Telehealth During and After Covid-19




Rise in Telehealth during Covid 19

In the last year and a half, state-mandated travel and operating capacity restrictions have caused a need for remote consultations in the medical field, which has led to an exponential growth in the use of telehealth channels and services during the Covid-19 pandemic. According to a report by FAIR Health, “Compared to one year ago, October usage of telehealth increased by 3,060%, comprising 5.61% of all ‘claim lines’ processed by the payers the organization tracks, compared to 0.18% the previous October.”[12] This trend can also be observed in health center capabilities. Reports of the Health Center Program Data indicated an increase from 43% of health centers capable of providing telemedicine in 2019 to 95% in 2020.

The rise of telehealth can be observed in both in-patient and out-patient settings. Most remote consultations appear to be related to behavioral health and chronic illness.[13] One study found that mental health conditions made up 51.81% of all telehealth consultations in 2020.[12] On one hand, this trend can be explained by the fact that physical medicine just started using telehealth as a primary tool for doctor-patient consultation, whereas mental health consultations were more accessible via telehealth channels even before the pandemic. On the other hand, it can be explained by the spike in mental health conditions during the pandemic. What is Telehealth?

“Telehealth [or telemedicine] is defined as the delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies.”[1] Various channels of digital communication include:

  • Mobile health apps that store and send data to healthcare professionals;

  • Video tools, such as Zoom calls;

  • Audio technologies such as phone calls; and

  • Remote patient monitoring tools such as wearables and Bluetooth-enabled devices (e.g., scales, glucose meters, and skin patches).[2]

Most of these channels are now easily accessible to the majority of the public through smartphones, computers, tablets, and smart watches. The process of telehealth typically includes data collection, transmission and evaluation, and may or may not lead to an intervention by the HCP.

Telehealth services range from simple data transfer from one hospital to another, to patient education platforms (such as WebMD.com), and remote consultations between patient and physician.

Benefits of Telehealth

One of the most prominent benefits of telehealth is the convenience and increased accessibility to the patient.[3] Telehealth saves time and money for patients because they no longer need to arrange for transportation to and from appointments, find childcare, take time off from work, pay for parking, etc. This is particularly advantageous for some elderly and disabled patients as telehealth eliminates the need to arrange for someone to accompany them to their appointments. Remote sessions also have the potential to reduce wait times and ease the crowding of ERs and outpatient clinics.[4]

Patient experiences and satisfaction also increase through telehealth. One study found that 87% of patients would use a telehealth platform again.[5] Other studies confirm that patient satisfaction with telehealth is high.[6,7] One of those studies finds that one-third of participants preferred telehealth visits over traditional in-person visits. That said, from a provider standpoint, most clinicians agree that in-person visits often provide a higher quality of care to the patients.

Telehealth offers additional benefits to the health care providers. Clinicians now have the unique opportunity to extend their client base beyond their physical location.[8,9] Additionally, telehealth can relieve the educational burden of the physician by having patients explore online health education materials. However, with online health education materials comes the opportunity for misinformation. Future efforts will need to focus on ensuring that patients are getting accurate and appropriate information online.

Drawbacks of Telehealth

With technological advancements always come drawbacks that need to be addressed. One initial drawback of telehealth is that healthcare providers now must restructure their current workflows to integrate telehealth as a service. Covid-19 has forced many providers to jumpstart that process, but it will take time and effort to produce reliable infrastructure and best practices. However, there is evidence that telehealth services can decrease patient visit times and thereby increasing practice efficiency.[9]


Another drawback that applies to most connected technologies is cyber security. For telemedicine to exist, highly sensitive medical data needs to be transferred from one location to the next securely. The Harvard Medical School recently published a letter discussing privacy and information security concerns in the medical industry.10, 11 The authors write in response to Covid-19, “the Department of Health and Human Services recently lifted several restrictions on communication apps”, leading to an increased risk for cyber-attacks, especially on fast growing services such as Zoom.10 Data-encryption, regular software updates and following cyber-security best practices are some of the best safeguard practices to prevent against attacks and data breaches. Additionally, telehealth puts a high broadband demand on our digital infrastructure. Broadband requirements will need to be scaled up to deal with those increased demands and allow for reliable connections.[15]

As discussed previously, telehealth makes quality care more accessible to many, however, individuals with poor or no internet connection and people who struggle with modern technology, won’t be able to take advantage of those benefits. Future advancements in telehealth will need to address the needs of these populations.

The Future of Telehealth

Regardless of the potential decrease of telehealth “after” Covid-19, telehealth is widely expected to stay for the long-term.[16] Permanent coverage of telehealth by Medicare [17,18] as well as state-enacted parity laws to cover telehealth services the same way face-to-face visits are covered1 imply a willingness to continue towards a more widely accessible healthcare infrastructure. Even so, one poll showed that healthcare providers are still on the fence about the future of telehealth, with 31% expecting an increase, 35% expecting a decrease, and 34% expecting to see no change in the utilization of telehealth.[19]

The pandemic has resulted in a major shift from traditional in-person visits to remote consultations in the medical industry, which in turn have spurred changes in reimbursement and provider readiness. Now is the time to address the benefits and drawbacks of telehealth and determine the most equitable path forward.




Sources:

1 https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0268

2 https://welkinhealth.com/remote-patient-monitoring-devices/

3 https://chimecentral.org/klas-chime-study-healthcare-telehealth-concerns/

4 https://pubmed.ncbi.nlm.nih.gov/28446045/

5 https://www.ortholive.com/blog/patient-experience-ortholive-telehealth-application/

6 https://www.jmir.org/2020/9/e20786/

7 https://pubmed.ncbi.nlm.nih.gov/26269131/

8 https://mhealthintelligence.com/features/the-benefits-and-challenges-of-telehealth-for-specialists

9 https://www.ortholive.com/blog/top-10-benefits-of-telehealth-for-patients-and-doctors/

10 https://academic.oup.com/jamia/article/28/3/671/6039104

11 https://www.healthcareitnews.com/news/telehealth-poses-big-cybersecurity-dangers-harvard-researchers-warn

12 https://www.healthleadersmedia.com/innovation/telehealth-usage-rises-increase-covid-19-cases

13 https://www.usnews.com/news/health-news/articles/2021-01-05/health-care-after-covid-the-rise-of-telemedicine

14 https://www.cdc.gov/mmwr/volumes/70/wr/mm7007a3.htm#:~:text=According%20to%202019%20Health% 20Center,2020%20(4%2C5)

15 https://www.broadbandgroup.com/nevada-broadband-telemedicine-initiative/

16 https://www.usnews.com/news/health-news/articles/2021-01-05/health-care-after-covid-the-rise-of-telemedicine

17 https://newdemocratcoalition.house.gov/imo/media/doc/21APR21_NDC%20HC%20Priorities%20Letter%20vF.pdf

18 https://www.congress.gov/bill/117th-congress/house-bill/366

19 https://www.mgma.com/data/data-stories/is-the-telehealth-boom-set-to-continue-in-2021-co

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