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Telemedicine can be traced back long before the internet, video conferencing, and phones.  Ancient hieroglyphs and smoke signals were some of the earliest forms of telemedicine.  The sharing health information evolved during the Civil war with the use of the telegraph.  Telemedicine continued to grow with the introduction of the telephone and its use during the Korean and Vietnam wars.   Then in the 1950’s, the television and videoconferencing helped expand the concept of telemedicine.  In the 1970’s the Space Technology Applied to the Rural Papago Advanced Health Care (STARPAHC) project allowed NASA to develop technologies to provide medical support to rural and crisis areas.  The internet phenomenon of the 1990’s changed the way telemedicine was used allowing for great improvements in sharing information, images, real-time video and audio, X-rays, scans, ECG, and vital signs.  In the 2000’s, the revolution of the mobile phone, apps, and electronic technologies increased the accessibility of telemedicine services.  According to the 2019 Pew Research Center on Americans, 90% use the internet, 81% own a smartphone, and approximately 75% own a computer.  The increase in mobile technologies was critical to the use of internet becoming mainstream in healthcare.  Today’s telemedicine services looks very different from that of the past.  Patients can gain access to real-time information from the comfort of their homes.  Medical providers can monitor patients through measurement devices through synchronous telemedicine.  They can also access electronic medical records and obtain interpretations of labs, X-rays, and scans from providers in other states or countries through asynchronous telemedicine.

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The utilization of telemedicine increased from 35% to 76% between 2010 and 2017, respectively.  Insurance claims also increase to 53% by 2017.  The highest utilizers are radiologists, psychiatrists and cardiologists with utilization at rates of 39.5%, 27.8% and 24.1%, respectively. The lowest utilizers are allergists/immunologists, gastroenterologists and obstetrician/gynecologists at rates of 6.1%, 7.9% and 9.3%.

Overall, the United States utilizes telemedicine services at a higher rate than other countries.  In other countries will only pay for for preventative or health consultation telemedicine visits that have proven improvements in quality of care.

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During COVID-19, the CDC analyzed deidentified encounter data from four of the largest healthcare providers.  According to the analysis, telemedicine visits increased by 50% in the first quarter of 2020 in comparison to the first quarter of 2019.  About 93% of the encounters were for non-COVID related conditions. According to the CDC, 69% of the telehealth encounters were for adults aged 18–49 years.

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Several of the existing laws and regulations limit further implementation of telehealth services.  HIPAA laws, which allows for stricter state laws to supersede the federal statute, add to these limitations and confusion. This web of federal and state laws makes identifying and complying with general information exchange and consent laws a difficult task that leads to facilities, providers, and health maintenance organizations to believe that data sharing via HIE is prohibited. As such, the Secretary of Health waived federal regulations to override state laws with more severe privacy protections of health information exchange (HIE) during the COVID-19 state of emergency through a Stafford Act declaration.  As a result, several states began to lift telehealth and telemedicine restrictions allowing patients access to much needed medical services.  Lifting these restrictions also allowed information to flow across from one provider to another provider without impediment.    The Journal of the American Medical Informatics Association, suggests a three tear approach to lifting the restrictions and ensuring continuity of care.  First, for the duration of the State of Emergency, all states must allow medical information regarding COVID-19 patients to be transmitted with the patient’s consent.   Secondly, the Office for Civil Rights must create a safe harbor BAA that covers entities and can be quickly adopted for the exchange of information about COVID-19. Currently, HIPAA requires a BAA for the exchange of health information through a health information organization.   Lastly, the Office of Civil Rights should issue guidance that clarifies that the minimum necessary rule for transmission of data does not apply to public entities.  According to the article, these public entities should have free access to COVID-19 patients electronic health records and information

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A few advantages of telemedicine includes healthcare providers ability to communicate with patients 24/7 via webcam-enabled computers and smartphones.  Technology has also been improved to incorporate the clinical setting and make telemedicine more scalable.  Plug-and-play telemedicine devices cover gaps at a low cost.  Telemedicine has also offered a low-cost solution for safe treatment during a pandemic.  With 85% of adults using the internet and 71% owning a smartphone, telemedicine has been able to expanded healthcare services to rural areas where specialist and other providers were previously unavailable, improving access to care. Telemedicine has also been shown to significantly reduce the cost of care.  In the future telemedicine, may bridge other gaps like those created by physician shortages, increasing patient follow-up after hospitalization, and decreasing the time it takes to receive care.

A few disadvantages include the lack of consumer awareness.  Approximately 72% of consumers in rural areas and 70.3% of consumers in suburban areas were unaware that telemedicine services existed.  Studies also show that consumer that currently lack access to care may lack access to telemedicine services as well.  Many of these consumers will not have access to internet or the knowledge of how to use the internet or telemedicine devices or applications.  Furthermore, telemedicine does not allow a medical provider to perform a physical examination; therefore, limiting the types of services that are appropriate for telemedicine.  Advancements in technology continue to close the gaps related to physical exams.

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American Hospital Association. (2019, February). Fact Sheet: Telehealth. Retrieved from American Hospital Association: https://www.aha.org/system/files/2019-02/fact-sheet-telehealth-2-4-19.pdf

Kichloo, A., Albosta, M., Dettloff, K., Wani, F., El-Amir, Z., Singh, J., Aljadah, M., Chakinala, R. C., Kanugula, A. K., Solanki, S., & Chugh, S. (2020). Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA. Family medicine and community health, 8(3), e000530. https://doi.org/10.1136/fmch-2020-000530

Lenert, L., & McSwain, B. Y. (2020). Balancing health privacy, health information exchange,. Journal of the American Medical Informatics Association, 1-4.

Lisa M. Koonin, D., Brooke Hoots, P., Clarisse A. Tsang, M., Zanie Leroy, M., Kevin Farris, M., Tilman Jollyend, M., . . . Aaron M. Harris. (2020, October 30). Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020.

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Why Innovative Uses of Telehealth should be Championed

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Why Innovative Uses of Telehealth should be Championed

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Why Innovative Uses of Telehealth Should Be Championed | Christine Zack | TEDxReno