Telehealth: COVID Opening Our Eyes to Modern Solutions

Scientists are only just beginning to understand the long-term effects of COVID-19 on individuals’ health, but a question that still eludes us is what are the long-term effects on society? As a result of the COVID-19 pandemic, more people have tapped into the convenience of telehealth (healthcare services delivered via technology rather than in-person), along with online video conferencing, instant grocery delivery services, and other preexisting services. During the month of September, Emory University in Atlanta, Georgia provided an incentive for students to utilize telehealth services: “You could win an iPad for signing up with TimelyCare.” As people begin to return to in-person activities, which services will remain useful post-pandemic and which will get left behind?

The origins of telehealth date back to long before the COVID-19 pandemic -- in 1879, only three years after the invention of the telephone, the Lancet published an article that mentioned telephone calls as a substitute for unnecessary office visits (Lustig, 2012). Nearly one and a half centuries later, modern technology has improved the quality and availability of telehealth; however, in-person visits are still the conventional method of healthcare delivery. Analysis of the reasons, costs, and benefits of telehealth can help us determine the post-pandemic future of telehealth.

COVID-19 INFLUENCE

In February 2020, the CDC recommended social distancing practices to people and healthcare providers. According to the Centers for Disease Control and Prevention, there was a 154% increase in telehealth visits during the last week of March 2020 compared to the same time during the previous year and 41%-42% of adults in the U.S. delayed or avoided seeking medical care due to COVID-19 concerns (CDC, 2020). Additionally, doctors treating COVID-19 cannot treat others. The large volume of delayed (and more advanced) cases will lead to reopening challenges (Barach et al. 2020).

SUPPLY/DEMAND FOR HEALTHCARE

Telehealth has the potential to address worries that the rising demand for healthcare in the U.S. cannot be matched with an increase in the supply of care providers. According to a workshop summary in 2009 by Patlak and Levit, the U.S. population is increasing and aging, demanding more healthcare and better healthcare. As the medical field advances, providing new treatments that enhance the quality of life and offer the promise of longer life, consumers demand more advanced healthcare. However, this uptick in demand cannot be met by the current supply given that there is a shortage of physicians and nurses. Medical professionals are overworked and physicians are retiring. Although the healthcare sector will experience job growth, new physicians take 10-16 years to undergo education and training. 

Economic Analysis of Telehealth

A study by the Journal of Medical Internet Research, a leading digital health journal, looked at recent cost-minimization, cost-effectiveness, and cost-utility studies regarding telehealth compared to conventional care. The results are as follows:

• 17 cost-minimization studies

  • 53% of studies reported telehealth to be cost-saving

  • 35% reported telehealth to be cost-saving after a certain threshold

  • 12% reported telehealth to increase costs

• 8 cost-effectiveness studies

  • 50% of studies reported telehealth to lower costs and increase effectiveness

  • 50% of studies reported telehealth to increase costs and effectiveness

• 25 cost-utility studies

  • 32% of studies reported telehealth to decrease costs and increase health-related quality of life

  • 68% of studies reported telehealth to increase costs and increase health-related quality of life

The study found that cost reduction was primarily driven by allowing doctors to see more patients by reducing travel and consultation time. Telehealth can also free up space in emergency rooms for more urgent cases. Alternatives to in-person visits, such as remote monitoring, can predict hospital visits and allow for lower-cost preventive care rather than higher-cost post-incident care; however, the costs of administration and monitoring mean that the benefits of remote monitoring are mostly in productivity rather than saved short-term costs.

PITFALLS

Although telehealth can increase access to healthcare by connecting patients and physicians across large distances, there are still inequalities in technology access.

There are elements of an in-person visit such as physical examinations that cannot be done using telehealth. In these cases, video is not always more time-efficient and not always able to match the quality. Nonverbal signals and interpersonal connections may be weaker in telehealth than in person, lowering the quality of communication between providers and patients.

In addition to the inability of technology to replicate certain in-person elements, there are also concerns about technology privacy. Some third-party telehealth services raise privacy concerns. BetterHelp, a therapy app, states in its privacy policy:

“We may also share your information with vendors and service providers, including our data hosting and data storage partners, analytics and advertising providers, and vendors providing technology services and support, payment processing, and data security. We also may share information with professional advisers, such as auditors, law firms, and accounting firms.”

It also advertises 24/7 access to care, which sounds good in theory, but some studies show that patients can become overly reliant on therapy: “Because telehealth is so convenient, this can lead patients to seek care for conditions that might resolve on their own or for reasons that may not improve population health. So it can lead to overutilization, which is a key concern with telehealth” (Pine, 2021). In summary, these pitfalls may be reasons why many preferred conventional in-person visits to telehealth pre-pandemic.

FUTURE

Interpersonal connections are important and telehealth cannot always provide the same level of care as conventional in-person visits. The main benefit is convenience. Will consumers value the convenience over the remaining benefits of in-person care after COVID-19 is less prevalent? More advances in technology and hopefully cybersecurity laws to protect consumers will increase demand for telehealth in the future.

Edited by: Andrew McArthur

Works Cited

Barach, P., Fisher, S. D., Adams, M. J., Burstein, G. R., Brophy, P. D., Kuo, D. Z., & Lipshultz, S. E. (2020, December). Disruption of healthcare: Will the COVID pandemic worsen non-covid outcomes and disease outbreaks? Progress in pediatric cardiology. Retrieved November 5, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274978/. 

Centaine Snoswell, A. C. S. (n.d.). Economic evaluation strategies in telehealth: Obtaining a more holistic valuation of telehealth interventions - Centaine Snoswell, Anthony C Smith, paul A scuffham, Jennifer a whitty, 2017. SAGE Journals. Retrieved November 1, 2021, from https://journals.sagepub.com/doi/full/10.1177/1357633X16671407. 

Centers for Disease Control and Prevention. (2020, October 30). Trends in the use of telehealth during the emergence of the COVID-19 pandemic - United States, January–March 2020. Centers for Disease Control and Prevention. Retrieved November 1, 2021, from https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm#F1_down. 

Centers for Disease Control and Prevention. (2020, September 10). Delay or avoidance of medical care because of COVID-19–related concerns - United States, June 2020. Centers for Disease Control and Prevention. Retrieved November 1, 2021, from https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a4.htm#:~:text=As%20of%20June%2030%2C%202020%2C%20an%20estimated%2041%25%20of,avoided%20urgent%20or%20emergency%20care. 

Gogia, S. B., Maeder, A., Mars, M., Hartvigsen, G., Basu, A., & Abbott, P. (2016, November 10). Unintended consequences of TeleHealth and their possible solutions. contribution of the Imia Working Group on Telehealth. Yearbook of medical informatics. Retrieved November 1, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5171569/. 

Lustig, T. A. (2012). The role of telehealth in an evolving health care environment: Workshop summary. National Academies Press. 

Neil Ravitz, M. B. A. (2021, April 26). The economics of a telehealth visit: A time-based study at Penn Medicine. Retrieved November 1, 2021, from https://www.hfma.org/topics/financial-sustainability/article/the-economics-of-a-telehealth-visit--a-time-based-study-at-penn-.html. 

Patlak, M., & Levit, L. A. (2009). Ensuring Quality Cancer Care through the oncology workforce sustaining care in the 21st century ; Workshop Summary. National Acad. Press. 

Privacy policy. BetterHelp. (n.d.). Retrieved November 1, 2021, from https://www.betterhelp.com/privacy/. 

Pros and cons of Telehealth. RAND Corporation. (n.d.). Retrieved November 1, 2021, from https://www.rand.org/multimedia/video/2021/03/17/pros-and-cons-of-telehealth.html. 

Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020, October 19). Determining if telehealth can reduce health system costs: Scoping review. Journal of medical Internet research. Retrieved November 1, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605980/. 

TimelyCare. Emory University - TimelyCare. (n.d.). Retrieved November 1, 2021, from https://timely.md/schools/index.html?school=emory&.