Telehealth is undeniably part of the past, present, and future of healthcare. In the 1960s, the National Aeronautics and Space Administration began to use telemetry to study biometric data, first in animals and then humans, to assess physiologic and psychologic effects of space travel. Today, patients can have virtual office visits via videoconferencing. Clinicians text photos to each other for a new-age curbside consult and those photos can be uploaded to the patient's medical record with the click of a button. Telepharmacies are operating, particularly in rural areas, where pharmacy technicians and pharmacy residents work under video surveillance by registered pharmacists hundreds of miles away. Patients can access their medical records from their phones and communicate with their providers and schedule appointments electronically. The future of telemedicine is in the hands of health information technology innovators and entrepreneurs who are changing the face of healthcare.
The Health Resources and Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support and promote long-distance clinical healthcare, patient and professional health-related education, and public health and health administration.1 Applications of telehealth include live videoconferencing, linking the patient and provider; store-and-forward videoconferencing that uses recorded information, generally sent to specialty providers; remote patient monitoring, in which electronic technology records and transmits health and medical information for a patient in one location to a provider in another location; and mobile health, which uses mobile devices to provide medical and public health information.1
This expansive definition presents numerous opportunities for PAs and other healthcare providers to engage in the rapidly growing field of telehealth. The online-only article “Telemedicine improves diabetic retinopathy screening, prevention, and treatment” by Joanne DeTore, RPA-C, and Denise Rizzolo, PhD, MS, PA-C, in this issue reviews the effect of teleophthalmology in screening patients for diabetic retinopathy, a leading cause of blindness in adults. The data reported in the article show that telemedicine improves access to eye care, improves adherence to annual eye screening recommendations for patients with diabetes, improves rates of early detection and therefore early treatment of diabetic retinopathy, and reduces the cost of screening patients for diabetic retinopathy. The article confirms the power of technology to transform health despite limitations to these services.
Telehealth applications are being used to meet the triple aim of the Affordable Care Act, which seeks to improve the quality of patient care (including measurable patient outcomes and increased patient satisfaction), improve the health of populations, and reduce the cost of healthcare.
According to the 2018 US Telemedicine Industry Benchmark Survey, some of the greatest benefits of telehealth involve increased patient satisfaction, improved patient engagement in their healthcare, and an enhanced overall patient experience.2 Healthcare systems also are successfully using telehealth services to improve access to care for patients living in rural areas.2
The 2017 American Well consumer survey found that patients are interested in seeing a clinician via videoconferencing because they can get a video appointment more quickly than a face-to-face appointment and because video appointments (which do not require travel and clinic wait time) are less disruptive to a patient's day.3 Most patients, including 72% of parents of children under age 18 years, were willing to see healthcare providers over video.3 Additionally, patients reported greater satisfaction with the treatment of their health problems in video compared with in-person office visits.3 Patients are now choosing healthcare plans that cover telehealth and choosing providers who offer telehealth services. Many patients are even willing to pay out-of-pocket for telehealth services.3
Despite these benefits, challenges remain to the widespread use of telehealth services. Significant discrepancies exist between state laws on the provision of and payment for telehealth services.2 Restrictions to Medicare and Medicaid reimbursement and the debate over parity (whether telehealth visits should be reimbursed at the same rate as in-person visits) challenge the ability of telehealth programs to expand. Integrating telehealth services into existing electronic health records (EHRs) adds an additional layer of complexity to the EHR and can increase the administrative burden of busy clinicians. Additionally, healthcare systems must ensure the security of two-way communications and compliance with patient privacy laws. Clinicians also must be proficient in the use of available technologies while recognizing the limitations of such technologies when it comes to providing patient care.4
Careful patient selection is crucial for the success of telehealth programs because not all types of office visits are appropriate for remote visits. The increased patient satisfaction of telehealth visits may be due in part to appropriate patient triage. Conditions that are well suited for telehealth are those that can be treated without the need for a physical examination or point-of-care testing, including care of patients with stable chronic diseases, postsurgical follow-up, after-hours care, geriatrics, prescription refills, and appointments for women who desire birth control.2
The pitfalls of telehealth are not insurmountable and telehealth programs are expanding across all care settings. But, as patient satisfaction and desire for convenient healthcare push us toward more telecommunication and less in-person communication, are we losing the art of medicine in favor of the business of medicine? Are we choosing efficiency over relationships with our patients, or will we have better relationships with more satisfied patients? To me, it is a bit like my morning cup of tea. Sometimes I enjoy the ritual of a warm, steaming mug and the connectedness that comes from sharing it with a beloved friend or relative. Other times, I use an app to order ahead and sip my tea from a to-go cup as I get on with my day. I get a cup of tea either way; it is the experience that changes.