Office professions aren’t the only facet of the modern workforce that have benefited from increased interest in using a hybrid approach for conducting business. The healthcare industry, in response to the ongoing pandemic, is moving rapidly in that direction as well.
With the onset of COVID-19, the concept of “telehealth” came to mainstream prominence among hospitals and private practices alike. In the two years since the WHO declared COVID-19 to have reached pandemic levels, telemedicine has become the standard and almost universally accepted way of providing patient care. The advantages it offers the healthcare industry go beyond its initial purpose, which had been to minimize exposure risk for both patients and medical staff.
Telehealth services are cost-effective, and it allows healthcare providers the ability to expand access to specialized care according to medical specialty. Due to telemedicine’s overall accessibility and flexibility for patients, it can exponentially bolster a given healthcare organization’s patient satisfaction while providing a balm to any issues born through physician shortages.
However, telemedicine does not come without its share of drawbacks. Foremost among them is the issue of lack of sufficient technological resources in certain areas of the country that make telehealth services almost impossible for healthcare providers working in those regions. While digitizing medical data has proven to be an immense convenience for HCPs, there are always the problems surrounding the efficacy of security measures regarding patients’ personal information. Lastly, telemedicine provides a distinct challenge when it comes to performing necessary patient examinations.
Despite the leaps telehealth has made in such a comparatively short timeframe, there are still modifications that need to be made before it can be fully implemented into the larger domain of healthcare. By dedicating time and resources to realizing telehealth’s full potential, every specified group within the healthcare system can stand to benefit, with increased preparedness for future pandemics chief among this service’s many assets.
However, it is important to note that “telehealth” and “telemedicine” are not one and the same. “Telehealth” encompasses the entire spectrum of ways in which both information and communication technology are used to provide patients with access to every aspect of healthcare. “Telemedicine” generally refers only to the remote clinical services function of telehealth.
Despite its rapidly growing popularity, telemedicine has yet to be fully or widely integrated into the American healthcare system due to heavy legislative and regulatory restrictions.
Telehealth Before COVID
Even prior to the pandemic, the usage of telehealth has been rapidly increasing in the USA alone. Between 2010 and 2017, the percentage of American hospitals that utilize technology to connect remotely with patients has increased over 40%. The specialties that use telemedicine the most are radiology, psychiatry, and cardiology. On the other hand, the specialists that use it the least tend to be allergists/immunologists, gastroenterologists, and obstetricians/gynecologists.
However, despite the sharp spike in telehealth’s popularity across the country, strict licensure laws prevent further expansion. Each practitioner is beholden to legislature involving coverage, payment, licensing, credentialing, prescribing, medical malpractice, privacy/security, fraud, and abuse–with the laws regarding these many things varying by state. Furthermore, as recently as 2015, electronic consultations were illegal in some places in the US.
Compared to countries such as South Korea, Japan, and those in the European Union, the USA is using telehealth services at a much higher rate. Federal and state governments need to adapt quickly to the growing need for telemedicine, with future legislation maintaining accessibility, availability, accountability, and quality as the foremost priorities when regulating telehealth services.
COVID-19’s Impact on Telemedicine
Amid the COVID-19 pandemic, telemedicine’s primary application has been towards that of a forward triage model, in which patients are screened and sorted prior to in-person consultations, which is crucial in avoiding unnecessary exposure risk and rendering continuing medical care to patients who are self-quarantining.
As a result of telehealth’s newfound and widespread implementation, new methods of medical triage have been developed. For example, automated logic flows, also referred to as bots, can refer moderate- and high-risk patients to specialized triage lines containing on-call nurses that can help them assess their medical needs and determine if an in-person consultation is necessary.
The Centers for Medicare & Medicaid Services has recently adapted telemedicine usage into the federal Medicare program, allowing healthcare services to continue while minimizing the spread of COVID-19. During this time, all Medicare beneficiaries across the USA were able to receive telemedicine care at the same rate as in-person care. Communication with patients via webcam and SMS was possible 24/7 for healthcare providers.
The typical telemedicine appointment includes video calls between patient and practitioner, though they may opt instead for text, email, or mobile app communications instead. As technology advances, so too does telehealth’s capabilities to render remote patient care; increased connection dependability along with improvements in audio and video quality have all contributed positively to telemedicine appointments.
The Need of the Hour
There is one sector within the USA that stands to benefit the most from national implementation of telehealth services: Rural America. While the number of Americans living in rural areas has been declining between 2010 and 2020, there are still roughly 46 million US residents in Rural America, which comprises 14% of the nation’s population, according to the 2021 edition of “Rural America: At a Glance” published by the US Department of Agriculture.
While most rural Americans have health insurance, a large portion feel that they do not have adequate access to healthcare, which can be attributed due to two major factors: inability to afford care and difficulty in accessibility because of either distance or lack of local healthcare providers who accept their insurance. Of the nearly 2,000 rural counties in America, as of the 2020 federal census, 15% are categorized as being in “persistent poverty”. When compared to the “persistent poverty” percentage of metropolitan counties, which is only about 4%, there is a significantly higher number of impoverished Americans in Rural America.
Most rural adults own smartphones and have consistent internet access. By implementing telemedicine practices in these areas, healthcare providers can both increase patient education and facilitate continued good health via remote management of chronic conditions. Significant barriers to the implementation of telehealth services in rural America include Medicare/Medicaid’s limited insurance coverage for telehealth, issues with licensure regarding physicians’ legal ability to provide care across state lines, and lack of technological advancements and remote patient monitoring (RPM) devices in rural areas compared to urban ones.
Telemedicine may enhance provider productivity and open new revenue streams, which can benefit healthcare professionals who spend time traveling between several medical facilities to provide care. Furthermore, telemedicine can significantly decrease the rural patient’s need to travel by allowing them to conduct routine checkups and consultations remotely.
Complications & Obstacles
A major disadvantage with any evolving technology is the initial lack of consumer awareness. Many patients do not have sufficient knowledge regarding their access to telemedicine, the services it can offer them, or its cost. On the patient side, common barriers to telehealth implementation involve age, formal education level, computer literacy, access to sufficient bandwidth through internet service providers, and lack of accessibility to information regarding their own healthcare as it relates to telemedicine.
For healthcare providers, telehealth barriers include cost (especially in regards to attaining multiple licenses to provide remote care across states), reimbursement for remote services through health insurance agencies, legal liability, patient privacy/confidentiality, security of patient data, access to modern equipment, efficacy, and efficiency. Patients and providers may use third-party websites or applications to share health data, including diagnoses and examination results. This presents an issue regarding security of patient data that is not necessarily within the healthcare provider’s control, which can make telemedicine particularly susceptible to data leaks and cybercriminal activity.
Finally, performing a remote physical examination is its own unique challenge because of the lack of physical interaction between patient and practitioner. This alone will render telemedicine ineffective for certain medical specialties. For example, cardiopulmonary examinations, that depend mainly on auscultation and abdominal examinations requiring palpation observation, will be difficult to conduct through telemedicine. However, new technology, such as electronic stethoscopes and smartphone applications that help patients measure their palpation, is emerging to address these obstacles.
On the other hand, specialties that depend on visual, physical examinations (dermatology) or verbal communication (psychiatry) may be relatively spared from this drawback thanks to increased access to quality cameras and voice chat functions.
Over the past several decades, we have been hit with numerous epidemics, such as West African Ebola, Swansea measles, Zika, and Kivu Ebola. With the H1N1 pandemic in 2009 and now the novel COVID-19 pandemic, it is likely that more unfamiliar diseases and viruses will arise in the future.
Before COVID-19, issues with regulation and reimbursement prevented telemedicine from being fully immersed in the American healthcare domain. Yet, as the ongoing pandemic has proven, these services are essential, especially in times of international medical crises; telehealth allows HCPs to continue providing high-quality healthcare while maintaining physical distance and preventing further spread of the virus.
Through continued research into ways to adapt telemedicine for various physical examinations, telehealth can be perfected for widespread use and contribute to a higher level of preparedness for future pandemics.