Telehealth: From Video Visits to Strategic Business

COVID-19 CATALYZED innovation in healthcare. When social-distancing protocols created an obstacle to providing in-person patient care, telehealth bridged the gap, and virtual video visits went from a rarely used alternative to common standard of care almost overnight. Demand for an interconnected, collaborative model of care that puts patient participation through technology at the forefront of health management is on the rise.

Early Forms of Telehealth

“Tele” simply means “at a distance.”¹ People have been innovating ways to communicate vital health information from one geographic location to another for centuries, the earliest forms of which included smoke signals, communication drums and reflective devices — anything that could be used to transmit important information about a health situation.²

Today, telehealth involves “the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance.”³ In broad terms, telehealth connects patients who need care with providers who deliver it from far away.

Modern Telehealth

Digital tools connected patients with providers long before COVID-19 necessitated virtual visits through online dashboards, email communication and automated prescription refills. These tools gave patients access to providers, as well as their personal health information, which enhanced overall quality of care.

But other forms of telehealth were not yet widely embraced. Asynchronous telehealth, often referred to as “store-and-forward” telehealth, was possible, but restricted. It allowed providers to collect patient data via virtual interviews, as well as compile and share patient information such as MRIs, X-rays and lab work among members of the care team. Evaluation could occur outside of real-time interactions from anywhere.

Further, technology for synchronous, face-to-face virtual video visits also existed before the pandemic, but it was not widely used either. Concerns about access to the technology necessary for video visits, cost for services rendered and quality of care gave patients and providers pause. Video visits were mostly reserved for rural patients without immediate access to healthcare professionals, but even rural usage was low.⁴ Reimbursement restrictions and regulatory red tape made it difficult to implement telehealth technologies across the board.

The COVID-19 Catalyst

The COVID-19 public health emergency forced providers to embrace emerging telehealth technologies to stay afloat during an uncertain time. Video visits quickly went from rarely used to heavily relied upon. In addition to triaging suspected cases of SARS-CoV-2 infection, video visits were also used to perform routine primary care visits, monitor chronically ill patients and perform inpatient and outpatient support. Because patients could be “seen” by a medical provider at a distance, video visits protected both patients and providers from possible COVID-19 exposure regardless of the reason patients were seen.

When it became apparent that the situation warranted lifting regulations restricting the use of telehealth services, payers were quick to modify their existing rules to ensure services were available to meet patients’ needs.⁵ Eliminating restrictions on when and how providers could use telehealth according to Medicare’s fee-for-service model made it accessible to a larger population of patients.

Virtual video visits are now widely accepted by patients as part of their providers’ standard of care. In fact, more patients accept — and even expect — them now versus even just three years ago.

A study conducted by the National Center for Biotechnology Information assessed patient use of and satisfaction with telehealth services before and during the COVID-19 pandemic and found that both “patients and healthcare providers have a high level of satisfaction with use of telehealth” and reported willingness to continue using video visits after the pandemic.⁶

Telehealth Tomorrow

The pandemic changed more than healthcare delivery; it also altered the way patients interact with their own health, a change that catalyzed innovation of tools to meet evolving expectations. Going forward, telehealth will be about more than providing virtual urgent care visits to mitigate the spread of COVID-19. It’s increasingly about leveraging emerging technologies to improve access to, convenience of and collaboration with healthcare.

• Access. Telehealth expands access to specialty care by connecting patients to the healthcare professionals they need, particularly in rural areas where specialists may not be available. It helps offset provider shortages across the country by giving patients another option for receiving care. It also allows providers to consult with other more specialized providers on an as-needed basis.
• Convenience. Patients are increasingly behaving like consumers; they want quality service at a price they can afford. Emerging telehealth technologies give patients the power to get the care they need, when and where they need it, at a price they can more easily afford, without the hassle or headache of traditional office visits. Decreased wait time and increased access to specialists located far from home make telehealth desirable. Digital front doors streamline health management, making it easier and more convenient for patients to engage with their care team, schedule appointments, refill medications and more.⁷ Decentralization of services allows for in-home data collection: patients to conduct tests from the comfort of their own home.
• Collaboration. Telehealth gives stakeholders tools to work together to improve the quality of patient outcomes. Providers are increasingly able to consult with each other across organizations through targeted collaborative agreements.⁸ Patients want to play an active role in managing their own health, and telehealth tools are giving them a way to do so.

Moving Toward Mobile Health and Remote Patient Monitoring

Interconnected engagement is at the heart of the future of telehealth, particularly in terms of specialized medicine. Consumer-driven mobile health apps and patient monitoring equipment enable patients and providers to stay in sync as they partner to manage an array of conditions.
Mobile Health, or mHealth, refers to mobile app-based tools that give patients an active role in managing their care while communicating real-time data to healthcare professionals. AndHealth is one such app designed to help patients identify and address the root cause of chronic illnesses. It integrates action plans, behavior trackers, video chats, one-on-one health coaching, lab work and prescription management.⁹

Another example of mHealth is Healthy.io, an app that uses the power of the smartphone camera to increase access to medical testing. Currently used for kidney disease testing, Healthy.io’s medical selfie technology shows promise for other chronic conditions as well by providing clinical results at crucial moments. It closes gaps in access and care, while increasing patient satisfaction and reducing costs. Patient data is digitized in a format that can be easily analyzed by artificial intelligence and shared across systems.¹⁰

Remote patient monitoring (RPM) uses technology to monitor and collect patient health data in real time, outside of a traditional clinical setting. It offers clinicians deeper insight to and tracking of symptoms needed to monitor a patient’s condition remotely. One example is a continuous glucose monitor that reminds diabetics to take their insulin, allows clinicians to monitor disease and remotely sends blood pressure and blood oxygen levels. An estimated 70.6 million U.S. patients will use RPM tools by 2025.11

Toward a Connected Future

COVID-19 catalyzed development of technologies that are reimagining the way patients and providers communicate, gather and share information and participate in healthcare management. Expectations for convenient, connected care will continue to drive innovation for tools to meet specialized needs, enhance patient experience and improve overall health at lower costs.