Dr. Kimberly Scott
Decades ago, the mere thought of receiving care, medical advice, or a diagnosis over a webcam and microphone was viewed as something from the Twilight Zone. Today, as the healthcare system tries to continue to serve patients, telehealth and telemedicine has become an integral component of doctor-patient interactions. The personal connections that we have through doctor-patient interactions can still be achieved through the advances in technology using telehealth and telemedicine. The waiting room in the doctor’s office and the exam rooms have been replaced with great backdrops, which could be a crisp blue or green screen sitting in a closet.
A few burning questions are, how did we get to this point? Is “telehealth” the new face of healthcare from afar? What about the clinical aspect of care, and what does treatment look like for those patients who are unfamiliar with technology, lack technological skills, or most of all, lack access to insurance to receive the necessary “remote” care? Ready or not, this is the new way to deliver virtual healthcare during a time where many people have self-quarantined, under a curfew, or are quarantined.
Telehealth & Telemedicine
Telehealth and telemedicine consist of technology and healthcare information via computers, laptops, phones, iPads, among other electronic devices. This digital format allows information to be accessed remotely. The Center for Medicare and Medicaid Services (CMS) defines telemedicine as a “two-way real-time interactive communication between the patient and the physician or practitioner at distant site.” (2020). Among the reasons to seek a healthcare provider today (i.e., convenience, disability, age, flexibility, etc.), COVID-19 is one of the best motivators that comes to mind. The moniker “social distancing” has been a prevalent term used the passed few months; however, what we are actually practicing is social consciousness. Socially conscious means we are aware and understand that we are linked to each other and that we need to take care of each other. Literally, we are in this together.
The need to limit contact and observe social distances is key for both the patient and the observer. With shortages of necessary supplies (i.e., face masks, gowns, hand sanitizer, etc.) and the increase in cases, maintaining social distancing is crucial. As a result, healthcare and technology has bridged the gap, now allowing doctor-patient interactions to continue at a distance. This interaction will become part of the new norm in healthcare whether it is synchronous “live visit” or asynchronous (i.e., assessment off-line, email, recorded visit).
With the introduction of telehealth and telemedicine into the standard practices of modern-day medicine we are now able to access services that were once hard to obtain. However, there are still a few nuances that must be considered in addition to accessibility, insurance, and technology. These include accountability, confidentiality and privacy in telemedicine, and ethics and telehealth. These nuances are no different from a face to face visit but must be carefully observed during all encounters.
According to the American Medical Association (AMA), “Although physicians’ fundamental ethical responsibility does not change, the continuum of possible patient-physician interactions in telehealth/telemedicine give rise to differing levels of accountability for physicians.” (n.d.) This means upholding fiduciary obligations, mitigating conflict of interest, sharing objective information, and preventing unauthorized access to patient information.
As the crisis continues, Datoc (2020) reported on the expansion of Medicare telehealth programs in the United States which is supported by the United States President. In conjunction, the President also participated in an interactive veteran’s affair telehealth event, which gave him the first-hand knowledge of the importance of the telehealth expansion. This support could not have come at a better time. Many states have been tapped to cover the programs with the Health Insurance Portability and Accountability Act (HIPAA) being waived to deliver care under the circumstances accurately. This expansion allows Medicare recipients to receive care in several venues, such as clinics, hospitals, and nursing homes.
Future of Telehealth
In the future, what would telehealth/telemedicine look like? Will providers and patients get so good at telehealth that it begins to replace walking into the office? Will that turn into a “virtual” walk in the office, with artificial intelligence (AI) checking in patients? What would this look like for students in medical school? Would part of the curriculum entail “internet etiquette,” telemedicine 101, or perhaps an introduction to telehealth technology? These questions are not unusual since the AMA has reported that telehealth is up 53%, growing faster than any other component of healthcare. Lastly, is telehealth/telemedicine here to stay, or is it all a hype during COVID-19 pandemic?
American Medical Association: How telehealth is the Netflix of medicine – and why it matters https://www.ama-assn.org/about/leadership/how-telehealth-netflix-medicine-and-why-it-matters
American Medical Association: How Permanente uses telehealth during the COVID-19 pandemic https://www.ama-assn.org/practice-management/digital/telehealth-booming-who-are-power-users
American Medical Association: Key changes made to telehealth guidelines to boost COVID-19 care https://www.ama-assn.org/delivering-care/public-health/key-changes-made-telehealth-guidelines-boost-covid-19-care
Healthcare IT News: Caregility unveils mobile telehealth app, gives it away to fight pandemic https://www.healthcareitnews.com/news/caregility-unveils-mobile-telehealth-app-gives-it-away-fight-pandemic
Healthcare IT News: OCR will ease restrictions on telehealth tech during COVID-19 https://www.healthcareitnews.com/news/ocr-will-ease-restrictions-telehealth-tech-during-covid-19
HealthIT.gov: What is telehealth? How is telehealth different from telemedicine? https://www.healthit.gov/faq/what-telehealth-how-telehealth-different-telemedicine
MayoClinic: Telehealth: Technology meets health care https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878
Telehealth doctor visits may be handy, but aren’t cheaper overall (2017) https://www.npr.org/sections/health-shots/2017/03/26/519543337/telehealth-doctor-visits-may-be-handy-but-arent-cheaper-overall
Wall Street Journal: What you need to know about telehealth during the coronavirus crisis https://www.wsj.com/articles/what-you-need-to-know-about-telehealth-during-the-coronavirus-crisis-11584874801