Types of Telehealth
Telehealth, also known as telemedicine, refers to the provision of medical care and healthcare services from a distance. Telehealth has been offered to patients for decades, but thanks to advances in technology, healthcare providers have been able to expand the range of telehealth services they provide.
With many patients having access to a smartphone or tablet and Wi-Fi, healthcare providers have been able to significantly improve the reach of telehealth. The telehealth software solutions now available have also made providing telehealth services far easier, and healthcare providers and patients alike have greatly benefitted.
Telehealth services have been shown to cost-effectively enhance the quality of care that can be provided to patients. Studies have shown that the many different types of telehealth greatly benefit patients, and can reduce the number of patients requiring hospitalization and reduce readmissions into hospital after discharge.
COVID-19 Greatly Expanded the Types of Telehealth Services Offered
The COVID-19 pandemic greatly expanded telehealth services, not just the types of telehealth services offered, but also the number of patients who now have the option of receiving care remotely.
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Telehealth proved invaluable during the COVID-19 pandemic to prevent the spread of the virus. People who contracted COVID-19 could remain isolated while continuing to receive medical care remotely, which stopped them infecting others. Non-COVID patients could receive medical care for other conditions without being placing at risk of contracting COVID by travelling to a physician’s office or hospital.
During the COVID-19 Public Health Emergency, the Department of Health and Human Services encouraged healthcare providers to adopt and use telehealth as a way to safely provide care to patients in all appropriate situations, such as providing routine health care such as wellness visits, medication consultations, dermatology (skin care) and eye exams, nutrition counseling, and mental health counseling – all of which can easily and safely be provided by using two way communication systems such as instant messaging solutions and video teleconferencing platforms.
To make it even easier for healthcare providers to offer different types of telehealth services to patients during the pandemic, the HHS’ Office for Civil Rights adopted a flexible approach to HIPAA compliance with respect to telehealth. OCR issued a Notice of Enforcement Discretion and said it would not impose penalties for noncompliance with the regulatory requirements of HIPAA in connection with the good faith provision of telehealth during the public health emergency. The Notice of Enforcement Discretion ends on May 11, 2023, but has a 90-day grace period.
The CMS also issued temporary measures to make it easier for people enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) to receive medical care through telehealth services during the COVID-19 public health emergency. The CMS permitted Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to serve as distant telehealth sites and provide telehealth services to patients in their homes. The CMS also significantly expanded the list of the types of telehealth covered in Medicare to also include emergency department visits, initial nursing facility and discharge visits, home visits, and therapy services.
Different Types of Telehealth Technology
There are many different types of telehealth technology available, each aimed at establishing a strong connection with the patient, regardless of where they are situated. During the provision of telehealth services, healthcare providers gather important information, update patient records, and give patients medical advice to help them manage health complaints. The aim of telehealth technology is to provide patients with the same, or a better quality of care, as they would receive during an in-person consultation.
In order to provide these virtual visits, healthcare providers can use a variety of techniques and types of telehealth technology. Some of the most common ways of providing telehealth to patients are listed below:
- Telemedicine in real-time: Healthcare workers converse with patients in real-time, just as they would during an in-person consultation. The patient can be located anywhere, provided they are able to speak privately, with the only real difference being the two-way communication medium used – telephone, videoconferencing platform, or messaging service. These telehealth visits are typically conducted for medical history reviews, checkups, evaluations, and for providing some types of treatment.
- Remote patient monitoring: Healthcare providers have the ability to review patients’ progress during their treatment plan, without requiring them to visit a physician’s office for a face-to-face consultation. This is an excellent way of delivering care to patients who simply cannot make it to a health center for a physical appointment due to the travel distance/cost, time commitment involved, or because their medical condition makes such visits difficult or impossible.
- Physician collaboration: Using telehealth technologies, medical professionals can communicate with each other quickly, easily, and remotely – which improves the level of care they can provide to patients. For instance, a primary physician can quickly link up with a specialist consultant without leaving their own office. In addition to this, physicians can connect with a great many more specialists than previously possible. Many telehealth communication tools allow instant messages to be sent, eliminating the game of phone tag that often happens when using the telephone.
- Store-and-forward. One of the main reasons for using telehealth is store-and-forward. This refers to the storage of medical information such as images, test results, vital signs, lab reports, and medical documentation, all of which can easily be shared with the appropriate people. The sender and receiver do not need to be available at the exact same time. A caregiver can gather the data, upload it, share it, and leave the data for review by a different provider whenever they are available without any information loss.
- Medical imaging: Telehealth solutions speed up the sharing of X-rays, scans, and other images between a treatment team and external consultants. Using this process, images can be examined at any time by a specialist radiologist linked to the telehealth system and medical specialists can be easily consulted, no matter where they are located. They do not need to be in the same town or state. Patients can choose to get the very best care from healthcare providers no matter where they are located, without having to travel.
There are many benefits that come from providing telehealth services to patients, with all parties typically benefiting. Patients that only want in-person consultations can still choose to see their healthcare providers in that manner, but many patients are now realizing that virtual care is far more convenient and cheaper, with no reduction in the quality of care provided. Healthcare providers can also make important savings by providing healthcare services remotely and can greatly improve medical center workflows.
Key Benefits of Telehealth
1. Remote monitoring enhances doctor-patient relationships
Telehealth can be implemented to check up on patients’ medical conditions and treatment plans without the need for patients to attend a physical appointment. This method of communication allows medical staff to show patients how to look after themselves in the time leading up to their next physical appointment, ensure they are following their treatment plan correctly, and answer any questions they may have. This improves the provider-patient relationship, while also eliminating the cost of travel for the patient and the need to take time off work.
2. Improved patient reach
Healthcare clinics can literally consult with anyone who is connected to the Internet or has access to a telephone. Telehealth also allows patients in rural areas to access the best medical care, including having consultations with leading doctors and healthcare clinics, no matter where those individuals or clinics are located. Telehealth greatly improves the reach of healthcare providers and ensures all patients can receive quality medical care.
3. Cutting the amount of patient no-shows
No-shows can be incredibly costly for healthcare providers. When patients have to travel for appointments, it is all too easy for them to be delayed and miss their appointment time. The result is staff end up wasting their valuable time, which could be much better spent providing care for other patients. One U.S. study showed telehealth can cut no-show rates by up to 50%.
4. Improved clinical workflows
Offering telehealth services to patients can greatly enhance clinical workflows and improve efficiency. Telehealth platforms have been shown to make it easier and faster to prioritize patients, communication is greatly improved, there is more reliable data capture, and the analysis of patient data is accelerated for improved decision-making. A report from The Medical Group Management Association (MGMA) showed most of the best performing clinics in the United States have implemented telehealth and have reaped the benefits.
5. Increased practice revenue
Medical practices and hospitals that have started offering telehealth services to patients have achieved significant cost savings over providing physical appointments. Telehealth is a much cheaper way of providing medical care to patients, as the overhead costs per visit are significantly reduced. Telehealth takes less time, allowing doctors and medical staff to see more patients per day, which means more billable hours. Further, the software solutions required to start offering telehealth are not expensive to implement, and many integrate with existing healthcare technologies.
6. Lower patient costs
Typically, a telehealth visit involves a doctor or nurse consulting with the patient via a phone, laptop, or another digital device. This cuts the money that would have to be spent by the patient on fuel or travel, parking, babysitting, and leave from work, which makes healthcare much more affordable for patients who have to pay for – or contribute towards – healthcare costs.
7. Higher patient satisfaction scores
Studies conducted by telehealth solution providers show that telehealth has proven incredibly popular with patients. Telehealth has been well received by patients, who have provided excellent feedback and reviews from using telehealth platforms. Those positive reviews translate into better patient satisfaction scores for healthcare providers.
8. Patients receive better healthcare
There have been several studies conducted that show telehealth improves the quality of healthcare provided to patients, especially for individuals in rural locations who cannot physically attend appointments easily due to the distances they would need to travel and the associated costs. The adoption of modern technology has also helped to reduce footfall in emergency rooms in hospitals, as many unnecessary visits are prevented through telehealth consultations. With a reduced workload, ER staff can concentrate on the patients that require emergency care and provide essential medical care more quickly and efficiently, which can improve patient outcomes.
Compliance Requirements for Telehealth Nursing
With telehealth there are no physical barriers. Telehealth nursing can be provided to a patient anywhere in the United States using a smartphone, tablet, or computer and an instant messaging app, teleconferencing solution, or clinical communication and collaboration (CC&C) software. However, there are legal considerations for nurses. The main stipulation is that the person providing the telehealth nursing must be in possession of a valid nursing license.
Historically, nurses were licensed to practice in a single state where they lived, which meant nurses could not practice across state lines unless they also had a separate license to practice in that state. The introduction of the Nurse Licensure Compact (NLC) made the provision of telehealth nursing far simpler. The NLC authorizes eligible nurses to practice telehealth across multiple states, while only requiring a single nursing license.
Currently, under the NLC, nurses can practice in virtually all U.S. states, with some exceptions. California, Connecticut, Hawaii, Nevada, and Oregon have no pending NLC legislation as of April 2023. NLC legislation is pending in Alaska, Illinois, Massachusetts, Michigan, Minnesota, New York, Rhode Island, and Washington.
Due to COVID-19 and the pressing need for telehealth nursing to be provided, many states have issued licensure waivers to allow physicians and nurses to provide telehealth services more easily. You can find out more about the changes from the Federation of State Medical Boards.
Nurses are also required to comply with certain standards, including the following:
- Any health, safety, and quality assurance requirements – such as those related to The American Academy of Ambulatory Care Nurses and the American Nurses Association provisions on telehealth nursing care.
- International nursing standards on telehealth: The International Council of Nursing sets standards for nurses in about 130 countries.
- HIPAA requirements: Nurses who conduct virtual visits must be trained on how to comply with the HIPAA Rules during remote interactions. That means only authorized, HIPAA-compliant technologies can be used, and the requirements of the HIPAA Privacy Rule must be followed.
Even though there are numerous benefits to conducting telehealth nursing appointments there are some potential issues with virtual visits. Telehealth can only be provided to patients that have access to the appropriate technology – such as a smartphone. Many patients requiring nursing care may lack familiarity with modern communication devices or only have old or incompatible technologies. There are also potential privacy issues, as patients may not be able to converse in an environment where they can discuss health issues confidentially.
Best Telehealth Platforms
It is impossible to determine a list of the best telehealth problems because what might be suitable for one healthcare facility may not be suitable for another. It is also the case that the best telehealth platforms for one type of healthcare provider may not be the best telehealth platforms for a different type of provider. For example, a solo practitioner will not require their telehealth platform to have as many capabilities and integrations as a physician in a large hospital group practice.
Additionally, some healthcare providers may require their platforms to transfer patient data to an EHR and for the patient’s care team to be notified automatically when certain health issues occur. For other healthcare providers, platforms with this level of sophistication may be more than is required and may represent a waste of money. Alternatively, a sophisticated telehealth platform may be too complicated to configure and use, or might not be compatible with legacy technologies.
Whatever platform is adopted by a healthcare provider, it is important the vendor is willing to enter into a Business Associate Agreement. This is because, even if the platform is suitable for all use cases, there has to be a Business Associate Agreement in place before the platform is used to create, use, store, or transmit PHI. This requirement applies even if the vendor cannot access PHI because it is encrypted due to “persistent access” guidance provided by HHS’ Office for Civil Rights.
A Warning Regarding Telehealth Solution Providers
As the provision of telehealth services accelerated during the COVID-19 public health emergency, so did the number of telehealth solution providers. Unfortunately, some newer telehealth solution providers are not as familiar with the requirements of HIPAA as those that have been providing multiple types of telehealth services for many years, and several claim to provide fully HIPAA-compliant telehealth solutions despite concerns that their knowledge of HIPAA may be lacking.
Consequently, healthcare providers evaluating telehealth solutions are advised to include at least one member of the compliance team in the evaluation process before entering into a contract with a telehealth solution provider to avoid subscribing to a service they may not be able to use – or, worse, subscribing to a service that results in HIPAA violations, impermissible disclosures of PHI, and data breaches. As ever, do your due diligence. Do not rely on the vendor’s sales pitch for compliance.
Conclusion
Telehealth was not initially developed to reform healthcare provision, but over the past few years and especially during the COVID-19 public health emergency, telehealth has been proven invaluable and has helped to significantly enhance efficiency in healthcare while reducing the cost of healthcare provision.
Telehealth services significantly expanded due to COVID-19; and, now the public health emergency has passed, it is unlikely that telehealth services will fall in popularity. All signs indicate telehealth is here to stay and will likely even be expanded further due to the benefits to providers and patients alike.
