Telehealth is the offering of health-related services and information via electronic information and telecommunication infrastructure. It allows sharing of electronic data (e.g. test results, clinical notes), long-distance patient and clinician contact, care and care direction, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. Telehealth could also include two practitioners discussing a case over video conference; remote access robotic surgery; remote physical therapy, home monitoring through continuous sending of patient health data; or a videophone interpretation during a consult. Telehealth is primarily used in virtual regular or urgent care for non-emergencies and non-invasive settings.
Covid-19 has accelerated the adoption of Telehealth. The pandemic has forced the healthcare industry to adapt and innovate and continue to treat people while reducing personnel exposure to potentially ill patients, saving PPE, and curtailing patient surges at provider facilities. Telehealth services have removed many accessibility barriers for necessary patient care while minimizing Covid-19 transmission risks to other patients and personnel. While the use of Telehealth skyrocketed in the early days of the pandemic, the demand is somewhat reduced as of this writing. However, the widespread adoption of Telehealth is likely to increase. And there are technology companies offering Telehealth services.
What would be some of the considerations to investigate before starting on this journey? Here are a few.
- What medical telehealth service/s will be offered? For example, will it be in Internal Medicine, Clinical Departments, Cardiology, etc.? The requirements for these segments will be unique to each and the teleservice infrastructure has to be developed appropriately.
- Under what settings will the service be offered? For example, will it be used for remote guidance or service (such as chart monitoring, arranging transport) to doctors and nurses administering care to a Covid patient? Or can it be in Teletrauma care? Or as evident during Covid-19, where some facilities were using telehealth as a “forward triage” center, allowing doctors to pre-screen patients with Covid-19 symptoms, with only the sickest ones being moved to ER. Each setting is unique in its requirement and must be thoroughly understood for workflow.
- How will impact the business? There is a concern among Hospitals and Physicians that a reduction in off-site procedures will reduce reimbursements and virtual doctor’s visits can take longer that in-person ones. Teledoctors could spend more time with fewer patients for less money. This is not an appeal for Telehealth. Thus, a rigorous business case has to be completed to determine the financials.
- What is the broadband infrastructure? In many remote areas, broadband and wireless is either limited on unavailable. Conducting data intensive Telehealth consults will not be successful without acceptable wireline and wireless data transmission rates. Even telephone consults can be problematic if the physician has difficulty accessing the patients medical records.
- What devices are to be supported for the services? For example, if home health monitoring service is offered, devices such as, blood pressure monitors, pace makers, etc., have to connected to the network. The infrastructure for supporting these devices have to be available.
- What data exchange protocols are necessary? This is important when there are multi-facilities with different EMR/EHR systems with practitioners and patients. For patient data to be available for remote consults and care, a seamless interface is preferable without having to navigate between different systems. The more the number of configurations the more the bandwidth consumption and potential transmission tardiness.
- What payer payment structures are needed? Prior to Covid-19, the payment structure dis-incentivized engaging with telehealth services and there was no interstate payment parity related to telehealth, Medicare coverage was extremely restrictive. However, payers have adapted their reimbursement structures for payment parity, and Medicaid programs have removed their limitations around originating sites, geography, practitioner eligibility and services. Strict in-state physician licensing requirements are also an inhibitor to Telehealth.
- What are liability concerns for Telehealth practices? It is entirely possible to mis-diagnose conditions remotely as opposed to in-person treatment. This should be comprehensively investigated prior to offering a service.
While Telehealth is appealing and better than no diagnosis, wider public acceptance and success will require a detailed approach for the factors, and more of them, outlined above.