No one enjoys going to medical offices. What is there to love about sitting in a waiting room surrounded by sick people? And who wants to get in the car, or worse—public transit, and leave the house when they feel sick? This is especially true when the illness or condition could easily be diagnosed and treated by having a conversation with a healthcare provider.
“At least 80%, if not more, of what we do as primary care doctors is to listen, to observe, and to ask questions,” says Georgine Nanos, MD, MPH, a physician and CEO of Kind Health Group in California. “This is how we arrive at most diagnoses.”
It’s no surprise that telehealth is gaining popularity in the United States. It’s convenient, it’s cost-effective, and it keeps patients safely away from each other—something that is especially important for protecting public health during the coronavirus pandemic.
What is telehealth?
“Telehealth is a method of delivering clinical health services to patients at a distance using interactive audio and video telecommunication,” explains James R. Powell, MD, CEO/CMO of Long Island Select Healthcare. “Telehealth can be used to provide just about any type of service that doesn’t require the doctor to smell or touch the patient. In general, telehealth helps people get access to the care they need by overcoming the barriers of distance, time, quarantining, stigma, and/or the patient’s own lack of mobility.”
Telehealth can be used in a variety of settings:
- At home, by individuals connecting with healthcare providers
- At schools, to connect with a healthcare provider for advice on care for an ill or injured student
- In hospitals, to consult with specialists in another city
- In seniors’ residences and care facilities, particularly ones locked down due to an outbreak like COVID-19, for medications, follow-ups, assessments, and therapy sessions
- For remote patient monitoring (RPM), which sends readings from devices used by the patient at home (such as a blood pressure monitor, a pulse oximeter, or a glucose monitor) to the medical team for monitoring. This allows providers to send messages back to the patient or to connect via video call. COVID-19 kits, including digital stethoscopes, are currently being developed for RPM.
Some healthcare providers will provide consultations by phone—particularly during the coronavirus outbreak—but video communication is more common.
Telehealth can provide a number of services. At Dr. Nanos’ clinic, they address issues such as:
- Chronic illness follow-up
- Chronic pain follow-up
- Cough and cold
- Diabetes management
- Discussing test results
- Eye infections
- Follow-up visits
- General questions for the doctor
- High blood pressure follow-up
- Mental health follow-up such as anxiety and depression
- Medication questions, adjustments, and refills
- New fever
- Smoking cessation
- Specialist referrals
- Sinus problems
- Sleep problems
- Substance abuse counseling
- Vomiting and diarrhea
- Weight loss and wellness
Telehealth vs. telemedicine: What’s the difference?
While the terms are often used interchangeably, they refer to different practices.
Telehealth is a broad term for health services rendered remotely using communication technology, not limited to medical consultations.
Telemedicine is a subset of telehealth that meets the requirements of clinical services (the practice of medicine between a patient and a healthcare provider). Essentially, telemedicine is like a visit to a healthcare provider, but virtually, usually via video-conferencing.
Telemedicine providers are required to follow the same Health Insurance and Portability Act (HIPAA) responsibilities for virtual care as they are for in-person patient care.
Why is telehealth important during a pandemic like COVID-19?
“Telehealth supports social distancing by letting healthy people, or people with non-coronavirus conditions, receive primary and urgent care without leaving home,” says Dr. Powell. “This is critical with so many hospital beds and emergency room bays needed for coronavirus patients.”
Telehealth can also be used as a form of triage. If a patient isn’t sure whether an illness or injury requires a trip to an in-person healthcare provider, or even an emergency room, a telehealth consultation can determine severity and if further care is needed. If an in-person visit or emergency room trip is deemed necessary, the telehealth practitioner can call ahead to the ambulance, hospital, or in-person care provider with their primary assessment and information. In addition to improving the care of the patient, this is especially helpful during an outbreak like coronavirus to prepare medical staff for a potentially infectious patient.
Does insurance cover telehealth?
Many insurance providers do offer telehealth coverage, and the number of services covered is increasing. Almost every state has at least some Medicaid telehealth services covered by the program, and Medicaid and Medicare have recently instituted regulations to encourage the use of telehealth during the coronavirus public health emergency.
Blue Cross and Blue Shield have expanded their telehealth coverage in response to the COVID-19 pandemic, as have many commercial insurers.
“Ask your doctor’s office whether they are providing telehealth as an alternative to an in-clinic visit, and whether it will be covered,” says Dr. Powell. “Call your insurer to ask about telehealth coverage or go online to see your covered benefits. They may have updated their websites to reflect the answer to your questions.”
What to expect at your telehealth appointment
“Much like an in-office visit, the physician will review the medical chart and history, and then speak with the patient directly to evaluate them,” says Nishant Rao, ND, the Chief Medical Officer at DocTalkGo in California. “The doctor will ask medical questions and may request prior records or that additional lab testing be performed. The physician may write a prescription, which is then sent directly to a mail order pharmacy for home delivery or a local pharmacy for the patient to pick-up.”
Some telehealth technology requirements to consider include:
- A reliable device such as a smartphone, tablet, or laptop that enables audio/video
- A program, app, or website to connect with the care provider
- A good wired internet connection or strong wifi
- Headphones (not essential, but can be helpful with privacy and to block out noise)
How can a patient prepare for a telehealth appointment?
Before the appointment, find a private, quiet space with good lighting. Dr. Nanos suggests logging onto the program 15 minutes before the appointment. Patients should also make sure they know what to do if they become disconnected from the care provider during the appointment. The care provider may call the patient if this happens, so it’s important to ensure the provider has correct contact information for the patient.
Have any information the care provider may need handy, such as recent lab results, imaging that has been done, etc.
“The things that patients can do to prepare for a telemedicine visit are specific to the type of issue that is being addressed,” says Fernando Ferro, MD, the medical director of Mercy Personal Physicians at Overlea in Maryland. “If a patient has been sick with an infection, it is helpful if they have checked and recorded their temperature. They should have their medications handy to verify that they are taking the medications that we have listed in their chart. If the patient has hypertension, it is helpful if they have been monitoring their blood pressure at home with a home monitor and recording the readings.”
Patients should have a list of questions and concerns ready and be prepared to show the care provider anything that needs to be assessed visually, such as a rash.
What happens if a diagnosis can’t be made via telehealth?
Healthcare professionals conducting telehealth visits will determine if further consultation, testing, or treatment is needed. This may include sending the patient for an in-person consultation with a healthcare provider, advising a patient to call 911 or to go to the hospital for emergency care, or ordering lab tests or imaging.
Can medication be prescribed via telehealth?
Yes! In most cases, new prescriptions and renewals can be prescribed via telehealth, even if this is the patient’s first appointment with the care provider. Dr. Powell adds that in response to the COVID-19 crisis, the Drug Enforcement Administration (DEA) has relaxed provisions regarding prescribing controlled substances via telehealth or by phone.
The prescribing provider sends the prescription to a home delivery service or to a pharmacy. Filled prescriptions are then dropped off at the patient’s residence, mailed, or available for pick-up at the pharmacy, depending on which option the patient chooses.
What are some of the benefits of telehealth?
- Accessibility. Many patients face barriers when it comes to in-person healthcare visits. Whether due to disabilities, physical distance/living in a rural area, or transportation difficulties, many patients are able to receive medical consultations via telehealth they may otherwise have missed.
- Cost efficiency. Patients save in transportation costs and travel time, along with overall healthcare costs thanks to better access to treatment.
- Faster availability of appointment times. Care is available whenever a patient has time, and a doctor has a slot. There are more options when you aren’t limited by location.
- Flexibility. Patients and providers do not need to communicate in real time. Photos of visible conditions such as rashes, data such as blood pressure readings, or patient questions can be sent to the provider at any time. The provider can review this health information, send questions or other materials to the patient, or send instructions ahead of the scheduled appointment time.
- Lowered exposure to infection. The patient isn’t exposed to others who may be contagious, like they would be in a clinic, and healthcare providers aren’t exposed to potentially infectious patients.
What are some of the limitations of telehealth?
“There are several issues such as trauma, wound care, shortness of breath, and active bleeding that can’t be managed over a telemedicine visit,” says Dr. Nanos.
Testing such as blood work and X-rays would also require an in-person appointment to be performed, though they can be ordered through telehealth.
What is the future of telehealth?
“The current pandemic has greatly increased the use of telemedicine, and I believe that it will be more widely used after the pandemic than it was previously,” says Dr. Ferro.
Health organizations such as the American Hospital Association (AHA) are advocating for the expansion of telehealth practices and for more telehealth services to be covered by insurance.
Even before the COVID-19 crisis, the use of telehealth was on the rise. As the healthcare system continues to integrate virtual check-ins and telecommunications technology, patients can look forward to more health care services from the comfort of their own homes.
Related resources for telehealth
- Fact Sheet: Telehealth
- What’s the Difference Between Telemedicine and Telehealth?
- Innovations in Telehealth: A Lifeline for Patients and Doctors
- HIPAA Compliance for Telemedicine Providers
- Kind Health Group
- Long Island Select Healthcare
- Telemedicine benefits