The arrival of Covid-19 meant health systems around the world had to adapt rapidly. But the pandemic had a particular impact on the way patients receive care from their doctors in the United States. Modern technology now makes it possible for individuals to be seen by a healthcare professional without them having to be in the same room. This is known as telemedicine or telehealth.
During the crisis, US officials have opened up access to these remote health services. More people than ever before are speaking to their doctor using video conferencing technology using their home broadband connection.
“Telemedicine offers patients better access to care, improved health outcomes and increased patient empowerment,” says director of thematic analysis at GlobalData, Kathryn Whitney. “For healthcare professionals, it allows high-risk patients to be monitored and treated more easily, as well as improving efficiency and work-life balance.”
For years, analysts have highlighted the potential benefits of using telehealth for the management of chronic health conditions, such as diabetes, asthma and heart disease. But until recently, access to telehealth services was patchy at best in the US.
Even though telehealth had the support of many healthcare providers before the current coronavirus pandemic, there were reasons it wasn’t adopted widely across the country. Most states required insurers to cover remote services but didn’t stipulate payment parity. This meant the reimbursement for a telehealth visit might be less than half the physical equivalent. Doctors just didn’t have an incentive to offer remote services to their patients, so many didn’t bother.
“Prior to Covid, most people were walking into the office of a doctor for their care,” explains, director of the Center for Technology Innovation at the Brookings Institution, Dr Nicol Turner Lee. “Telehealth, though it was provisioned within the Affordable Care Act for use, just wasn’t widely adopted or marketed by doctors as a potential option.”
Privacy was another concern. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), some doctors struggled to find telehealth service providers willing to partner with them because of harsh penalties that could be imposed in the case of unintentional security or privacy violation.
When Covid-19 hit, everything changed. The pandemic placed a huge stress on medical systems. Suddenly the ability to offer screening questions and remote consultations was important to determine if a patient needed face to face treatment. By diverting non-urgent cases from hospitals, resources were freed up for those with the most critical need. Patients at higher risk of serious illness from the coronavirus such as elderly patients could still get advice from a doctor without having to enter a healthcare facility. And those that did need to be seen face to face encountered fewer patients in the waiting room, lowering the risk of infection when entering a healthcare setting.
“The question became: how can you deliver healthcare in a way that mitigates the risk while at the same time providing quality care?” says Turner Lee. “And so we turned to technology that for decades was not necessarily approved by the medical community or the insurance community but was suddenly embraced by both.”
The pandemic response
As part of the coronavirus response, many health insurers waived out-of-pocket costs for telehealth services, which enabled more patients to access care this way. At the same time, the federal government and several states enacted emergency laws to raise reimbursements rates for healthcare providers offering remote services.
Additionally, the Office for Civil Rights (OCR) at the Department of Health and Human Services stated it would not impose sanctions for HIPAA violations. Doctors could now use channels that were previously discouraged to meet with their patients, such as FaceTime and Skype, making telehealth services accessible to anyone with a device that could connect to the internet.
“We are empowering medical providers to serve patients wherever they are during this national public health emergency,” OCR director Roger Severino said in a statement. “We are especially concerned about reaching those most at risk, including older persons and persons with disabilities.”
The whole country essentially engaged in a national pilot of telehealth services. And soon, healthcare leaders began to see the benefits of the move.
“It allowed individuals to get real-time service,” says Turner Lee. “It reduced the likelihood that someone could be infected by going into care centres, but I think it also alleviated some of the stress from doctors because now they could ease some of the load of in-person visiting.”
There are plenty of case studies that back up the benefits of telehealth. In 2016, Frederick Memorial Hospital in Maryland trialled a remote patient monitoring platform for people with chronic conditions. Patients were given a tablet and Bluetooth health devices that collect biometric data so doctors could regularly monitor them and communicate in real-time. The hospital saw emergency room visits drop by half for patients using the platforms. While re-hospitalisations reduced by 89% over a 30-day period.
The new normal?
Of course, telemedicine has some limitations. Unless the patient has the right equipment, a doctor can’t get their vitals in real time. But for most medical queries, a virtual appointment is certainly better than no appointment at all. It can also be a useful triage system to determine who really does need to be seen face to face.
“The great thing about telehealth and its use during the pandemic is that it actually became a really good proof of concept that it was possible,” says Turner Lee. “The actualisation of the medium during the pandemic was really promising in that we can move towards this ecosystem without sacrificing health care quality.”
Telehealth may even help to close gaps in health care coverage, she says. At the moment, there aren’t enough providers that exist in some of the most vulnerable communities. Using a smartphone or other internet device could help tackle healthcare disparities in the US which arise due to proximity to healthcare facilities.
“I’m pretty optimistic that if we were to keep this, we would see a better return on the healthcare system,” she says. “Especially in resolving some of the deficiencies in healthcare that we see with medically-marginalised populations.”
But the advantages of widespread telehealth adoption have left a number of questions, including what happens in a post-Covid world? Will telehealth become a more important aspect of healthcare – and will it be able to continue without the previous state and federal law restrictions? And what impact will the looming November election have on this issue?
Right now, all those points are uncertain. But maintaining access to remote care could be particularly important in the short term. Until the threat of Covid-19 completely disappears, social distancing will likely have to continue. Health queries that can be addressed without seeing a provider face to face will still have value. And long term, as patients and doctors get more used to the technology, more benefits of telehealth may emerge.
“It’s better to have telehealth as a best practice that can potentially be instituted into the delivery of healthcare versus something that we did as a band-aid to solve an immediate problem,” concludes Turner Lee.