Healthcare professionals, adjusting to the coronavirus pandemic, have turned to telemedicine to get the job done. Orthopedic surgeons, unable to check in with patients in person, use telemedicine to assess how patients are healing. Meanwhile, pediatricians split their days in half between “well child” video checkups and in-person immunizations. Prior to the pandemic, the adoption rate of telehealth by consumers and healthcare professionals was “pretty low,” according to Ann Mond Johnson, the CEO of the nonprofit American Telemedicine Association. Now, rates have “skyrocketed,” as the future of telemedicine is here now.
“…Physicians realize that in many instances, they could take care of the situation without actually laying hands on people. We have a bias of physicality in healthcare and what they found was that that was not necessary,” Johnson told Nautilus.
Amid the disruption and chaos caused by the COVID-19 pandemic, friends and families have flocked to video calling to stay in touch. In a similar vein, hospitals, private practices, and other healthcare facilities have surged in adopting telemedicine, a technology that helps doctors connect with and monitor patients remotely. Across the country, hospitals have set up entire telemedicine systems. It was spurred by global catastrophe, but telemedicine is also a potential silver lining for the future of healthcare accessibility.
Originally intended to treat patients in rural, remote areas or in areas where there’s a shortage of doctors and other healthcare workers, remote healthcare has found increased necessity during the pandemic. With telemedicine, patients can reach their doctor by phone or video call, describe their symptoms, receive their diagnosis, get a prescription ordered, or follow up with doctors after a treatment or procedure—all from the safety of their homes. These alternatives to in-person meetings have proved helpful in keeping people at home, out of confined spaces with other potentially sick people, in an effort to slow the spread of the virus.
Though we most commonly think of remote doctor and patient appointments as telemedicine, this type of healthcare includes two other solutions—asynchronous tools that allow patients to send information to their doctor, and remote monitoring, which helps doctors keep track of a patient’s health.
As the country transitions to a “new normal,” however, utilization has begun declining (Johnson said she wasn’t at liberty to share those figures yet), but Johnson doesn’t believe it will decline to pre-pandemic levels. She also credited asynchronous tools like interactive COVID assessments for the surge in telemedicine—these tools allowed people to log their symptoms, then determined whether they could have COVID-19, and told them what to do next.
A different kind of distance learning
Shelly, a speech language pathologist in the Dallas-Fort Worth area who asked to go by her first name only, works with children with a range of communication needs, from better understanding social rules of language to pronouncing certain sounds and becoming comfortable with eating.
During the pandemic, her practice has continued to have in-person appointments, but about one-third of her clients transferred to telemedicine sessions for safety concerns. Of those clients, only one-sixth have transferred back to in-person sessions.
She previously worked at a local university on research involving telemedicine and adults, and she told Nautilus she was glad that telemedicine was progressing. But she wishes more parents elected to take their appointments online instead of in person. Not just for safety, she said, but also because research on speech pathology supports parent intervention. (In short, the pandemic has led to better outcomes for some of her clients.) However, Shelly thinks all of her families would prefer to switch back to in-person appointments if it weren’t for the pandemic.
“That’s what I’m really doing on telehealth, is telling these parents how to play with their kid to facilitate communication. And even though I know all my parents would prefer that I were the one doing it, it’s better for the kid,” she said. “My kids who I’m seeing on telehealth, they’re still meeting their goals and adding on new ones.”
For the families who still come in, the practice does temperature checks and requires face masks (though children under 10 aren’t required to wear masks in Texas), but some of the therapy techniques require children to see her mouth movements or body language. So when she can’t wear a mask during sessions, she still wears a face shield and cleans her station after each session.
“I don’t know what an ideal world would look like, [but] I will say this doesn’t look perfect. Is this the right way of going about it? I don’t know. But these kids need help, and I would rather be doing this than my kiddos going a whole year—or more, who knows when this is going to end—and [them] missing out on these pivotal moments in development that they need,” Shelly said.
Shelly’s license allows her to work with all kids in Texas, so telemedicine broadens the accessibility of speech therapy for families who need to drive 45 minutes to see her in person, or who live across the state. But telemedicine is only as accessible as the technology and financing that facilitates it. Without resources such as high-speed internet or health insurance that covers video appointments, telemedicine potential remains untapped for some.
Where telemedicine must improve in the future
Even if all patients were on board with telemedicine, the U.S. is still far away from fully implementing telemedicine. Take, for example, patients on Medicare. Before the pandemic, they could only access live telemedicine appointments for certain services if they lived in a health professional shortage area. Beneficiaries also had to travel to certain eligible “originating sites” to receive the appointment, such as another doctor’s office.
In March, the Centers for Medicare and Medicaid Services waived these rules by expanding the list of eligible services and allowing beneficiaries to receive telemedicine care at their homes. In July, lawmakers in the U.S. House of Representatives proposed a bipartisan bill to make some of these expansions permanent, including eliminating most restrictions of location and originating sites and requiring a study on the use of telemedicine during the pandemic.
And then there are other factors of accessibility, such as the necessary expansion of and access to high-speed broadband internet in rural, low-income and native communities, and for people with disabilities. According to research published in July in the Journal of the American Medical Informatics Association, access to broadband internet in rural areas must be prioritized for the expansion of telehealth programs. Expanded programs will also require that health outcomes be evaluated and barriers to implementation be identified.
But even with internet access, there are still barriers to the technology. For example, video care may lack interpreter services, have a poor user interface, and raise concerns for patient confidentiality, according to Daniel Horn, a primary care physician and the director of population health for the Division of General Internal Medicine at Massachusetts General Hospital.
Additionally, more Americans than ever are uninsured or underinsured as a result of record-breaking unemployment during the pandemic. According to a study from Families USA, a nonpartisan consumer health advocacy nonprofit, an estimated 5.4 million Americans lost their health insurance between February and May. Another study from the nonpartisan Kaiser Family Foundation, which took into account the family members of the insured people, said that estimation is actually 27 million. The cost of telemedicine varies like any other cost of care, and there are dozens of telehealth providers who operate without taking insurance. While some health insurance companies are investing in their telemedicine services as a result of the pandemic, others are scaling back.
Regardless, particularly during a period of such high unemployment, cost of care may be of great concern for people attempting to access healthcare at all. Johnson told Nautilus that the American Telemedicine Association doesn’t take a position on universal healthcare or any other kind of healthcare system. Instead, they’re driving home the idea that telemedicine isn’t some alternative to healthcare but is healthcare itself, revealed by the pandemic to be much more applicable and versatile and a part of this new normal.
Said Johnson: “We just think that telehealth is health and it’s not separate.”
Sources: National Institutes of Health, HealthAffairs, HealthCareIT News, Wired, NPR, Slate, Journal of the American Medical Informatics Assocation, Washington Post, New York Times, TechCrunch, USA Today