Submitted by: John (Jack) D. Rudnick, Jr., Ed.D., professor, Thomas More University

One of the vital innovations fueled by digital technology for the viability of the nation and the healthcare industry is the concept of telehealth. The implications of telehealth transcend multiple disciplines and underscore the need for developing broad-based critical thought processes and considering the benefits through a broadened community lens. The comprehensive reach of telehealth can be seen in: the art and science of medicine and healthcare delivery; the efficacies realized from a business perspective; the sociological aspects of research and trends determined from studying population segments; human behaviors from psychological and counseling perspectives; the implications of co-morbidities and healthy lifestyles studied in exercise sciences; and, the ethical implications of decision-making. 

Because of COVID-19, telehealth surfaces to the forefront of an industry’s technology infrastructure to provide access for care delivery. Environmental issues driven by Mother Nature, acts of God , or a force majeur such as 9/11, tornadoes, earthquakes, and, most recently, COVID-19 have driven this need for innovation.

Telehealth and Telemedicine Defined

Telehealth is “the use of electronic information and telecommunications technologies to support long distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging (e.g. radiology services), streaming media, and terrestrial and wireless communications.” (healthit.gov. 2020) Telehealth is distinguished from telemedicine because it refers to a broader scope of healthcare services than telemedicine. While telemedicine refers specifically to remote clinical evaluation, diagnosis and provision of treatment services, telehealth can include remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services. (healthit.gov. 2020)

While telehealth has been around in the healthcare space for many years, it is only recently that it has assumed critical importance to sustaining continuity of the healthcare system. Over the years, barriers to embracing this technology as an integral part of the system have included suboptimal optics and resolution for bidirectional communication, a slowness of the Centers for Medicare and Medicaid and commercial insurers to agree upon adequate reimbursement for telehealth treatments, and the upfront cost for the large expenses associated with establishing adequate platforms. However, the advent of smartphones, development of HIPAA compliant software, and the epoch COVID-19 circumstances that have necessitated a swift adoption of telehealth to keep the healthcare delivery system afloat have propelled telehealth to the forefront as a pivotal tool and strategy. It is likely that telehealth will help define “the new normal” of health delivery and become more accepted and adopted by all stakeholders as part of physician-patient interaction. Because telehealth is a relatively new and emerging concept, perhaps an overview and primer will help consumers of healthcare to better understand advantages and disadvantages.

Foundations of Healthcare Delivery

The benefits of Telehealth for the general public, can best be described around the four foundational pillars of healthcare: access, cost, quality, and continuity.

Access

• Increases access to healthcare; patients can be diagnosed and treated earlier

• Helps to reduce the geographic barrier resulting from potential lack of transportation

• Provides the potential opportunity for patients to be seen sooner; and diagnostic tests can often be placed into motion, being ordered more quickly

• Enables health care professionals to remotely evaluate, diagnose, and treat patients. Particularly useful in isolated or rural areas

Quality 

• Eliminates the need for a caregiver to serve as a driver and miss work

• Improves the patient engagement experience and promotes improved patient-centric satisfaction

• (Oftentimes) reduces the waiting time for the appointment as well as wait time to be seen during the appointment time at the office

• (In the current environment) offers a safer alternative by comparison to coming to an office face-to-face

• Improves provider satisfaction, offering a balance to their work and family life

• Improves health outcomes; patients diagnosed and treated earlier often have improved results and less costly treatments

• Improves organizational productivity. Employees can avoid absences from work when telehealth services are available on site or when employees can remotely participate in consultations about family members

Cost 

• Cultivates opportunities for cost reduction. Home visits can reduce high overall costs of transporting distances and the added requirements for a caregiver

• Dramatically lowers the “no-show” rate allowing providers to be more efficient and effective

• Reduce overhead cost and the need for in-office staff, i.e. receptionist, medical assistant, thereby lowering personnel costs and other expenses due to office hours

Continuity

• Is ideally suited for follow up visits and consultations 

• Facilitates referral to other specialists, sub-specialists, or support services needs

Patient Engagement

Many telehealth applications empower patients to play an active role in their healthcare. In the shift towards value-based healthcare, patient engagement has become essential in the management of chronic conditions. For many patients, staying motivated in managing their health can be a challenge. When a patient can easily access their physician through video calls or messages, they will be less frustrated and more encouraged to ask questions and participate in their care.

Telehealth can help patients feel more at ease as the visit takes place in their home; and patients are likely to be more engaged in the physician/ patient process. In the context of a sports metaphor, it is like having benefits akin to a home court advantage. Patients are not in unfamiliar surroundings with distractions and often intimidating sterile physical environment where the likelihood of feeling rushed and unplanned interruptions happening are more likely in a busy office setting.

Tradeoffs and Shortcomings

While telemedicine technology is getting better, not all solutions are equal. Rural, remote, and older patients who often can’t physically make it to the office for various reasons (distance, time, sickness) are beginning to rely more heavily on telemedicine. However, these groups of people are more likely to have weaker and less stable connections than those in population centers and who are typically more “connected” in general. Implementing a telemedicine solution that is made to deal with remote, low-bandwidth patients is crucial to serving this population. If the video patient/doctor visits are unstable and unclear, then the reason to offer this option to people who may rely on it the most is null and void.

As with any different and new program, change brings tradeoffs. Additional shortcomings may include: 

• Regulatory and reimbursement barriers (unknown after COVID)

• Physical examination opportunities are limited 

• Telemedicine equipment and technology is improving but bidirectional solutions are imperfect

• A digital divide exists among some populations; video chat may be difficult as older patients struggle with technology and internet access if there is a low bandwidth making connectivity suboptimal

• Activating the initial telehealth apps are sometimes difficult for non-technology natives

• Telemedicine is not as personal

Discussion

Telehealth can continue to improve access to healthcare and reduce costs. Technology will continue to drive innovation in the healthcare space and expand possibilities to include more remote specialty consultations and clinical education for students and current practitioners. It is likely that additional entry-level technician careers will develop for those interested in learning technology specifics. Assisting licensed providers with technical support can perhaps expand the capacity of professionals to work “to the top of their licenses!”

John (Jack) D. Rudnick, Jr., is a tenured professor at Thomas More University in the Department of Business Administration and Accountancy. He served as a healthcare administrator in the U.S. Navy Medical Service Corps and as a physician/medical programs recruiter. He also served as chief operating officer for a large specialty medical group practice and ambulatory surgery center, administrator for long term care facilities, director for a school-based health center initiative, and vice president for large healthcare systems.

The views, thoughts, and opinions expressed in this article belong solely to the author, and are not necessarily those of Thomas More University.