SummaryHealthcare, like many areas of modern life, has been transformed by the internet and related digital technologies.
Among the many new services and capabilities that have emerged from the digital revolution in healthcare, few have been as prominent or potentially far-reaching as telehealth.
Telehealth is defined as the delivery and facilitation of medical and health-related services via telecommunications and digital communications technologies. From the first transmission of X-ray images in 1948 and the first clinical video exchange a decade later, telehealth has evolved into a multitude of solutions designed to improve care while facilitating information exchange between patients and providers or among providers on the patient’s care team.
Some of telehealth’s most visible tools are mobile health (mHealth) applications that deliver clinical information remotely or support patients in maintaining health and managing disease. As the diversity and sophistication of mHealth solutions continue to increase, a new era of unprecedented connectivity between patients and providers is expected to emerge, resulting in more personalized, convenient, and cost-effective care.
Telehealth or Telemedicine?
Although the terms telehealth and telemedicine are often used to convey the same general concept of provider–patient connectivity, telemedicine is actually a subset of telehealth, since it refers solely to the administration of medical care via remote means. Telehealth, on the other hand, encompasses all health-directed activities that incorporate telecommunications technologies.
Telehealth’s 4 primary modalities or mechanisms of information exchange are:
- Mobile Health: mHealth solutions can be accessed via cellphones, watches, and wearables, and through programs delivered on tablets or laptops. In 2017, upwards of 325,000 smart phone apps were available, providing everything from disease education and management to prescription adherence Applications addressing diabetes management, cardiovascular disease, and medication management are among the most popular.
- Video Conferencing: High-resolution cameras, audio links, and video scopes are used to provide remote consults and examinations. Conferencing enables consults between physicians, and it can be harnessed to provide care for patients in rural locations, deployed military personnel, and prison inmates. The South Carolina Department of Corrections and the Medical University of South Carolina, for example, are using video conferencing to diagnose and treat inmates remotely. The approach reduces inmate travel expense and increases provider safety.
- Remote Patient Monitoring (RPM): RPM uses digital technologies to collect medical and health data from individuals or patients in one location and electronically transmit the information to providers in a different location for assessment, diagnosis, and recommendations. RPM applications allow providers to continually monitor health data for patients in the home or in a non-acute care facility to reduce readmission rates. Monitoring activities may focus on a range of data, including vital signs, blood sugar, blood oxygen levels, weight, and electrocardiogram output.
- Store-and-Forward: Store-and-forward telehealth technologies enable the capture, storage, and transmittal of health information. This information can include CAT scans, MRIs, X-rays, photos, and videos, and typically is shared between providers, specialists, and care team members to assist in diagnosis and treatment.
Telehealth saves time and money by minimizing the burden of distance between patients and providers and by delivering remotely generated patient information to aid providers in diagnosis and treatment. RPM and adherence tools will become increasingly important in the management of chronic disease as value-based reimbursement gains traction among payers.
For physicians, virtual consults and visits allow them to work more efficiently and help reduce appointment no-shows. For patients, telehealth cuts travel time, travel cost, and the costs associated with missing work. Telehealth is particularly valuable for improving access to care in rural, underserved areas, home to approximately 62 million Americans—19% of the population—yet served by just 9% of all physicians.
A 2012 report by the Institute of Medicine for the National Academies found that telehealth improves rural hospital volume, increases quality of care, and reduces costs by reducing both readmissions and unnecessary emergency department visits.
Physician Use Still Low
As more facilities in both rural and urban areas implement telehealth functionality, patient usage has continued to rise, from fewer than 350,000 patients in 2013 to an estimated 7 million in 2018. Even so, telehealth utilization by physicians remains the exception rather than the rule.
A recent study found that in 2016, just 15.4% of physicians worked in practices that used telehealth for a wide range of patient interactions, including e-visits and radiological diagnoses. At the same time, 11.2% of physicians worked in practices that relied on telehealth for interactions between physicians and other healthcare professionals.
Specialties that rank the highest for telehealth interactions with patients include radiologists (39.5%), psychiatrists (27.8%), and cardiologists (24.1%). Those who used telehealth most frequently to communicate with other health professionals included emergency physicians (38.8%), pathologists (30.4%), and radiologists (25.5%).
Other Telehealth Challenges
Several key issues continue to hinder utilization and limit provider uptake. A 2017 survey of more than 100 hospitals conducted by KLAS Research and the College of Healthcare Information Management Executives revealed that most respondents consider integration between their electronic health record and virtual care platform vendor to be nonexistent or unidirectional.
Half of the respondents reported that telehealth reimbursement is a limitation, noting that some payers reimburse for telehealth visits at rates lower than face-to-face care. Laws governing telehealth reimbursement vary in each state, which can result in substantial differences in regulatory requirements as well as payment rates.
Representing a recent win for telehealth, the Centers for Medicare and Medicare Services significantly expanded access to telehealth services for enrollees in both Medicare Advantage and original Medicare plans in 2019. Previously, seniors enrolled in original Medicare could only receive telehealth services if they lived in rural areas. Now providers will be reimbursed by Medicare for virtual check-ins between patient and physician nationwide. Similarly, Medicare Advantage plans will be able to offer an expanded range of telehealth benefits this year.
In the private markets, the percentage of large employers offering health plans that cover telemedicine jumped from just 27% in 2015 to 74% in 2018.
The Future of Telehealth
In the years ahead, telehealth is expected to play an increasingly critical role in chronic disease management. Telehealth’s ability to engage patients in their own care, provide continuous provider monitoring, identify early symptoms, and enable prompt interventions makes it optimal for diseases like congestive heart failure, stroke, and chronic pulmonary disease.
Another area of expanding interest involves the development of the hospital-at-home model, wherein acute, hospital-level care is provided in the patient’s home for clinically appropriate patients. A pilot project conducted by Presbyterian Health Services of Albuquerque showed in-home patients had comparable or better outcomes versus inpatients and had higher satisfaction levels. The program also achieved savings of 19% versus costs for similar inpatients.
Similarly, telehealth is seen as a good match for post-acute care by addressing access issues, reducing readmissions, improving health, and facilitating care coordination.
The continued growth of mHealth applications will likely foster increased cooperation between stakeholders and members of the health IT industry. Partnerships and collaborations between developers, clinicians, scientists, government agencies, and others should emerge to support unified objectives, new use cases, and greater integration into the clinician workflow.
Avalere has expertise in digital technologies, patient perspective, and strategic partnerships to help partners optimize their telehealth strategies.
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