COVID-19 Transforming Virtual Care
Rachel Kulchar, Princeton University
Introduction
Telehealth is defined as the use of information-based communications and technologies systems for the purpose of exchanging medical information and services, diagnosing and providing advice about a treatment, and improving a patient’s health status across geographic distances, rather than via direct face-to-face contact [1-6]. Telehealth includes both medical and dental services, employing the terms telemedicine and teledentistry, respectively, with the word “tele” meaning distant [2-3,7-8]. Four essential components comprise telehealth: teleconsultation, telediagnosis, teletriage, and telemonitoring.7 With the advancements of technology, telehealth has become more efficient and accessible, being implemented in rural hospitals, school systems, prisons, military settings, community hospitals, and many others, all while providing a way for medical facilities to parlay information on an international level [2,7,10-11].
Historical Origin of Telehealth
This focus toward providing care while patients can remain at home is not a recent phenomena. In 1879, the Lancet published an article discussing the benefits to performing patient-care over the phone in hopes of eliminating unnecessary office visits [10]. A few decades later, in 1906, the electrocardiogram was invented, and the invention of teleradiology in 1959 shortly followed [3,10]. Since the 1920s, clinics on ships have utilized radio transmissions to discuss medical practices [10]. During the 1990s, interest in advancing telehealth spiked, resulting in a state and federal allocation for telemedicine of over $100 million in the 1994 fiscal year. At this same time, individual states began conducting their own research to develop telemedicine systems, investing more than $50 million [3]. More than 60% of all US-based healthcare facilities and around 50% of all US-based hospitals employ telehealth practices daily, with a 2016 report by Kaiser Permanente of Northern California reporting its telehealth communications exceeded that of in-person visits [1].
Creating Healthcare Access with Telehealth
Specifically, telehealth aims to provide for underserved populations in remote areas as over 20% of Americans reside in areas with physician and healthcare specialist shortages [5,7,12-13]. Patients with no medical insurance are 20% more likely to prefer telehealth to in-person visits, with many institutions offering $50 virtual, continual medical services for common conditions [11,14]. In terms of patients’ perspectives regarding telehealth, most believe the main goal to be an increased access to care [11]. Multiple studies have shown that almost 100% of patients who used telehealth were satisfied and planned to continue using virtual services in place of in-person services while also recommending the service to others [14-15]. Virtual care, in the absence of human touch, must overcome this barrier with unique communications.
Challenges and Benefits of Telehealth
Telehealth has been employed by many health systems which can be attributed many benefits: increasing care delivery and accessibility; providing services after normal clinic hours; reducing the need to travel for medical care; increasing care delivery via networking and the sharing of digital information; reducing medical costs and wait times; reducing burdens of physician shortages; reducing disease exposure for patients and healthcare professionals; conserve limited medical equipment; facilitating medical services, such as refilling prescriptions and providing education sessions and consultations; reducing patient demands on healthcare facilities; and improved professional education [1-2,4-5,6-7,16].
In light of these advantages, telehealth also possesses limitations: decreasing sense of personability, empathy, and communication levels over virtual settings; organizational, logistical, and technological challenges; technological barriers for patients; increasing fear in patients regarding the accuracy and completeness of medical examinations; medicolegal and copyright issues; limited broadband access of health centers; confidentiality, privacy, and security concerns; language and hearing barriers; disproportionate challenges that the South and rural areas face in implementing telehealth; and limitations of physicians to provide the same level of diagnostic capabilities as an in-person physical examination [2,4,6,15-17].
Telehealth vs In-Person Care
Inspecting the differences inherent to in-person and virtual care is vital to determine the merit of adopting video-based methods of care. Convenience, privacy, effectiveness, communication, and comfort are several pillars patients claim to assess while comparing telehealth to traditional services [15]. Mashima et al. sought to discover whether voice therapy could be efficiently delivered via telehealth standards; they concluded that there were no differences in outcome measures when comparing virtual to in-person visits and that both groups of subjects demonstrated improvements [18]. Similarly, Polinksi et al. found that 32% of patients studied prefered telehealth care to traditional care, with 57% confirming that the care they received virtually was on par with in-person visits. 98% of all patients were satisfied with their medical caregiver’s abilities, 94% were very satisfied with the education and treatment plans they were presented with, and 95% of were very satisfied with telehealth care, technology used in virtual care practices, and convenience of using telehealth [14]. Many who choose to engage in virtual care services as an alternative to traditional visits attributed their decision to shorter or no wait times, decreased cost, and overall convenience levels [14-15]. Strikingly, the average time until a patient is able to schedule a 20-minute appointment with a physician is 20 days [11]. Powell et al. found that some patients felt more comfortable engaging in virtual consultations as they could remain in a familiar setting during appointments and expressed desire to receive future serious news over video [15].
Conclusion
Creating a clear and well-defined understanding for health care professionals on how to ensure a digital trust relationship built early on is essential. This is an opportunity--especially for pain patients-- which opens the door to educate, counsel, prevent opioid related adverse events and provide pain care guidance and prevention measures often missed during in-person care. However, as we bridge the new venue of digitization, it is fundamental that we derive the importance and opportunity, pausing and reflecting on the critical importance of this interaction to preserve it.
References
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