By: Mathew Byrne, PhD, RN, CNE
The schools all emptied; businesses sent their employees home; restaurants were quiet; and clinic doors were locked. A global pandemic systematically shut down much of the world and its economies. The initial wave and ongoing impacts of the Covid-19 pandemic have left many care settings without safe options for routine care and outreach. Despite the availability of smartphones – the ubiquitous device in the hands of patients and providers — there were barriers to the broad use of telehealth to bridge the care gaps caused by the pandemic.
Historically, telehealth has been almost glaringly absent from the health care delivery landscape. There have been start-ups. with growing popularity of models often funded outside of traditional insurance, but there was no widespread adoption. Unbeknownst to most of the public, the low use of telehealth was not due to a lack of tools or interest, but rather a lack of incentive and obstructive regulations. Face-to-face models of care were traditionally reimbursed at significantly higher levels than telehealth visits, that is, until recent rule changes were enacted in response to the Covid-19 pandemic.
The CARES Act and several federal agency announcements, all enacted around March 2020, created a catalyst for change related to the use of telehealth (American Medical Association, 2020). The relaxation of privacy rules, a larger number of allowable technologies, and an increase in reimbursement created an attractive opportunity to restore access for many patients and financially strapped health care agencies.
The option for telehealth services to be delivered with fewer regulatory hoops and a larger array of technology platforms rapidly expanded its utilization and adoption. Not all face-to-face care services could be replicated, but the growing number of Bluetooth and data-enabled devices allowed for greater transmission of not just video and audio, but transmission of biometric data like weight, blood sugar, and blood pressure.
As with any rapid change, there continue be those who lag behind for a variety of reasons, for example, gaps in access to high-speed internet, lack of digital literacy for many vulnerable people and communities, and lack of telehealth competency among registered nurses (Lozano, 2020). An examination of patient outcomes, consumer trust, and access will be important, especially if calls are heeded for making telehealth rule and reimbursement changes permanent.
The potential for making these changes permanent has been discussed regularly in political and practice circles. Consumer demand for the convenience and relative ease of telemedicine, along with advocacy from professional groups such as the American Telemedicine Association, will factor into what the future holds for the ways in which telehealth may grow and evolve. In the meantime, telehealth is a means of ensuring continuity of care during the uncertainty of the acute phase of the pandemic, as well as for those who traditionally have difficulty accessing face-to-face care settings.
American Medical Association. (2020, April 27). CARES Act: AMA COVID-19 pandemic telehealth fact sheet. https://www.ama-assn.org/delivering-care/public-health/cares-act-ama-covid-19-pandemic-telehealth-fact-sheet.
Lozano, K. (2020, April 9). COVID-19 on the tele-front lines: What telehealth nurses are encountering in the coronavirus battle. MobiHealthNews. https://www.mobihealthnews.com/news/covid-19-tele-frontlines-what-telehealth-nurses-are-encountering-coronavirus-battle