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Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic

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Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic

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Centers for Disease Control and Prevention

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Background

Changes in the way that health care is delivered during this pandemic are needed to reduce staff exposure to ill persons, preserve personal protective equipment (PPE), and minimize the impact of patient surges on facilities. Healthcare systems have had to adjust the way they triage, evaluate, and care for patients using methods that do not rely on in-person services. Telehealth services help provide necessary care to patients while minimizing the transmission risk of SARS-CoV-2, the virus that causes COVID-19, to healthcare personnel (HCP) and patients.

While telehealth technology and its use are not new, widespread adoption among HCP and patients beyond simple telephone correspondence has been relatively slow. Before the COVID-19 pandemic, trends show some increased interest in use of telehealth services by both HCP and patients. However, recent policy changes during the COVID-19 pandemic have reduced barriers to telehealth access and have promoted the use of telehealth as a way to deliver acute, chronic, primary and specialty care. Many professional medical societies endorse telehealth services and provide guidance for medical practice in this evolving landscape.Telehealth can also improve patient health outcomes.

Telehealth Modalities

Several telehealth modalities allow HCP and patients to connect using technology to deliver health care:

Synchronous: This includes real-time telephone or live audio-video interaction typically with a patient using a smartphone, tablet, or computer.
In some cases, peripheral medical equipment (e.g., digital stethoscopes, otoscopes, ultrasounds) can be used by another HCP (e.g., nurse, medical assistant) physically with the patient, while the consulting medical provider conducts a remote evaluation.

Asynchronous: This includes "store and forward" technology where messages, images, or data are collected at one point in time and interpreted or responded to later. Patient portals can facilitate this type of communication between provider and patient through secure messaging.

Remote patient monitoring: This allows direct transmission of a patient's clinical measurements from a distance (may or may not be in real time) to their healthcare provider.

Benefits and Potential Uses of Telehealth

Telehealth services can facilitate public health mitigation strategies during this pandemic by increasing social distancing. These services can be a safer option for HCP and patients by reducing potential infectious exposures. They can reduce the strain on healthcare systems by minimizing the surge of patient demand on facilities and reduce the use of PPE by healthcare providers.

Maintaining continuity of care to the extent possible can avoid additional negative consequences from delayed preventive, chronic, or routine care. Remote access to healthcare services may increase participation for those who are medically or socially vulnerable or who do not have ready access to providers. Remote access can also help preserve the patient-provider relationship at times when an in-person visit is not practical or feasible. Telehealth services can be used to:

Screen patients who may have symptoms of COVID-19 and refer as appropriate

Provide low-risk urgent care for non-COVID-19 conditions, identify those persons who may need additional medical consultation or assessment, and refer as appropriate

Access primary care providers and specialists, including mental and behavioral health, for chronic health conditions and medication management

Provide coaching and support for patients managing chronic health conditions, including weight management and nutrition counseling

Participate in physical therapy, occupational therapy, and other modalities as a hybrid approach to in-person care for optimal health

Monitor clinical signs of certain chronic medical conditions (e.g., blood pressure, blood glucose, other remote assessments)

Engage in case management for patients who have difficulty accessing care (e.g., those who live in very rural settings, older adults, those with limited mobility)

Follow up with patients after hospitalization

Deliver advance care planning and counseling to patients and caregivers to document preferences if a life-threatening event or medical crisis occurs

Provide non-emergent care to residents in long-term care facilities

Provide education and training for HCP through peer-to-peer professional medical consultations (inpatient or outpatient) that are not locally available, particularly in rural areas

Strategies to Increase Telehealth Uptake

Promote and optimize the use of telehealth services for the safety of HCP and patients while using the Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care to determine when in-person care is appropriate. Include options for language interpretation, as needed.

Communicate with insurers/payers to understand availability of covered telehealth, telemedicine, or nurse advice line services

Use tele-triage methods for assessing and caring for all patients to decrease the volume of persons seeking care in facilities, especially during times of high transmission of contagious diseases such as COVID-19

Provide outreach to patients with limited technology and connectivity and offer flexibility in platforms that can be used for video consultation, or non-video options, when possible

Telehealth Reimbursement

Insurance payers and HCP professional associations have supported the transition to telehealth services during the pandemic. The Centers for Medicare & Medicaid Services (CMS) issued multiple waiverspdf icon external icon , providing flexibility (e.g., geographic location, type of health site) during the pandemic and granting payment parity between telehealth and in-person clinical care for Medicare. Medicaid programsexternal icon are administered at the state level and states can choose whether or not to cover telehealth services as an alternative to traditional in-person methods of care.

Safeguards for Telehealth Services

Understand individual federal and state regulations and restrictions, temporary mandates and directives, and expiration dates

Monitor for updated regulatory actions for healthcare systems and HCP

Regional systems that provide services in multiple states must be particularly attentive to individual state requirements

HCP should track eligibility criteria based on their specific profession

Maintain awareness of the Office for Civil Rights (OCR) announcements related to HIPAA and COVID-19external icon

Train providers and staff on policies, practices, and protocols for using telehealth services, including appointment scheduling, documentation and billing, referral processes for specialty care, urgent and emergent care, laboratory services, pharmacy prescriptions, medical equipment, and follow-up visits

Explore the use of telehealth services in all parts of the healthcare delivery system including FQHCs (federally qualified health centers)external icon , community clinics, pharmacies, and school-based health centersexternal icon

Potential Limitations of Telehealth

Interstate licensure challenges and other regulatory issues that may vary by state

Situations in which in-person visits are more appropriate due to urgency, underlying health conditions, or inability to perform an adequate physical exam

The need to address sensitive topics, especially if there is patient discomfort or concern for privacy

Limited access to technological devices (e.g., smartphone, tablet, computer) needed for a telehealth visit or connectivity issues

Level of comfort with technology for HCP and patients

Cultural acceptance of conducting virtual visits in lieu of in-person visits by HCP and patients

References

³ American Medical Association, 2020. AMA Digital Health Research: Physician's motivation and requirements for adopting digital health-adoption and attitudinal shifts from 2016 to 2019. https://www.ama-assn.org/system/files/2020-02/ama-digital-health-study.pdfpdf icon external icon

¹¹ Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergencypdf icon external icon

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essential health services during covid-19

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benefits and limitations of telehealth during covid

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pros and cons of telehealth during covid

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Changes in the way that health care is delivered during this pandemic are needed to reduce staff exposure to ill persons, preserve personal protective equipment (PPE), and minimize the impact of patient surges on facilities. Healthcare systems have had to adjust the way they triage, evaluate, and care for patients using methods that do not rely on in-person services.

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How coronavirus turned telemedicine into the new face of health care

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How coronavirus turned telemedicine into the new face of health care

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The coronavirus pandemic has overwhelmed hospitals, physicians and the medical community. That's pushed telemedicine into the hands of providers and patients as the first response for primary care. Telemedicine isn't new to the medical community. It just hasn't been embraced widely before the pandemic. Here's how it works and what it means for the future of health care.

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How coronavirus turned telemedicine into the new face of health care

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1. Have you ever used telehealth for your personal health purpose, or have you used it at your work practice? How’s your experience of using telehealth?

2. Do you have any concerns about telehealth? As a nurse informaticist, how would you address these concerns?

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Telehealth is defined as the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration (HRSA, 2021).

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Hearing a lot about telehealth lately? It's not a coincidence. Telehealth is a great way to get the health care you need while still practicing social distancing.

What does telehealth mean?

Telehealth - sometimes called telemedicine - 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. If you have a phone or a device with internet access, you already have everything you need to get medical care or services through telehealth - you may be able to:

Talk to your doctor live over the phone or video chat.

Send and receive messages from your doctor using chat messaging, email, secure messaging, and secure file exchange.

Use remote patient monitoring so your doctor can check on you at home. For example, you might use a device to gather ECG or other vitals to help your doctor stay informed on your progress.

What types of care can I get using telehealth?

You might be surprised by the variety of care you can get through telehealth. Your doctor will decide whether telehealth is right for your health needs.

If you need care - especially during COVID-19 - it's worth checking to see what your telehealth options are.

For example, you may be able to get:

General health care, like wellness visits

Prescriptions for medicine

Dermatology (skin care)

Eye exams

Nutrition counseling

Mental health counseling

Urgent care conditions, such as sinusitis, back pain, urinary tract infections, common rashes, etc.

Benefits of telehealth

Although virtual visits may not be as common as traditional in person doctor's appointments, there are many benefits that explain why this type of care is growing in popularity.

Limiting physical contact reduces everyone's exposure to COVID-19

Visiting virtually can address health issues wherever patients are, even from the comfort of home

Staying put cuts down on commuting, travel in bad weather, time off from work, need for child care

Using virtual health care tools can shorten wait times to see a provider and expand the range of access to specialists who live further away

Telehealth isn't a perfect fit for everyone or every medical condition. Make sure you discuss any disadvantages or risks with your doctor.

Get tips for finding a doctor who provides telehealth.

Disclaimer: The reference to named video- and text-based communications software for telehealth is informational and not intended as an endorsement of those services.

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What is telehealth? | Telehealth.HHS.gov

# data[].attributes.attachment_link.description
Hearing a lot about telehealth lately? It's not a coincidence. Telehealth is a great way to get the health care you need while still practicing social distancing. Telehealth - sometimes called telemedicine - 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.