The Truth of Telehealth

During the summer of 2020, my whole world stopped when my right knee alarmingly swelled up, causing me unbearable pain and immobility. As everyone around me was using their free time during quarantine tobake, exercise, craft, and more, I was stuck in bed, unable to even walk downstairs to pour myself cereal in the morning. I rested, elevated, and iced my knee, yet the swelling, redness, and puffiness raged on. I started watching YouTube videos to practice ‘yoga for knee pain’ or to find therapy videos about exercises I could do to lessen the pain and increase mobility. Months went by with little improvement. Unfortunately, during the heat of the pandemic, with populations stricken with COVID-19 and doctors and hospitals stretched thin trying to treat Covid patients, my mysterious knee injury was not a top priority case, and I was unable to book an appointment with the doctor. Finally, almost two months after my symptoms first reared their ugly head, I was able to get an appointment with the orthopedic doctor. The catch: the appointment was online. 

The coronavirus pandemic undoubtedly hit the globe like a storm. Reducing staff exposure to infected peoples, preserving personal protective equipment (PPE) for the first responders treating COVID-19 patients, and minimizing non-COVID infected patient surges at facilities were prioritized in order for the medical community to effectively respond to COVID-19 (CDC, 2020). In-person services were no longer an option for non-COVID-19-afflicted people needing medical treatment, for their exposure to coronavirus would be greatly increased if they were to step foot in a medical facility treating the disease. Therefore, telehealth services and technology have now grown to dominate the healthcare field as an effective and easy solution to connect healthcare professionals and patients and to treat patients while minimizing the transmission risk of the coronavirus (CDC, 2020). These online services are slowly finding their way into the norms of healthcare practices, and they are truly revolutionizing the healthcare field. In order to properly analyze the effects of telehealth in healthcare, it is necessary to examine its benefits, shortcomings, and future role in medicine, even after the long-awaited end to the coronavirus pandemic. 

To begin with, telehealth is the “broad range of technologies and services to provide patient care and improve the healthcare delivery system”, including clinical and non-clinical services, such as administrative meetings or medical education (Cranford, 2020, p.1). Telehealth also includes the subset telemedicine, which “involves the use of electronic communications and software to provide clinical services to patients without an in-person visit” (Cranford, 2020, p.1). These two methods display a balance of medicine and technology that can be adopted by the healthcare field to make healthcare available and safe during the pandemic. 

The CDC explains that telehealth is divided into three further modalities that allow healthcare professionals and patients to connect and interact using technology. These include: 

• Synchronous: real-time audio-video/telephone interactions between the professional and patient, 

• Asynchronous: messages, images, data are collected and interpreted by the professional at a later time, 

• Remote patient monitoring: direct transmission of patient’s information from a distance to the healthcare provider 

(CDC, 2020, p.1). 

It is also important to note the numerous benefits of telemedicine/telehealth and its ability to effectively provide healthcare. First of all, telemedicine simply requires a web camera and a secure patient portal for the healthcare professional and patient to effectively interact (Thomas, 2018). The long waiting times, high cost of consultation visits, and patients’ lack of access to their own medical records are issues that we might have faced when interacting with healthcare professionals; however, telemedicine can actually eradicate these issues with its convenience and reliability. In fact, telemedicine can even provide better health outcomes: the easy access to patient records makes prescriptions more accurate and second opinions on health issues more accessible (Thomas, 2018). These benefits made the telemedicine fields of teleradiology, telemental health, telecardiology, home telecare, and even teledermatology accessible and affordable to patients (Thomas, 2018). 

Moreover, telehealth can be used to provide coaching and support for patients with chronic health conditions or in need of physical or occupational therapy, monitor clinical signs of chronic conditions, engage in case management for patients with difficulty accessing care, follow up with patients, and even provide education and training for healthcare professionals (CDC, 2020). The uses and benefits of telehealth and telemedicine are truly innumerable, and with prolonged use, they only continue to grow. 

Additionally, telehealth not only helps the patient, but the healthcare professional as well. According to a study performed by the American Medical Association, the improved efficiency and increased patient safety of telemedicine motivated physicians to use digital health tools, which actually helped address physician “burnout” (AMA, 2020). Using telemedicine allowed physicians to see more patients, provide a new stream of revenue, and differentiate their practice--factors that all helped decrease physician burnout and increase physician productivity (AMA, 2020). 

Fig.1. “Improved efficiency and increased patient safety remain the top motivators for physicians to use digital health tools” AMA (2020)

Telehealth has actually been practiced by the medical community for a few years, but it has grown in importance and necessity during  the pandemic. Not only do telehealth services provide access to the physician, but they also cover the emergency department, initial nursing facility and discharge, home and therapy visits and services (HHS, 2020). The Centers for Medicare & Medicaid Services (CMS) has also issued waivers providing flexibility during the pandemic depending on location, type of health service, etc. (CDC, 2020). Additionally, most insurance plans, Medicaid, and Medicare also cover telehealth services, making it truly accessible to the majority of the population (HHS, 2020). 

However, telehealth is still in its developing stages, and it is not without its faults. The CDC outlines several drawbacks of telehealth that still need to be addressed. These include the difficulty of addressing sensitive topics and patient privacy virtually, accessing technological devices or connectivity issues, ensuring appropriate levels of comfort with technology for both the healthcare provider and the patient, and securing cultural acceptance of virtual healthcare compared to in-person visits using telehealth (CDC, 2020). 

Moreover, the WHO discusses some of the shortcomings of telehealth on a global scale. They discovered that telemedicine is far less progressed in low-income countries than in high-income countries, and there is a lack of national agency to promote the use of telemedicine in such areas (WHO, 2010). The WHO also found that if the existing technological infrastructure of a region is too underdeveloped for telemedicine programs to be effectively implemented, these areas need to first develop “e-government, e-commerce, or eLearning” infrastructure virtually before they can transition to e-medicine (WHO, 2010, p. 83). Finally, the issue of maintaining patient confidentiality is a fear when technology is used to provide healthcare services. Telemedicine needs to be totally secure and invulnerable to interceptions to ensure that patient information remains wholly confidential. However, no matter how secure the patient portals may be, there is always a risk of hacking and infringement of personal privacy. 

My personal experience with telehealth was very beneficial for me, but it was not without its flaws. I was able to show my swollen knee and visual symptoms of my knee immobility (inability to climb stairs, squat, bend knee, etc.) to the physician, but they were not able to touch or examine the knee in person to make an accurate diagnosis. My physician was able to provide me with simple exercises, therapy, and home remedies to assist with the knee pain, but it was only after my in-person clinical visit and subsequent MRI that I was diagnosed with a knee effusion (fluid accumulation in my knee joint) which was causing all my issues. Soon after the diagnosis and understanding of what was wrong with my knee I was able to take the appropriate medication and therapy I needed to fix my health issue, and now I am almost back to full range of motion with my knee. However, despite the challenges, I am still eternally grateful for the role of telemedicine in providing me access to medical professionals during a global pandemic and reducing my risk of exposure to COVID-19 through my virtual health visits. I am extremely hopeful to see the progressive strides that telehealth and telemedicine will take in the future to further improve the quality and effectiveness of healthcare for all. 

References

AMA digital health care 2016 & 2019 study findings. American Medical Association. (2020, February). https://www.ama-assn.org/system/files/2020-02/ama-digital-health-study.pdf. 

Cranford, L. (2020, May 4). Telemedicine vs. Telehealth: What's the Difference? Chiron Health. 

https://chironhealth.com/blog/telemedicine-vs-telehealth-whats-the-difference/.

Secretary, H. H. S. O. of the, & Assistant Secretary for Public Affairs (ASPA). (2020, July 15). Telehealth: Delivering Care Safely During COVID-19. HHS.gov. 

https://www.hhs.gov/coronavirus/telehealth/index.html.

TELEMEDICINE - WHO. World Health Organization . (2010). 

https://www.who.int/goe/publications/goe_telemedicine_2010.pdf.

Thomas, D. L. (2018, August 23). What is Telemedicine? News. 

https://www.news-medical.net/health/What-is-Telemedicine.aspx.

Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic. (2020, June 10). https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html.