Based on an article by Matt Schur from the AMT Pulse, Spring 2021.
Throughout 2020, as the pandemic raged, rapid telehealth adoption was simply a matter of necessity. We needed to protect vulnerable frontline healthcare workers, so they could continue to care for patients, conserve personal protective equipment and minimize exposure at healthcare facilities. For those unfortunate enough to suffer dire complications from COVID-19, remote video calls provided a glimmer of hope and connection amid isolation.
As we begin to move beyond COVID-19’s wake, one thing seems clear: Telehealth is here to stay. There are challenges yet to sort through, but for many, the potential of regularly and safely engaging with healthcare providers while remote is too important to pass up.
“What we see as a problem in every state in the country is access to affordable, quality healthcare,” says Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, President, National Association of Pediatric Nurse Practitioners; Clinical Professor of Nursing, Baylor University, Houston, Texas. “What telehealth is doing is increasing access not just to healthcare, but to quality healthcare.”
The impact of that is nothing short of revolutionary, adds Ann Mond Johnson, CEO, American Telemedicine Association, Washington, D.C. “I heard a great quote from Anand Iyer, a respected global digital health leader at Welldoc: ‘An engaged person is the blockbuster drug of the 21st century.’ Telehealth has shown to help people become engaged in their health and also keeps them connected to their healthcare providers, feeling better cared for and, ultimately, achieving better quality of life and improved outcomes,” Mond Johnson says. “Telehealth is a very important component for insurers and healthcare systems in engaging patients—and you really want people to be engaged in their health in order to better manage, or even reduce, health conditions.”
Despite the rise in popularity and use, a prevailing question seems to remain: Just what is telehealth?
According to the Health Resources and Services Administration, an agency within the Department of Health and Human Services, telehealth is: “The use of electronic information and telecommunication technologies to support long-distance clinicalhealthcare, patient and professional health-related education, public health and health administration.” Or, more simply, telehealth is about administering healthcare from a distance. That includes everything from medical assistants coordinating care over the phone to a patient sending a dermatologist a picture of a rash.
For Kelli Garber, MSN, APRN, PPCNP-BC, Lead Advanced Practice Provider and Clinical Integration Specialist for the Center for Telehealth at the Medical University of South Carolina, Mount Pleasant, South Carolina, one of the most vivid examples of telehealth’s benefits is an experience she had with a student who was in 10th grade and living in a rural area near Myrtle Beach, South Carolina. Within the first two weeks of school, he was taken to the hospital by ambulance twice because of severe asthma attacks.
Geography complicated his healthcare. To get to work, his parents took a bus to Myrtle Beach that only runs in the morning and at night. His family wasn’t able to come back during the day to take him to appointments. As a result, he was only being seen when in crisis—until telehealth came along.
Garber began by meeting with the student and completing a thorough asthma assessment via telehealth. She was able to meet with him frequently to reassess his condition and to educate him on his medications and self-care. Based on these visits, she prescribed two asthma medications. In collaboration with the school nurse and nurse telepresenter, she was also able to get the whole family to identify his controller and rescue inhalers, working with everyone, so they understood which medication to use and when.
In a town where it was hard enough to get one parent and a child to a single health appointment, telehealth allowed Garber to work frequently with the entire family for months. While remote, Garber was also able to consult with the school staff, a local pharmacy and other specialists to create the best care environment for the student.
“One of the beauties of telehealth is that we can continue to see the child frequently,” Garber says. “We don’t have to depend on a family being able to get in the car, to get out of work and come bring the child to you. We’re able to have follow-up visits to make sure that medications are helping, that the child is improving and that they are having a successful outcome.”
When she first met the child, Garber says he would keep his head down and not really engage. “I think he had been so used to not breathing well that he just thought it was normal,” she says. “Once we started to get control of his asthma and he started to feel better, he came out of his shell. He was smiling and laughing and interacting.”
With the help of medication, the patient, who has a learning disability, learned to read, which he couldn’t do before. “I ended up following him through his senior year, and he graduated in 2019—a very healthy young man with no more emergency room visits after our program started to work with him. We brought the care to him. We made a difference in his life and in the lives of many others who otherwise wouldn’t get care.”
Another reason Dr. Mechanic gets excited about telehealth is its ability to break down language barriers. In many care settings, especially those that serve diverse populations, it can be difficult to have providers or interpreters readily available to communicate directly with a patient. With telehealth, an interpreter can be available whenever needed. Dr. Mechanic adds: “Having interpreter services, even for translating consent forms, is hugely important. It is one of our biggest priorities.”
Telehealth isn’t set to replace in-person care. They should complement one another, with providers choosing an approach based on the situation. Behavioral sciences, neurology, gastroenterology— all are fields where telehealth may prove the superior care option. But just as many, if not more, advantages exist for in-person care across the board. Checking for a mass in the abdomen, using a stethoscope— physical examinations are still crucial.
“Telehealth is not for all people, situations or conditions,” Mond Johnson says. “We have to use this time to reimagine how we deliver care to more people everywhere. If all we do is use technology to replace face-to-face visits, we will have sold the whole thing short. We need a two-channel or hybrid healthcare system that includes both in-person and virtual care.”
Ultimately, the shift toward greater telehealth use was inevitable, with COVID-19 only serving as a propellant, Mond Johnson says. “We have an opportunity and obligation to solve getting care to underserved communities,” she adds. “The uptake has been so significant, the acceptance has been so broad, and there are so many possibilities of what we can do to address inequities in this country that have been around for far too long. We are going to fix this.
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