When discussing telehealth, one first needs to refer to definitions. The Health Resources Services Administration defines telehealth as “The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.” It is differentiated from telemedicine which is focused on remote clinical services. Telehealth today is most commonly associated with video conferencing between a provider and patient. However healthcare encompasses more than the encounter and includes support processes and tools which will hopefully contribute to better outcomes. Electronic health records and interoperability of examination tools with video technology now permit a virtual exam similar to an in-person one. There are now well-defined clinical practice guidelines for telehealth by the American Telehealth Association. I will discuss ways in which telehealth will provide benefits to both patients and providers.
- Telehealth will place the patient as the focal point of care. It is all too apparent that the patient encounter is not what it used to be. Regardless of its duration, there are measures the provider can take to improve the quality of the encounter. Physicians are frustrated by spending more time with the computer than with patients. Nurses too are frustrated with the decrease in direct patient care due to increased time spent with computers. Telehealth video conferencing technology puts emphasis on the literal face to face encounter. It therefore by default puts the patient as the focal point of the encounter. A provider would likely feel more self-conscious looking at a computer and not the patient on the screen in this setting. This technology places the provider outside of his normal comfort zone of the exam room. A telehealth visit has patients more comfortable in their own environment with the provider as a (virtual) guest.
- Telehealth will close gaps in care. Coverage for telehealth varies by state in the USA. Medicare coverage for these services are limited to geographical regions defined by the HHS “…when the originating site (where the patient is) is in a Health Professional Shortage Area (HPSA) or in a county that is outside of any Metropolitan Statistical Area (MSA), defined by HRSA and the Census Bureau, respectively.” While one can understand the utility of closing care access gaps, the gaps themselves have widened over time to include larger and more urban populations. Shortages of certain specialties, most notably mental health are now glaring. In addition, the time and financial costs incurred by the patient and caregiver of an office visit can be markedly decreased with telehealth.
- Telehealth will reintroduce humanism back into medicine. I believe that telehealth will demand improvements of providers’ interpersonal skills. The ease of use I believe will likely increase the number of provider interactions, supplemented with data transmitted via other technologies(see below). Telehealth will be expanded to include providers other than physicians as a natural extension of existing care team models. Telehealth will eliminate the ‘routine office visit’ which provides an often useless and uninformative snapshot of clinical time. The encounter will therefore be more need-driven and by extension meaningful. The availability of caregivers to participate in a telehealth encounter will be greater (perhaps even via technology allowing triangulation). There are even capabilities of telehealth visits transmitted from the primary care office room to a specialist. Convenience, less provider distraction, and a more relaxed patient in a familiar environment all support a more humanistic ‘meeting.’
- Telehealth will accelerate the use of mobile health technologies. Though one’s first thought of telehealth brings back a vision of a console television from the 1960’s, we are already at a point where telehealth is mobile. A pioneer in this arena is 3GDoctor. Established companies like Verizon have entered the virtual mobile health visit space. Telehealth has been around for about 40 years. Regulators and payers are revisiting telehealth and familiarizing themselves with all mobile health technologies in their efforts to implement tools which can ease pain points in healthcare delivery. The association of mobile health tools with telehealth, the ‘mobilization’ of telehealth itself, and the present adoption of telehealth by healthcare enterprises on a widespread scale will all accelerate the implementation of mobile health strategies. Telehealth adoption is being driven by shortages of specialists in the fields of mental health, neurology, intensive care, and dermatology. Payers are expanding coverage and providers are getting acclimated to remote-based technologies. There is more interoperability with digital IT with telehealth relative to mobile technologies. Mobile health technologies will benefit as a result of all of these factors.
- Telehealth will increase practice options for providers. From a provider standpoint, telehealth might usher in a new type of practitioner. Physicians and other providers might be required to achieve added qualifications in telemedicine. Those drawn to the combination of technology and ‘direct’ patient care might be drawn to telemedicine. Providers will care for patients virtually in different geographical areas, potentially leading to a more enriching professional experience.
I look forward to telehealth becoming a more significant part of mainstream healthcare and to the trails it is blazing for mobile health in general. Ideally I would envision the ATA working with HIMSS to further the cause of the highest quality of care that all digital technologies may provide. From a clinical standpoint they will all be used in a complimentary fashion. For further reading, I would recommend a review by the Information and Technology and Innovation Foundation.