Major, deep-rooted problems in the healthcare system were brought into sharp focus by the COVID-19 pandemic. Healthcare organizations in many regions – already stretched to near-full capacity before the pandemic – have been pushed to the brink of collapse. While they scrambled to respond, they began to lean heavily into the nascent tools and techniques of telehealth to keep the public safe. This shift has been corroborated by a recent Parks Association study identified significant increase in the use of telehealth across all demographic groups:
“For instance, just 6% of those ages 65 and older had used a telehealth service in 2019 vs 29% in 2020. Similarly, just 6% of those who are most resistant to new technology…had tried telehealth in 2019, versus 24% today. This increase across demographic groups illustrates the movement of telehealth from an emerging technology service to a solution delivering care to the mass market.”
This is perhaps one of the biggest surprises of the pandemic – patients responded positively to their health needs being managed through technology. This has led to further speculation as to how it might be used to fix additional challenges faced by the sector and what it will mean for healthcare both now and in the future. Of one thing we can be certain – the pandemic has fired the starting gun on a telehealth revolution.
Of course, with that revolution come questions, and perhaps the most important is whether healthcare providers and insurers are willing to seize the opportunities in front of them by making the necessary changes to how they operate.
Perhaps the best example is the use of telehealth solutions to facilitate remote patient monitoring. This use case is spurred by the need to both keep vulnerable individuals away from hospitals, where they risk infection, and to prevent facilities from becoming overwhelmed by a sudden influx of patients.
Web-based and mobile applications are being utilized to upload patient-recorded information about their vital signs (including blood pressure, blood glucose levels or lung function) from their homes. In addition, wearable devices can transmit real-time data such as heart rate, gait, posture control, tremors, physical activity or sleep patterns, to care teams. This can be augmented by home monitoring devices for vulnerable adults such as the elderly or those with dementia that detect and report activities such as falls or extended periods of inactivity.
The increased use of telehealth has also started to address the shortage of trained medical staff – something that has contributed to high levels of clinical staff burnout. With fewer people visiting hospitals for treatment, health systems have been able to remotely increase patient capacity without incurring further strain on resources and can actually provide patients with a higher quality of care.
Telehealth is also shifting away from acute to chronic care, with better screening to assess risk and urgency to determine whether the patient can wait or must be seen immediately. Certain health-related indices are now tracked through non-intrusive detectors. This data complements screening to provide more information for evaluation purposes.
Moving beyond the imperative brought about by COVID-19, the healthcare sector must put in place the right infrastructure so it can realise the full potential of telehealth. A number of key aspects must therefore be addressed:
Firstly, it is vital that there is a safe and secure method of sharing patient health data electronically. The real requirement is for a personal health record (PHR) system that can gather information about an individuals’ health that they can control and maintain. Available anytime, such PHR systems would provide care teams and emergency personnel access to vital information quickly, including recent diagnoses, medication prescriptions, and any drug allergies. Indeed, partly though regulatory structures such as the Health Insurance Portability and Accountability Act (HIPAA), there is now growing confidence that the technology is secure, facilitating virtual consultations between patients and medical practitioners sharing valuable data that assists in diagnosis and monitoring.
Patient-informed consent must also be addressed. The U.S. Department of Health and Human Services (HHS) Office for Civil Rights announced it would not enforce certain HIPAA requirements during the pandemic. Even so, care providers are still encouraged to notify patients of the privacy risks and provide all available encryption and privacy modes when using such applications.
Finally, and key to facilitating the expansion of telehealth, is the all-important – and always challenging – issue of reimbursements. In March 2020, Congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act. This legislation allows healthcare professionals to bill Medicare fee-for-service for patient care delivered by telehealth during the current pandemic. This has resulted in the Centers for Medicare & Medicaid Services introducing a range of new telehealth-specific reimbursement codes. The legislation also allows services to be provided by phone, a major step forward. As for the private health insurance sector, some companies have already accepted telehealth and it is anticipated that the remainder will soon follow.
COVID-19 has facilitated the transition to widespread telehealth adoption far quicker and more seamlessly than anyone could have predicted – or planned. Traditional roadblocks to telehealth have diminished, thanks to increased availability of the technology, pragmatic regulatory changes, and the willingness of patients and providers to embrace new solutions. After all, the pandemic gave them no choice.
The telehealth revolution is undeniably underway with, most importantly, patients saying they are ready for it. The question remains whether healthcare providers will remain open-minded to the new possibilities or if we will see inertia and self-interest resist its adoption.