Telehealth During COVID-19 and Beyond
The future of telehealth and telemedicine is strong, especially after mass adoption of this technology during the COVID-19 pandemic.
The COVID-19 pandemic has drastically changed our lives over the course of one year. In order to “flatten the curve,” we have adjusted the ways in which we live, work and socialize.
Young and old alike have adopted virtual technology, for school, work and for communicating with friends and family. The health industry is no exception. During the pandemic, we saw an explosion of telehealth and telemedicine visits. This convenient technology allows practitioners and providers of many health tenets to use an internet connection and computers, smartphones or tablets to conduct virtual visits with their patients.
We spoke with four TTUHSC faculty members about the pros and cons of telehealth in their respective fields and what it means for the future of healthcare.
What Types of Medical Appointments Can be Handled via Telemedicine?
Our four experts weighed in on telehealth and telemedicine technology within their fields of expertise, including general healthcare; clinical counseling and mental health; speech, language and hearing therapy; and even unique situations such as providing virtual healthcare within the prison system.
Dayna La Vallee, Assistant Professor in the Physician Assistant program, also works for the prison system using telemedicine. “Most of the patients I’ve seen have been established and are seeing me for a follow up,” she says. She is able to care for patients dealing with chronic conditions, such as high blood pressure and cholesterol, as well as allergies, sore throat, athlete’s foot and other skin conditions.
Sharon Hunt, Assistant Professor in the Healthcare Management & Leadership Department at TTUHSC, believes that many physician visits can be handled through telemedicine. “In the past, it was more consultations and follow-up visits,” she says. “With COVID, it’s been used even for primary care visits.” She points out that there is and will always be a need for face-to-face care in many instances, such as a post-surgery visit.
Logan Winkelman, PhD, Program Director and Assistant Professor within the Department of Clinical Counseling and Mental Health, points out that telemedicine is not always the right choice for every patient. Issues such as technological limitations and privacy have to be addressed. “We can’t assume it works for everybody,” she says. “Sometimes it’s not a good fit.”
Sherry Sancibrian, associate chair of the Department of Speech, Language, and Hearing Sciences, has been using telemedicine for several years, providing speech and language therapy to adults and children. She is also aware that telemedicine is not a “one-size-fits-all” solution. “Some elderly people we see have had a stroke or other brain injury, and it’s more than they can handle,” she explains. It’s also not likely that a young child would be able to make it through a telehealth appointment. “Imagine putting a 2 year old in front of a computer for a therapy session,” she says.
How Have Patients Responded to Telemedicine During COVID-19?
La Vallee says that the inmates she sees via telemedicine are happy for the opportunity to receive prompt care. She also believes that patients feel more comfortable in their home than a doctor’s office, which means they are more relaxed and able to open up more.
Hunt notes that the pandemic has made patients more responsive to telemedicine than
“Most of the users prior to the pandemic were middle aged and used it for convenience or because they were in remote areas,” Hunt explains. “The pandemic forced many to use telehealth for the first time, and surveys are saying that the majority of patients responded positively and plan to continue using it in the future.”
An option for “audio-only” visits was implemented due to the pandemic. Now, patients can use a telephone to visit with their provider, so having a video screen isn’t a requirement to use telemedicine.
“There’s always going to be the client or two who don’t respond well with this form and would rather see somebody in person,” Winkelman says. “Telemedicine is never going to be a replacement. It will always be a supplement.”
The providers agree that Texas has many rural areas without mental health providers, and telehealth makes it possible to treat those patients in a convenient way.
Sancibrian saw the trend of telehealth affecting speech therapy long before the pandemic.
“I feel so lucky that, about five years ago, our department felt like telehealth was going to be the new thing,” Sancibrian says. “We set up the business association agreement with Zoom in order to see a small number of patients who couldn’t travel to the office.” Cut to 2020 and COVID-19, and, “In one week’s time, we pivoted easily to 90 percent telehealth,” she says.
The Value Perception of Telehealth
In the past, some patients have had the perception that telehealth visits weren’t as valuable or effective than in-person visits. The pandemic seems to have put that perception to rest.
“Initially, people might have had that value perception until they go through and have a telehealth visit and realize they got their money’s worth,” Hunt says. With the success of telemedicine and the jump in those who are using it, she believes the fear of “not getting your money’s worth” has dissipated.
“Patients sometimes feel more value if their physicians are willing to see them [via telehealth] and might look for physicians that have this service,” she says.
Sancibrian is concerned that telehealth will continue to be perceived as a backup plan, when in reality it is often the best choice.
“Texas laws say the quality of service must be equivalent to the service you would provide in person,” she explains. This positions telemedicine as the second-best choice when the reality is that it is as good as face to face care if it’s done right.
La Vallee believes that patients who choose telemedicine do so for a reason, because they know what they’re getting.
“If they agreed to see us via telehealth, they already feel like they’re going to get the care they desire,” she says. “If they didn’t feel that way, they would make a physical appointment. It’s about convenience a lot of times.”
The Future of Telemedicine
The providers agree that telemedicine is here to stay. As more patients and providers have been left with little choice during COVID-19 than to use it and embrace it, the technology and availability will only increase. And since the experiences of patients have been positive, the demand for telehealth will certainly continue, they predict. Regulations will have to be evaluated as geography becomes less of an impediment to care.
“I see [telemedicine/telehealth] growing,” Hunt predicts. “Those who haven’t adopted telemedicine might have to.”
She also sees technology continuing to advance, opening up more data that healthcare providers can monitor, such as a patient’s pulse and blood pressure via a smartwatch.
Insurance companies were initially reluctant to cover telehealth visits the same as in-person, thinking it would add to their costs by increasing doctor visits. But what they have learned is that telehealth goes a long way toward preventive care, which lowers costs in the long run. Providers predict that patients are going to start looking for insurance providers that cover telehealth.
“A lot of the problems with healthcare have to do with access,” Winkelman adds. “If
we can get more practitioners available to clients, who otherwise might not have had
access to that healthcare, it allows us to reach so many more areas.”
Sancibrian says that laws and regulations will continue to adjust to the momentum of telemedicine.
“CMS (Centers for Medicare and Medicaid Services) has loosened some to allow urban-area Medicare patients to originate the healthcare visit from their home,” she explains. She sees laws being passed that will allow for coverage to be the same as in-person visits.
The biggest hurdle in behavioral health via telemedicine is state laws, Winkelman says. Different states have different requirements to become a counselor and provide telecounseling. So, what happens when patients travel over state lines?
“We’re seeing the necessity to advance these laws and regulations to benefit the client,” Winkelman says. “We’ve got to make it maneuverable for providers to provide their services to clients.”
Several states are working on an interstate compact in the field of speech and language therapy, Sancibrian mentions. The goal is for a practitioner to have a home state with other states reciprocating to allow you to practice via telehealth.
“We have to get at least 10 states to agree to participate, and we have six. So, we’re close,” she says.
A Bright Virtual Future for Telehealth
The healthcare community has proven during the past year that telehealth and telemedicine are effective technologies for a variety of facets of the medical industry, from mental health counseling to surgery post-op visits and everything in between.
“COVID-19 brought to all of us the ability to provide and the efficacy of providing telecounseling services,” Winkelman says. Prior to COVID-19, many questioned whether or not you could have a counseling session or a doctor visit via telehealth. And then the whole world went virtual.
“And virtual is better than nothing,” Winkelman says.
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