The provision of healthcare remotely by means of telecommunications technology.
The future of telehealth
Introduction — COVID-19
As clinics and hospitals restrict access to clinicians and cancel non-essential appointments in an effort to mitigate the spread of COVID-19, the use of telehealth services is increasing dramatically. Although telehealth services are still in their infancy at many healthcare institutions, some have started offering innovative telehealth solutions in response to COVID-19. Telehealth services include e-visits and interactions, telephone or video visits through a computer or smart device, and make it all more comfortable and satisfactory for many patients.
Artificial intelligence (AI) will play an even bigger role in future telehealth care. AI is becoming more mainstream in various clinical settings, enabling more evidence-based research to be integrated in the provision of every component of medical care, transforming the exam room of the future. A short-term benefit doctors will see soon is that everything will be voice enabled, including clinical documentation, which means they will be able to spend 100% of their time focused on patients rather than on data entry or paperwork.
Looking to the future, telehealth is already beginning to use AI-driven predictive analytics as a key tool in the evaluation of patient’s medical problems. Telehealth then functions as a data network to leverage research and enable early detection, faster intervention and more effective treatment. This same patient data enables administrators of a hospital or hospitals in a region to predict hospital capacity and resources. Thus hospitals in any region can operate as a telehealth network, enabling healthcare providers to monitor patient risk levels in any hospital in real time and make smart data-driven decisions about clinical resource allocation.
Continued from the emailed newsletter
New York’s Montefiore Medical Center has gone a step farther and developed a predictive analytics tool—based on integrations of claims, electronic health records, self-reported data, and other sources—to segment patient populations by risk profiles. Based on these profiles, technology like natural language processing enables a huge number of patients annually to be connected with community-based resources, digital interventions and services. These telehealth interventions have led to significant improvements in the numbers of preventable readmissions and Emergency Department visits while spotlighting the need for further improvement in health services.
Brain stimulation implants
This kind of data-driven technological progress has real benefits. A recent one is the development of brain stimulation implants intended for treatment of complex neurological diseases such as Parkinson’s and epilepsy. Telehealth now enables clinicians to be directly connected to the patient’s brain as it delivers a constant flow of patient-specific data and also patients can engage in managing their own neurostimulation therapy through a link to a mobile device. As healthcare continues its radical transformation, propelled by providers, payers and technology companies, the good news is that increasingly the focus of all participants is promoting better outcomes for patients and their wellness. All of the participants in this transformation (not just “change”) are convinced that data, AI, analytics and telehealth together have incredible potential for reinventing all dimensions of care.
Since the onset of COVID-19 some university hospitals and affiliated research centers in the U.S. have launched remarkable telehealth research and action programs. Among the most notable was a recent study led by researchers from NYU Grossman School of Medicine (part of Langone Health). The NYU Grossman School of Medicine includes a Center for Healthcare Innovation and Delivery Science (CHIDS) aimed at increasing collaboration among clinicians, researchers, educators and administrators who are working together to research and redesign the future of healthcare delivery in order to improve patient outcomes.
In the course of its telehealth research project, NYU Langone unexpectedly experienced a veritable explosion of urgent care and non-urgent care visits in response to COVID-19. Fortunately NYU Langone benefited from early investment in and development of telehealth technology. In addition, NYU Langone had been able to negotiate relaxation of federal and state restrictions on telehealth services and limitations of coverage by insurers. As a result, over just a six-week period, more than 140,000 video visits involving over 115,000 patients amounted to a veritable crash course in telemedicine even for this highly experienced medical research center. Their pool of emergency medicine providers increased from 40 to almost 300 in various specialties. Through all of it, amazingly, patients' satisfaction ratings with telemedicine visits remained positive.
The Federal Government and its Centers for Disease Control and Prevention (CDC) should have learned invaluable lessons from NYU Langone’s demonstrated ability to scale and expand telehealth quickly, prevent overcrowding and the spread of the disease. We don’t know what the CDC learned from this research project but we do know that, once considered merely a complementary mode of care, telehealth has become essential during COVID-19 to enable clinicians to quickly scale up virtual care offerings regardless of location, conserve critical supplies, and curtail exposure to COVID-19.
Very promising is the FCC COVID-19 Telehealth Program that provides $200 million in funding to help post-secondary educational institutions, community health centers, not-for-profit hospitals, community mental health centers and other local health agencies to more effectively utilize telehealth technology. Participating healthcare organization will be able to test different telehealth delivery models and to evaluate their cost, effectiveness, and improvement in quality of care.
Another insight from NYU Langone and other comparable research programs was that government action on a large scale was essential. Based in part on the results of such research, a $2 trillion coronavirus response bill was signed by President Trump that included temporary waiving of Medicare’s geographic restrictions on telehealth and broadening the types of telehealth devices allowed to conduct a visit. President Trump also signed into law the Coronavirus Preparedness and Response Supplemental Appropriations Act that included $8 billion in emergency funding and also authority for the Department of Health and Human Services to waive certain Medicare requirements to expand reimbursement for telehealth services. Several states have also temporarily waived certain licensure and other restrictions to permit greater utilization of telemedicine services during this public health crisis. The importance of these changes in reimbursements and regulations for telehealth services cannot be overstated.
In addition to the previously discussed lifting of several Medicare restrictions on the types of and eligibility for telehealth service reimbursement during the pandemic, we have seen the relaxation of HIPAA privacy laws that allow the use of smartphones, video conferencing platforms such as Zoom, and messaging services like WhatsApp, and also the ability to provide patient care across state lines (in 48 states). These have also helped increase implementation.
Despite these developments, however, state telehealth licensure processes have been expensive, time-consuming, and onerous. Regulations and policies vary across state lines, and remain prohibitive in some. Providers of telehealth services licensed in one state cannot provide these services across state lines. Even as investment increases and resolves financing issues, these regulatory hurdles are obstacles that will prevent a wider adoption at exactly the time when we stand to benefit the most: in the middle of a pandemic against which our main weapon is reducing physical contact as much as possible.
Due to the COVID-19 pandemic, most clinics and hospitals have restricted in-person delivery of non-essential healthcare services to slow the spread of the virus. However, delaying the diagnosis of health problems and risks can be problematic and even deadly. Because many medical professionals are unable to see patients in person due to the pandemic, we’re seeing them increasingly turn to telehealth out of necessity. Many clinics that used a mixture of in-person and telehealth services in the past have now transitioned to using only telehealth services due to the pandemic. SJFL will closely watch trends in how healthcare professionals are using technology to communicate with patients, deliver results, and provide support to patients during this time, and what medical professionals are reporting about technical difficulties, privacy concerns, decreased rapport-building, and increased access to services.
Best wishes to all from the St. James Faith Lab team!
The Rev. Canon Cindy Evans Voorhees
St. James Faith Lab