step in ensuring telehealth can expand and be adopted throughout the United States is to increase access to broadband services. Many areas across the country, notably rural areas, need fast internet connections in order to transmit key information adequately and efficiently.
Through the Federal Communication Commission’s Rural Health Care Program, rural health care providers can apply to the program and expand their online connectivity. The Program receives $400 million annually to improve broadband access in certain areas.
Increasing Virtual Specialty Care
Many specialties outside of general practice have relied on telemedicine and virtual care means to expand access to care and continue seeing patients during the coronavirus pandemic.
One of the specialties is notably dentistry, or in this case, teledentistry. Falling under the store-and-forward modality of telehealth, teledentistry offers patients remote oral health services including video consultations, remote monitoring and the ability to share records and images with other providers. Many states have now adopted policies related to teledentistry, with the following reimbursing for store-and-forward communication:
- New Mexico
Policy trends have now pushed for the inclusion of teledentistry as a specialty qualified for Medicaid and/or private insurer reimbursement.
Another notable specialty area of telehealth is stroke telemedicine or telestroke. As hospitals and other care facilities in rural areas do not necessarily have providers who specialize in stroke care on site, telestroke strives to bridge the gap. Emergency room doctors where the patient is located work together with neurosurgeons and radiologists from a distant site to provide patients with quick diagnoses and appropriate treatment. This removes barriers to care for many, allowing them to receive quality care from their community and reducing unnecessary and avoidable patient transfers.
Although increasingly coveted by patients, telehealth has also proven to help rural areas, among others, recruit and retain providers by building capacity among them. Tele-triage methods also allow providers to assess and care for patients, while diminishing the amount of people seeking in-person care in certain facilities. The increased access to primary and specialty care through telehealth can contribute to reducing costly emergency room visits and provide accessible and timely care to patients across the United States.
Changes Are Still Needed
Although the novel coronavirus pandemic has made strides for telehealth use in the healthcare industry, there is still much work left to be done before saying it has fully been immersed.
The increasing demand for such services amongst both patients and providers has led many states to adapt government and state regulations. Telemedicine has become a key aspect in maintaining the country’s ability to provide the six key aspects to a person’s right to health. However, there are still many states lagging behind and the need to further change regulatory and legal actions in six specific areas is necessary:
- Technological access
- Artificial Intelligence
Many specialties can conduct virtual visits much like they would in-person visits, prompting the development of telemedicine and regulatory changes to enable more and more providers to rapidly deploy such solutions.
As COVID-19 has proven, the progress, expansion and utilization of telehealth and telemedicine services has become increasingly crucial. It has allowed many healthcare professionals across the country to provide timely, quality care to their patients from the safety of their home while diminishing the risk of contagion for many others.
The coronavirus pandemic has resulted in the healthcare landscape needing to take a deep dive into their workflow and adapt many of their processes. Throwing everyone for a loop, one of the many saving graces has been the ability to continue seeing patients virtually while diminishing in-patient visits and personnel exposure to COVID-19, as well as freeing up hospital beds and other resources for patients in need.
If we continue to ride the telemedicine wave, more patients will have access to benefits including convenience of care, increased access to providers from a distance and decreased healthcare costs. The country will also be better prepared to provide quality care across the U.S. if another pandemic were to hit in the future.