Telehealth-A Temporary Convenience, or the Wave of the Future?

Telehealth-A Temporary Convenience, or the Wave of the Future?

S. Elizabeth Ford, MD, MBA, District Health Director, DeKalb County CEO, DeKalb County Board of Health, Georgia Department of Community Health

S. Elizabeth Ford, MD, MBA, District Health Director, DeKalb County CEO, DeKalb County Board of Health, Georgia Department of Community Health

Virtual video capacity for certain types of healthcare visits have been in place for many years, but the current COVID-19 pandemic has led to the expansion of Telehealth to a degree few would have expected. 

First let’s understand the difference between telemedicine and Telehealth.  Telemedicine applies to clinical care exclusively, and includes services such as cardiology, orthopedics and dermatology.  Telehealth provides a much broader level of care and includes behavioral health, early intervention evaluations, counseling and education. 

Prior to COVID-19, providers for fee-for-service Medicaid clients had 13,000 telemedicine visits per week.  By the end of April 2020, the total number had mushroomed to 1.7 million. Shelter-in-place and other social distancing regulations, as well as a generalized fear of COVID-19 infection, have prompted many clients to avoid crowded waiting rooms to be seen remotely in the comfort of their own home. Telemedicine allows patients to communicate with their providers via video conferencing in a safe environment, using HIPAA-compliant platforms. 

Telemedicine will be one of the essential keys to addressing health inequities, because it helps to improve access to healthcare. If a patient has childcare issues, or lacks transportation to get to a doctor’s office, telemedicine allows them to still receive care. A patient in Macon can easily be linked to a dermatologist in metro Atlanta to receive an examination, and that physician can then call in a prescription for treatment to the patient’s local pharmacy.

“Telemedicine will be one of the essential keys to addressing health inequities, because it helps to improve access to healthcare”

In rural Georgia, where there are several counties lacking either a pediatrician, an ob/gyn, or both, telemedicine and Telehealth have helped to address critical physician shortages, and increase access to specialty care. With a portable blood pressure cuff and Doppler machine, a pregnant woman in Albany can check her own blood pressure and perform an ultrasound, sending images of her unborn baby to her doctor hundreds of miles away. Once her child is born, she can receive developmental screenings for the baby, as well as evaluations for post-partum depression for herself. In Albany, Georgia—a city that has one of the highest infant and maternal mortality rates in the state-- telemedicine is not just a convenience; it is truly a life saver. 

Infectious disease clinics have used telemedicine for years as part of Direct Observed Therapy (DOT) for tuberculosis patients. DOT allows clinicians to ensure that TB patients are taking their prescribed medical regimens without having to do in-home visits. These assessments were done using a regular cell phone or a computer with a camera, but new equipment for telemedicine is much more sophisticated.

As telemedicine technology has improved, clinicians are now able to see structures in much greater detail. Dermatology cameras allow a physician to see a single strand of hair; with special attachments, ophthalmologists can see structures that lie behind the iris. Cardiologists can provide their patients with a tele-stethescope that allows the specialist to detect heart murmurs and other abnormalities. Conditions that previously had to be diagnosed face-to-face can now be detected between a patient and a doctor literally thousands of miles away.

Telemedicine and Telehealth platforms can also be used to train clinical staff as well as students, expanding educational options dramatically, and helping to address some of the academic issues resulting from current social distancing restrictions.

As mental health issues continue to exacerbate due to stress from isolation and economic uncertainty, Telehealth provides access to desperately needed behavioral health services. Individuals can be connected with mental health professionals during times of anxiety, thereby preventing dangerous actions or behaviors.

While telemedicine and Telehealth services are excellent alternatives for individuals lacking access to care in more traditional settings, they are not without challenges.  Much of the art of the practice of medicine involves human touch—being able to palpate a belly to assess for a mass, or manipulate an extremity to check for abnormalities in joints or tendons. Sometimes patients with non specific complaints will only have an accurate diagnosis after a hands-on examination. A urinary tract infection, for example, could present as nausea, back pain, or both.  A patient presenting for a telemedicine visit for back pain may only receive an orthopedic evaluation, and would not have the opportunity to have their urine tested.

The other challenge with Telehealth delivery concerns reimbursement. The current pandemic has led to support for the accelerated transition of healthcare to Telehealth services, and the Centers for Medicare and Medicaid Services has issued waivers that allow providers to bill for these services at rates comparable to regular office visits. It is unclear, however, whether this payment parity will continue, and if so, for how long. As Medicaid programs are administered at the state level, it will be up to individual states to choose to cover Telehealth services as an alternative to traditional in-person methods of care.

COVID-19 has dramatically changed the way the world operates, and has mandated society discover alternatives to face-to-face interaction. Telehealth, while not perfect, is an effective way to provide access to populations that may otherwise not have options for services, while maintaining the health and safety of both the patient and the provider.

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