This article appeared in Nejm Catalyst prior to the launch of Nejm Catalyst Innovations in Care Delivery magazine. more information.
Telehealth is defined as the delivery and facilitation of health and health-related services, including medical care, provider and patient education, health information services, and self-care through telecommunications and digital communication technologies. Live video conferencing, mobile health apps, “store and forward” electronic transmission, and remote patient monitoring (RPM) are examples of technologies used in telehealth.
telehealth and telemedicine
The terms telehealth and telemedicine are often used interchangeably, but telehealth has evolved to encapsulate a broader range of telehealth activities and services. digital health care. To understand the juxtaposition of telehealth and telemedicine, it is essential to first define telemedicine.
what is telemedicine?
the oxford definition of telemedicine is “the remote diagnosis and treatment of patients by means of telecommunications technology“. Telemedicine encompasses the use of telecommunications technologies and systems to administer medical care to patients who are geographically separated from providers. for example, a radiologist may read and interpret the results of images from a patient in a different county whose hospital does not currently have a radiologist on staff. or a doctor may conduct an urgent care consultation via video for a condition that is not life-threatening.
Where telemedicine refers specifically to the practice of medicine through remote means, telehealth is an umbrella term that covers all components and activities of health care and the health care system that are carried out remotely. through telecommunications technology. health education, portable devices that record and transmit vital signs, and remote provider-to-provider communication are examples of telehealth activities and applications that extend beyond remote clinical care.
Several technologies are being implemented for telehealth, including mhealth (or mobile health), video and audio technologies, digital photography, remote patient monitoring (RPM), and store and forward technologies.
mhealth: use of smartphones and tablets for telehealth
Today, 95 percent of Americans have cell phones and 77 percent have smartphones. these and other mobile devices can be harnessed to promote better health outcomes and greater access to care. mhealth or mobile health refers to healthcare apps and programs that patients use on their smartphones, tablets, or laptops. These apps allow patients to track health measures, set medication and appointment reminders, and share information with doctors. Users can access hundreds of mHealth apps, including tools for managing asthma and diabetes, as well as apps to lose weight or quit smoking. In addition, mobile devices allow users to schedule appointments and communicate with providers through video conferences and text messages.
Medicaid of Wyoming conducted a study to measure postpartum engagement and outcomes in patients who used a mobile health app called “Additional Due Date.” use of the app, which allowed women to record pregnancy milestones, access medical services, and search for symptom-related information, was associated with greater adherence to prenatal care and a decreased incidence of babies being born with low birth weight.
videoconferences, videoscopes and high resolution cameras in telehealth
Physicians are conquering distance and providing access to patients who cannot travel by providing appointments using real-time video communication platforms. video conferencing technology has been used to provide care to inmates, military personnel, and patients located in rural areas for some time. In addition, providers of care and funding, such as Kaiser Permanente, the Department of Defense, and the Department of Veterans Affairs, have been exploiting telehealth modalities to increase access to health care services and promote better quality of care. . in another example, s.c. The Department of Corrections and the Medical University of South Carolina are using videoscopes and high-resolution cameras to remotely diagnose and treat inmates. They are also conducting virtual appointments using video/audio communication applications to reduce inmate transportation costs and increase security by keeping inmates in and providers out of correctional facilities.
remote patient monitoring (rpm)
Remote patient monitoring involves the reporting, collection, transmission, and evaluation of patient health data through electronic devices, such as wearable devices, mobile devices, smartphone applications, and computers with Internet access. RPM technologies remind patients to weigh themselves and transmit the measurements to their physicians. wearables and other electronic monitoring devices are used to collect and transfer vital signs data such as blood pressure, heart statistics, oxygen levels, and respiratory rate.
Devices are also used to track blood glucose levels and report high or low levels to patients and providers. In partnership with Stanford, Apple is testing whether its Apple Watch can be used to detect irregular heart patterns, and Livingcor’s Kardiaband allows Apple Watch users to take 30-second EKGs that can be easily transmitted to doctors. patients often go months without seeing their providers. rpm can enable early detection of complications and identify patients who need to seek medical care before in-person appointments. in addition, chronic conditions can be managed more easily and efficiently, resulting in higher quality care and outcomes, as well as reduced costs.
Patients often go months without seeing their providers. rpm can enable early detection of complications and identify patients who need to seek medical care before in-person appointments.
According to this 2015 Cardiac Implantable Electronic Device (ICD) study, patients whose implantation included remote monitoring capabilities had a higher survival rate than patients without it. “Furthermore, according to the Center for Technology and Aging, patients who participated in RPM were less likely to experience hospital stays, incurred fewer ER and ER visits, and reported better management of their symptoms. they also indicated greater physical endurance, as well as greater overall patient satisfaction and emotional well-being.
store and forward
Store-and-forward telehealth refers to the capture, storage, and transmission of patient health information for asynchronous delivery of health care using store-and-forward technology. CT scans, MRIs, X-rays, photos, videos, and text-based patient data are collected and sent to specialists and other members of a care team to assess patients and assist in their treatment. The technologies used to store and forward telehealth include secure servers and routers that temporarily host incoming information packets and then route them to the appropriate end users. secure email platforms are also used to store and forward telehealth services.
telehealth services and applications
As the internet and mobile devices now pervade our lives, it’s only natural that people want to harness telehealth technologies to improve care, offer convenience, promote access and support sustainability. Telehealth services range from video conferencing mental health consultations and sessions to public health broadcast text messages and on-demand provider education.
Telehealth Addresses Primary Care Physician Shortage/Specialist Shortage: Telehealth allows patients in smaller hospitals with fewer resources to gain access to specialists located in larger regional facilities. Undeniably, lack of access and hard-to-reach populations are drivers of telehealth innovations, as supported by this 2014 MUSC study on the use of telehospitalists to address physician shortages. Telehealth is being rolled out to treat incarcerated populations, as well as being rolled out in rural communities and underserved urban areas to improve the availability of healthcare.
Telehealth for Education and Training: Numerous organizations provide healthcare education with the help of digital telehealth technologies, including the Safety, Quality, Informatics, and Leadership (SQIL) program of Harvard, which takes a blended learning approach. . sqil uses on-demand content combined with in-person training to create a new model of medical education that uses “information technology (it), data, and a culture of continuous improvement to enable healthcare organizations to evolve into true learning systems “. Physicians short on time are increasingly using online and mobile platforms to meet CME and MOC requirements, and to prepare for board exams.
Telehealth and Patient Engagement: With telehealth technologies, patients have more control over their well-being. educational videos, mobile health management apps, and online health learning and support communities empower patients to manage chronic conditions, lose weight, increase physical activity levels, and gain emotional support. Diabetes patients benefit from carbohydrate tracking apps and use glucose monitoring devices to document and report their blood sugar measurements. other patients interact with their providers and schedule appointments through secure online communication portals. Additionally, they are accessing health education content via smartphones and computers to add to their self-care toolboxes. they are also using wearable devices and monitoring systems to gain insight into their sleep patterns, vital signs, and activity levels.
Telehealth and communication with providers: A significant development of telehealth is the increase in communication through digital and telecommunication platforms between care providers. care teams are enabled through telehealth technologies to more easily share information and collaborate in the treatment of their patients. pcps are using telehealth platforms to consult with specialists and other providers to promote access for their patients in areas of low provider availability.
Significant obstacles to more widespread adoption of telehealth are reimbursement limits and an inconsistent payer landscape. In a Klas-Chime study from October of last year, more than 50 percent of respondents from 104 health care organizations indicated that limits on reimbursement restrict their ability to expand telehealth services for patients. Medicare and Medicaid offer different degrees of flexibility, while private payers also represent different levels of funding.
Telehealth Reimbursement Medicare: Medicare, which funds care for patients who can benefit most from telehealth, will only pay if the originating site (location of service patient) is in a Non-Metropolitan Statistical Area (MSA) or Health Professional Shortage Area (HPSA). Medicare also limits the types of providers and facilities that can provide telehealth services. For more information, the Telehealth Resource Center (TRC) has provided lists of covered providers, sites, and services.
telehealth reimbursement medicaid: According to chiron health, medicaid systems in 48 states will reimburse for telehealth provided via live video systems, while medicaid programs from 19 states will pay rpm. 12 state programs will fund store-and-forward telehealth and seven states will allow payment for all three categories of telehealth. But even though Medicaid is more tailored to telehealth than Medicare is, the rules governing payment through state Medicaid programs vary considerably. for example, some states require patients to be in a medical facility and not at home while receiving telehealth care, and others require a licensed provider to stay with patients while receiving telehealth services.
Reimbursement from Telehealth Private Payers: There is no federal mandate requiring private payers to reimburse for telehealth services, but several states have enacted telehealth parity laws. Parity laws require payers to cover the same types of services provided via telehealth as those provided face-to-face. they also require payers to reimburse telehealth services at the same payment rate as in-clinic services.
The more widespread use and success of telehealth applications could spur resolution of these reimbursement issues. CVS has provided clinical services via telehealth since 2015. According to its study in the Journal of General Internal Medicine, 95 percent of patients “were very satisfied with the quality of care they received, the ease with which it was integrated telehealth technology in the visit, and the timeliness and convenience of your care”. If CVS’s merger with Aetna is finalized, increased competition may motivate other payers to find ways to offer telehealth services and, by extension, reimbursement levels.
95% of patients were highly satisfied with the quality of care they received, the ease with which telehealth technology was integrated into the visit, and the timeliness and convenience of their care.
Telehealth and the future of healthcare
Despite current reimbursement challenges, there are numerous benefits to increasing the use of telehealth to meet the national demand for healthcare. convenience of care, increased access, improved productivity for workers by not having to take time off and travel to appointments, reduced costs and time savings for doctors are just a few. For these reasons, providers, payers, and employers are moving forward with more and more telehealth solutions.
With the recent news that Amazon’s Jeff Bezos, Berkshire Hathaway’s Warren Buffet and J.P. Jamie Dimon of Morgan Chase have teamed up to revolutionize health care, it’s easy to speculate that telehealth technology will be a key strategy in efforts to cut costs. Other employers are also looking to cut prices with the help of telehealth. According to the Society for Human Resource Management (SHRM), not only are employers encouraging the use of telehealth services, but their employees, many of whom are digital natives, are quite comfortable using these services. Due to the lower costs of remote healthcare and increased worker productivity and satisfaction, organizations are likely to look to telehealth solutions. In addition, payers, like employers, may be attracted by lower medical costs, and consumers may be motivated by the convenience and promptness of care it offers.