Types of Telehealth
Telehealth, otherwise known as telemedicine, refers to the provision of medical care and healthcare services from a distance. Telehealth has been offered to certain 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 WiFi, 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 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. There are also cost benefits to providing remote healthcare services. Healthcare providers can cut costs, and receiving remote care over the phone or through HIPAA-compliant messaging and videoconferencing solutions is much cheaper for patients, especially those in rural locations and areas with poor access to healthcare facilities.
COVID-19 Greatly Expanded the Types of Telehealth Offered to Patients
The COVID-19 pandemic has greatly expanded telehealth services, not just the types of telehealth offered, but also the number of patients who now have the option of receiving care remotely. Telehealth has proven invaluable during the COVID-19 pandemic to prevent the spread of the virus. People who have contracted COVID-19 can remain isolated while continuing to receive medical care, which stops them infecting others, and non-COVID patients can receive medical care for other conditions without placing them at risk of contracting COVID when they travel to visit a physician’s office or hospital.
During the COVID-19 Public Health Emergency, the Department of Health and Human Services has 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 teleconferencing platforms.
To make it even easier for healthcare providers to offer different types of telehealth to patients, the HHS’ Office for Civil Rights has 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 under the HIPAA Rules against covered healthcare providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.
For example, covered health care providers could, by exercising their professional judgement, request to examine a patient exhibiting COVID- 19 symptoms using a video chat application, examine patients for a variety of other health issues, or provide treatment using telehealth instead of in-person consultations. Further, tools such as Zoom, Google Hangouts, Zoom, and Skype can be used to provide these services for the duration of the public health emergency, even if they would not, under normal circumstances, be classed as fully compliant with the HIPAA Rules.
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.
While there were geographical restrictions in place prior to the pandemic, during the COVID-19 public health emergency, any healthcare provider eligible to bill Medicare can bill for telehealth services, regardless of where the patient or provider is located.
Different Types of Telehealth
There are many different types of telehealth available, each aimed at establishing a strong connection with the patient, regardless where they are currently situated. During the provision of telehealth services, healthcare providers gather important information and update patient records, and give patients medical advice to help them manage their health complaint. The aim of telehealth 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 technologies. 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, check ups, 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. Some telehealth solutions allow patient data to be instantly transferred to the patient’s entire care team and the press of a button, or instantly added to the EHR. Should any issues arise with the patient, care team members can react quickly as they have all the available information at their fingertips. Telehealth also allows patients to self-monitor and check in with their healthcare provider quickly and easily, which also helps to ease the workload of caregivers.
- Physician collaboration: Using telehealth technologies, medical professionals can communicate with each other quickly and easily 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 and 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 them 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 tire 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 to 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 see more patients per day, which means more billable time. Further, the software solutions required to start offering telehealth are not expensive to implement, and even less so during the COVID-19 public health emergency due to OCR’s Notice of Enforcement Discretion which allowed a much broader range of telehealth solutions to be used.
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.
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. One provider, TigerConnect, reports 87% of surveyed patients as saying they would definitely use the platform again and would have further telehealth visits in the future.
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 appointment 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 and 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. Alaska, Connecticut, Hawaii, Oregon, Minnesota, New York, Nevada, and Washington have no pending NLC legislation as of June 2021. NLC legislation is pending in California, Illinois, Michigan, Rhode Island, and Massachusetts.
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 visits virtually must comply with the HIPAA Rules. 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 or have good internet access. Many patients requiring nursing care may lack of familiarity with modern communication devices or only have old or incompatible technology. There are also potential privacy issues, as patients may not be able to converse in an environment where they can discuss confidential information.
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 have been significantly expanded due to COVID-19, but once the public health emergency has passed, it is unlikely that telehealth service 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.