In response to the COVID-19 pandemic, governments across the United States relaxed restrictions on telemedicine, allowing more patients to receive healthcare remotely than ever before. This development brought a number of questions about how telehealth should be regulated to the fore. Is remote care as effective as in-person care? Would long-turn expansion of telemedicine reduce costs for patients and healthcare providers? Might a greater reliance on telehealth actually reduce access to care for some patients?
Telehealth is defined as the delivery of health care services at a distance through the use of technology. It can include everything from conducting medical visits over the computer, to monitoring patients’ vital signs remotely. Its definition is broader than that of telemedicine, which only includes the remote delivery of health care.
Telehealth can be delivered in one of three ways:
- Synchronous—when the doctor communicates with the patient in real time via computer or telephone
- Asynchronous—when data, images, or messages are recorded to share with the doctor later
- Remote patient monitoring—when measurements such as weight or blood pressure are sent to the health care provider
What you can do with telehealth
All of the following activities and services are possible with the help of telehealth:
- Recording measurements like your weight, food intake, blood pressure, heart rate, and blood sugar levels either manually, or through a wearable device, and sending them to your doctor.
- Having a virtual visit with your doctor or a nurse over your computer or smartphone.
- Using an online portal to check your test results, request prescription refills, send your doctor a message, or schedule an appointment.
- Sharing information such as your test results, diagnoses, medications, and drug allergies with all of the providers you see.
- Coordinating care between your primary care provider and any specialists you visit—including the sharing of exam notes and test results between medical offices in different locations.
- Getting email or text reminders when you’re due for mammograms, colonoscopies, and other screenings, or routine vaccinations.
- Monitoring older adults at home to make sure they are eating, sleeping, and taking their medications on schedule.
Downsides to telehealth
Telehealth offers a convenient and cost-effective way to see your doctor without having to leave your home, but it does have a few downsides.
- It isn’t possible to do every type of visit remotely. You still have to go into the office for things like imaging tests and blood work, as well as for diagnoses that require a more hands-on approach.
- The security of personal health data transmitted electronically is a concern.
- While insurance companies are increasingly covering the cost of telehealth visits during the COVID-19 pandemic, some services may not be fully covered, leading to out-of-pocket costs.
From Healthcare IT News (June 12, 2020):
Technology-enabled workflows now enable patients to complete most of the registration formalities prior to the visit, be it a virtual consult or a clinic visit. Registration kiosks in hospital lobbies may soon be enabled with facial recognition software to eliminate the need for touching any surface.
Routine examinations are also going virtual, with many diagnostic procedures now possible through remotely controlled devices. Caregivers are beginning to do their patient rounds through virtual visits. This trend will only grow in the coming years.
A vast and growing array of automated communication tools allows caregivers to use rule-based messaging to push everything from health coaching, post-discharge care instructions, and appointment reminders through IVR, text, SMS, and mobile alerts.
Dr. Sachin Nagrani, Medical Director at HEAL, talks about the benefits and growth in Telemedicine appointments.
From The Guardian (May 12, 2020):
“Now, everybody is on board,” says Dr Teresa Anderson, chief executive of the Sydney Local Health District. “There is not one clinical department across the district that is not providing care virtually.”
What a difference a pandemic makes. Although RPA Virtual Hospital was well into development when news broke from Wuhan in January, pandemic preparations meant it was scaled up far quicker than had been envisaged.
Anderson says RPA Virtual Hospital opened on 3 February with just six nurses. It now has more than 30 nurses, as well as medical and allied health teams, and 600 registered patients. Operating out of Royal Prince Alfred Hospital campus, it functions in many ways like a regular hospital, with a clinical handover, ward rounds, multidisciplinary team meetings and its own governance structures.
The virtual hospital is part of a wider suite of innovations developed at breakneck speed during the pandemic response, which include providing care in rented hotel and apartment accommodation to Covid-19 patients and others in quarantine, thus freeing up hospital beds.
The Covid epidemic spurred development of an addition to an already good medical care system.
A group of chronically ill patients were invited into the virtual care system. Nurses are used on initial encounter. They direct the enhanced home care, referrals or hospital care as needed. Electronic devices record the care given.
Hotels are used to quarantine suspected Covid patients, with telemonitoring.
As in America, the Covid epidemic has exposed the excesses of unneeded “elective” surgery, most notoriously surgery for back pain.
We can learn a lot by studying the health care of other countries.
Direct-to-consumer (or on-demand) telemedicine, a 21st-century approach to forward triage that allows patients to be efficiently screened, is both patient-centered and conducive to self-quarantine, and it protects patients, clinicians, and the community from exposure.
It can allow physicians and patients to communicate 24/7, using smartphones or webcam-enabled computers. Respiratory symptoms — which may be early signs of Covid-19 — are among the conditions most commonly evaluated with this approach.
Health care providers can easily obtain detailed travel and exposure histories. Automated screening algorithms can be built into the intake process, and local epidemiologic information can be used to standardize screening and practice patterns across providers.
Disasters and pandemics pose unique challenges to health care delivery. Though telehealth will not solve them all, it’s well suited for scenarios in which infrastructure remains intact and clinicians are available to see patients. Payment and regulatory structures, state licensing, credentialing across hospitals, and program implementation all take time to work through, but health systems that have already invested in telemedicine are well positioned to ensure that patients with Covid-19 receive the care they need. In this instance, it may be a virtually perfect solution.
From a ComputerWorld article (April 27, 2020):
“While the pandemic will prove the value of virtual care in a crisis, it will also demonstrate the effectiveness for ongoing chronic care management,” she said. “This moment will have a lasting effect on the adoption of virtual care and accelerate the shift from in-person care to virtual first engagement for multiple conditions and use cases.”
While the need for remote care will not be as acute once the pandemic crisis subsides, demand for telehealth systems will likely remain high. Forrester now expects more than one billion virtual care visits this year, the vast majority of them related to COVID-19.
“…After the crisis subsides, there will be a patient population that will want to continue to receive care online for some things, like managing chronic conditions, follow-up visits after an inpatient stay, surgery or to discuss diagnostic results,” she said.
In this case, it will be important for healthcare providers to ensure that patients are aware of the availability of services.
Wondering how to get started with telehealth? Check out the information below to better understand your options.
If screening tools and self-checkers do not lead you to the care or information you are seeking, you can reach out directly to your doctor or health insurance company for options that can help connect you to a provider online. Understanding telehealth
Find out what it is, what to expect during a visit, and what kinds of care may be available. Telehealth during the COVID-19 emergency
Whether you’re looking for health care related to COVID-19 or something else, find out more about how to prepare for the visit. Preparing for a video visit