Telehealth Providers of the Future

Telemedicine refers to the delivery of medical care and provision of general health services from a distance. Telemedicine has been practiced for decades with increasing evidence proving its potential for enhanced quality of care for patients, reduction in hospital readmissions, and increase in savings for both patients and providers. The COVID-19 pandemic has resulted in a significant increase in the reliance on telemedicine and telehealth for provision of health care services. Developments in telemedicine should be structured as complements to current health care procedures, not with the goal of completely digitizing the entire health care system, but rather to use the power of technology to enhance areas that may not be working at their full potential. At the same time, it is also clear that further research is needed on the effectiveness of telemedicine in terms of both financial and patient benefits. We discuss the current and rapidly increasing knowledge about the use of telemedicine in the United States, and identify the gaps in knowledge and opportunities for further research. Beginning with telemedicine’s origins in the United States to its widespread use during the COVID-19 pandemic, we highlight recent developments in legislation, accessibility, and acceptance of telemedicine.

It is every parent's or caregivers' worst nightmare to hear the classic barking cough of croup in the middle of the night. The unmistakable sound is at once disconcerting but also a symptom that helps identify a potential cause and treatment plan. Nesbitt and Katz-Bell1 describe a concerned mother having a physician listen to her croupy baby using “new” telephone technology, as published in the Lancet in 1879. It is one of the earliest documented telephonic health care encounters and one that begins a long history of the slow adoption and evolution of telehealth services. The coronavirus disease 2019 (COVID-19) pandemic has thrust telehealth into the spotlight as it serves as a critical means of maintaining patient contact and supporting the financial survival of some health care facilities. Perianesthesia practice is primarily one of proximity rather than distance. However, owing to many health care facilities halting surgical procedures during the pandemic, perianesthesia nurses have had to display their remarkable flexibility and versatility.2 Telehealth has not traditionally been a major part of perianesthesia practice, but the pandemic has forced many specialties to think creatively as to how telehealth might preserve continuity of care and potentially expand the scope of practice.

Coronavirus disease 2019 (COVID-19) spurred a rapid rise in telemedicine, but it is unclear how use has varied by clinical and patient factors during the pandemic. We examined the variation in total outpatient visits and telemedicine use across patient demographics, specialties, and conditions in a database of 16.7 million commercially insured and Medicare Advantage enrollees from January to June 2020. During the pandemic, 30.1 percent of all visits were provided via telemedicine, and the weekly number of visits increased twenty-three-fold compared with the prepandemic period. Telemedicine use was lower in communities with higher rates of poverty (31.9 percent versus 27.9 percent for the lowest and highest quartiles of poverty rate, respectively). Across specialties, the use of any telemedicine during the pandemic ranged from 68 percent of endocrinologists to 9 percent of ophthalmologists. Across common conditions, the percentage of visits provided during the pandemic via telemedicine ranged from 53 percent for depression to 3 percent for glaucoma. Higher rates of telemedicine use for common conditions were associated with smaller decreases in total weekly visits during the pandemic.

Digital health, virtual care, telehealth, and telemedicine are all terms often used interchangeably to refer to the practice of care delivered from a distance. Because virtual care collapses the barriers of time and distance, it is ideal for providing care that is patient-centered, lower cost, more convenient and at greater productivity. All these factors make virtual care tools indispensable elements in the COVID19 response. In this perspective, we offer implementation guidance and policy insights relevant to the use of virtual care tools to meet the challenges of the COVID19 pandemic.

Primary care practices rapidly adopted telemedicine visits because of the COVID-19 pandemic, but information on physician perspectives about these visits is lacking. Fifteen semi-structured interviews with practicing primary care physicians and physicians-in-training from a Southern California academic health system and group-model health maintenance organization were conducted to assess physician perspectives regarding the benefits and challenges of telemedicine. Physicians indicated that telemedicine improved patient access to care by providing greater convenience, although some expressed concern that certain groups of vulnerable patients were unable to navigate or did not possess the technology required to participate in telemedicine visits. Physicians noted that telemedicine visits offered more time for patient counseling, opportunities for better medication reconciliations, and the ability to see and evaluate patient home environments and connect with patient families. Challenges existed when visits required a physical examination. Physicians were very concerned about the loss of personal connections and touch, which they believed diminished expected rituals that typically strengthen physician-patient relationships. Physicians also observed that careful consideration to physician workflows may be needed to avoid physician burnout. Physicians reported that telemedicine visits offer new opportunities to improve the quality of patient care but noted changes to their interactions with patients. Many of these changes are positive, but it remains to be seen whether others such as lack of physical examination and loss of physical presence and touch adversely influence provider-patient communication, patient willingness to disclose concerns that may affect their care, and, ultimately, patient health outcomes.

NCTRC is a collaborative of 12 regional and 2 national Telehealth Resource Centers (TRCs), committed to implementing telehealth programs for rural and underserved communities. Funded by the U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA), administered through grant # G22RH30365, TRCs across the nation provide timely and accurate information on telehealth. Our 12 regional and 2 national TRCs are expertly staffed and lead the advancement and accessibility of telehealth with a focus in rural communities, Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs). As a consortium, we are dedicated to helping organizations and practices overcome barriers, advance telehealth education, and provide resources.

Our 12 regional TRCs are regional experts in telehealth implementation. TRCs are equipped to provide technical assistance, education, and resources on various topics. Each TRC has a regional uniqueness, allowing them to provide a wide range of assistance targeting local community needs. The NCTRC is dedicated in playing its part in expanding the reach of healthcare and sustainable telehealth programs in local, rural, and underserved communities for the most vulnerable populations.