Telehealth During COVID-19

Contributors: On behalf of the FHIMA Consumer Engagement Committee, 

• Sara Evans, CCA
• Deborah Guskiewicz
• Jean Patterson, LPN, CCA
• Takiyah Mitchell, BSHIIM, CCA
• Tamara Rodriguez, MSHIA, RHIA, CHTS-PW

With the emergence of the novel coronavirus and record-breaking infections across the country, the year 2020 was proven to be a challenging year for people, industries, and sectors world-wide. This is particularly true for the healthcare industry, as healthcare facilities, providers, staff, and patients all worked to find ways to deliver and receive healthcare safely. Telehealth is the use of electronic information and telecommunication technologies to provide care when you and the doctor aren’t in the same place at the same time (telehealth.hhs.gov, 2020). This method of delivering healthcare met healthcare safety requirements during a global pandemic; as such, providers and consumers relied on it heavily this past year. In fact, there was a 154% increase in telehealth visits during the last week of March 2020, compared with the same period in 2019. (Centers for Disease Control and Prevention, 2020)  So, what are the implications of increased telehealth use on providers, healthcare facilities, and patients? Let’s take a closer look at each of these cohorts. 

Telehealth from the Healthcare Provider Perspective

Telehealth provided many benefits for healthcare providers. The ability to virtually screen patients and to refer patients for the correct course of treatment is beneficial to both the patient and the healthcare provider as it protects both parties from possible COVID-19 infection. Telehealth also provides an effective way to follow up with patients after hospitalization and keeps the patient from interacting with possible infectious carriers. 

However, there are some downsides to telehealth from a healthcare provider’s perspective. Patients may present with emergent symptoms which would be best to diagnose in-person to perform an adequate physical exam. The provider must rely on the patient’s self-reports. Providers would need to ask more questions to obtain a comprehensive health history which may prolong the appointment time or the patient may leave out a symptom that would have been perceptible during in-person care which could compromise diagnosis and treatment. Other disadvantages are providers relying on technology and patients not having access to smart devices as well as reliable internet connections.

Telehealth from the Patient Perspective

Convenience is very important to many people. With telehealth, your physician has the ability to talk with you anywhere, anytime and about anything from a rash to medication planning. A visit that may have taken an hour or more is decreased with telehealth. In addition to convenience, patients do not visit facilities, so there is less possibility for exposure to COVID-19.  In the future, telehealth would be great for people with a compromised immune system, STDs, Hepatitis or cancer. 

Examples of telehealth for cancer patients would be managing and teaching about medications or treatments, check-ups between treatments, and consults with a palliative care specialist for signs and symptoms (The American Cancer Society). Additionally, telehealth would increase preventative care because more people will have access to physician counseling services, which will also decrease hospital admission rates. “Trends in telehealth encounters during January–March 2020 were compared with encounters occurring during the same weeks in 2019. The number of telehealth visits increased by 50%, and most encounters were from patients seeking care for conditions other than COVID-19.” (Koonin et al., 2020)

However, telehealth can only be used as a communication tool which means physicians would be unable to have hands on experience. For example, if you see discoloration in your skin that your camera does not, then your physician will not be able to help you as much as they would with an in person visit. Also, your physician will not be able to touch your body and feel if there is a lump or abnormality. The quality of care could go down and may result in misdiagnosis or changes in diagnosis after a correct examination.

Telehealth from the Healthcare Administrators and Facilities Perspective

The advantages of telehealth to healthcare administrators and facilities may include reducing the number of front desk and support staff required along with the amount of office space needed for waiting and exam rooms which would decrease overhead costs. Also, less exposure of staff and patients to illnesses and infections. Most importantly the ability to provide billable services to patients during the COVID-19 pandemic. The disadvantages include licensing and insurance billing requirements across state lines if the patient lives in a different state than where the office is located, finding the right digital platform for your practice and cost of said technology as well as adequate connections to provide quality care. Healthcare administrators must ensure the program is secure and fully compliant with privacy laws as well. 

The relaxation of laws and regulations around privacy and billing during the COVID-19 pandemic has provide expanded opportunities to use telehealth to provide patient care at a distance (Hawkins, 2020).  Moving forward, something to consider is the impact on privacy and security. Telehealth has been the savior of healthcare during this pandemic and will continue to provide quality care and services in the future. However, as healthcare providers and administrators know, preparation is the best medicine for the unknown. There must be laws and regulations in place for these extreme situations. 

References

Centers for Disease Control and Prevention. (2020, October 30). Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm

Hawkins, M. (2020, July 07). Think Ahead for Telehealth Security and COVID-19. Retrieved December 26, 2020, from https://journal.ahima.org/think-ahead-for-telehealth-security-and-covid-19/ 

How to get or provide remote health care. (2020). Retrieved December 28, 2020, from https://telehealth.hhs.gov/

Koonin, L. M., Hoots, B., Tsang, C. A., Leroy, Z., Farris, K., Jolly, B., . . . Harris, A. M. (2020). Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020. MMWR. Morbidity and Mortality Weekly Report, 69(43), 1595-1599. doi:10.15585/mmwr.mm6943a3

TELEHEALTH.HHS.GOV. (2020, November 18). Understanding telehealth. Retrieved from Telehealth.HHS.Gov: https://telehealth.hhs.gov/patients/understanding-telehealth/?gclid=EAIaIQobChMIhbHU_53z7QIVBbGGCh2Opw-wEAAYASAAEgLs4PD_BwE 

Villines, Z (2020 April, 20) Reviewed by Martinez, K M.D. Telemedicine benefits: for patients             and professionals Medical News Today Newsletter