The overnight change in health care delivery  
 

Betsy Rudd

PhD Student, College of Nursing

University of Utah 

 

Telehealth

Telehealth has taken on a new prominence in the delivery of primary health care in the United States, largely due to the SARS-CoV-2 virus. While virtual visits have long been an option in some Urgent Care settings, they have never been as popular with consumers as face-to-face visits. So while the market was growing in the direction of increased utilization, it was never a major contender for visit types in most settings and was never employed in the primary care setting.

 What is Telehealth?  

Frequently you might see telehealth and telemedicine used interchangeably. However, to be more accurate, telemedicine is the delivery of care through a technological platform of communication. Telehealth is the broad spectrum of remote care services.

 History

It may surprise you that neither the technology itself, nor the idea of telemedicine, is new. Telemedicine was envisioned as far back as 1925, by Dr. Hugo Gernsback. Dr. Gernsback developed the idea of a “teledactyl,” which was a theoretical device that would have allowed healthcare workers to provide virtual care to their patients. While at that time the technology did not exist, the initial concept has remained the same. In the 1950s, the first version of telemedicine took form via telephone consultations and transmitted images. Later in the 1960s, the United States government began to heavily invest in telemedicine through the Public Health Department, NASA, Department of Defense and Health and Human Sciences Department. Originally, the U.S. primarily used this as a method to address health care shortages – most frequently found in remote and rural setting. Additionally telemedicine found itself utilized for niche medical specialties such as radiology. 

Pros and Cons

One of the long touted benefits of telemedicine is the potential ease and convenience to patients. Ideally, this method cuts down on health care costs and expands access of care to a larger, previously underserved population. However, the technology to provide this care must be in place. Patients may not have access smart phones, computers, or internet. Additionally further training and equipment is needed to conduct these visits on the clinical side. While conducting a telemedicine visit, there is extremely limited capabilities of conducting a physical exam. And from an administrators perspective, navigating the complex policy and insurance reimbursements can feel like traversing a minefield.

 COVID-19 pandemic

However, these traditional risks and benefits dramatically changed overnight when the new threat of the SARS-CoV-2 virus came to the U.S. in early 2020. Now the main calculation of telemedicine became the risk of exposure. This catapulted telemedicine to the forefront of all primary care visits. Starting about March 6^th and spanning at least two months, nationwide patients were generally not allowed into the clinical buildings unless deemed absolutely necessary. To many clinicians unfamiliar with this method of care, telemedicine worked surprising well for a variety of visits previous thought unsuitable due to the limited nature of physical exams. However, simultaneously, may preventative visits best suited to telemedicine dropped off. Patients dealing with an onslaught of uncertainty prioritized their concerns, and preventive care did not make the top of their lists. Gradually, at the quarantines lifted, more patient began to flow back into the offices either in person or via telemedicine. Yet, it is still to soon to know what the far-reaching implications of this dramatic paradigm shift will be for the U.S. and for the primary care setting.    

 March 6^th 2020

However, this March 6^th date mentioned above will be an important in the history of telemedicine. This is the day that Medicare began paying for telehealth services without many the old restrictions that had served as barriers to care. This opened the door for the use of telemedicine in primary care nationwide, and exposed a whole generation of health care workers to a method of providing care never utilized by them before. Thusly, it proved that telemedicine can work effectively in a wider range of applications, such as in the primary care setting, than previously envisioned.

What’s next for telehealth?

It’s hard to say what will come next when the COVID-19 pandemic recedes, but it’s hard to imagine that telemedicine is going anywhere. There is good evidence that even without the current pandemic, the utilization of telemedicine would have continued to grow. Likely, the current events served to accelerate this platform of healthcare services. As the case rates continues to ebb and flow, telemedicine will likely continue to receive utilization in the primary care settings. Yet, at some point, Medicare will return to its written policy and cease to waive certain restrictions on services. This means pre-COVID barrier to insurance will resume. Now is the time as innovators to effect change on the policy to make telehealth permanently accessible to patients and health care providers. Research must be done on what new barriers or incentives to telemedicine exist post-COVID -- among both patients and health care workers. Does this technology improve or diminish satisfaction in primary care? Does it meet all the objectives of the IHI Triple Aim? While the technology is not new, the context of its use is new. To make the appropriate common sense changes to policy, we must fully understand the landscape from all angles. These question and many more should form the topics for new research into telehealth.    

References

Centers for Medicare & Medicaid Services. (2020). General Provider Telehealth and Telemedicine Tool

Kit. Retrieved June 16, 2020 from https://www.cms.gov/files/document/general-telemedicine-toolkit.pdf

 

eVisiit. (2020). What is telemedicine? Retrieved March 23, 2020 from

https://evisit.com/resources/what-is-telemedicine/

 

Institute for Healthcare Improvement. (2020). Triple Aim – the best care for the whole population at the

lowest cost. Retrieved June 12, 2020 from http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx

 

Lee, J. (2019). Telemedicine 101: history and evolution.

https://research.g2.com/insights/telemedicine#:~:text=Evolution%20of%20telemedicine,from%20one%20location%20to%20another.