Telemedicine During the COVID-19 Crisis

While COVID-19 continues to impact the course of daily life, people across the globe have had to adapt to a world with social distancing measures. As medical professionals outside of critical care strive to balance treating their patients with protecting themselves and their staff, the demand for telemedicine has increased. 

To meet demand amid the pandemic, Alex Azar, secretary of the U.S. Department of Health and Human Services, announced a temporary easing or suspension of various telehealth regulations in mid-March. The changes included licensing reciprocity for providers and more relaxed standards for prescribing controlled substances. Likewise, health care providers across the country have increased the availability of telehealth services as some hospitals face a disproportionate burden of providing care to COVID-19 patients. 

The use of telemedicine has increased in recent years, especially as internet access has expanded. Telehealth encompasses a wide breadth of services, such as conducting remote clinical health care and performing health administration using “electronic information and telecommunication technologies.”

Adoption of telehealth programs, however, has varied across jurisdictions. In January, only 24 percent of health care organizations in the United States had a virtual care system in place. In addition, prior to the outbreak of COVID-19, a variety of state and federal regulations on licensure and reimbursement for providers across state lines limited the use of telemedicine. 

Advocates of telehealth platforms have argued that these rules have hindered virtual care from reaching its full potential. Telemedicine, they have asserted, can help patients overcome factors that lead to health disparities such as transportation, costs, and access to quality care, especially for abortion and mental health care services. Socioeconomically vulnerable populations and those located far from medical facilities are often unable to access follow-up care or emergency treatment. Telemedicine could alleviate some of these barriers. 

Critics, however, have cited the medical, ethical, and legal disadvantages of widespread adoption of telemedicine, and have raised concerns about internet and technology access in rural areas, confidentiality, and fraud. Critics also have argued that telemedicine could not replace face-to-face visits in many circumstances, and that virtual platforms would not be a practical solution unless the government took further steps to subsidize and increase access to care. Some health professionals have asserted that telehealth’s success would ultimately depend on better tools and communication technology.

In light of the coronavirus outbreak, is telemedicine here to stay? Some commentators predict that the COVID-19 pandemic could fundamentally change the way that consumers seek and receive health care since social distancing measures have forced individuals to avoid doctors’ offices, hospitals, and clinics. Others assert that given new realities, providers will need increased funding and regulatory flexibility after the COVID-19 pandemic subsides to ensure the sustainability of quality telehealth care.

This week’s Saturday Seminar explores the benefits and drawbacks of telemedicine, including the ways that virtual telehealth platforms have streamlined and addressed cost, accessibility, and quality of care issues impacting the administration of health care.

• In an essay published in The Regulatory Review, editor Larissa Morgan discusses how the United States is simultaneously confronting two unprecedented health care crises: the opioid epidemic and the coronavirus pandemic. In response to health care professionals moving to provide care through telemedicine platforms, the U.S. Drug Enforcement Administration issued guidance that allows practitioners to prescribe specific controlled substances remotely to patients in a treatment program for self-administration. Addiction specialists, however, have concerns that allowing patients to self-administer controlled substances could have detrimental effects such as overdose or misuse. In response, various states have begun to adopt telehealth programs to support patients as they navigate opioid addiction along with COVID-19. 
• Nils Magnus Hjelm of St. George’s Hospital in London highlights the advantages and disadvantages of telemedicine in an article in the Journal of Telemedicine and Telecare. He argues that the advantages include the ability to provide health care to previously underserved communities, enhanced professional education, and improved communication between medical staff and patients. Telemedicine, he argues, also could substantially reduce the overall costs of health care services by facilitating a more efficient distribution of resources. Although Hjelm concludes that the benefits of telemedicine outweigh the drawbacks, he acknowledges that concerns remain about the quality of care that patients receive remotely, the increased potential for communication breakdowns, the impact on interpersonal relationships, and the bureaucratic difficulties that hamper implementation. 
• In their systematic review in the Journal of Telemedicine and Telecare,  Clemens Scott Kruse of Texas State University and his co-authors argue that, although telemedicine may increase access to health care, policymakers around the world must first address substantial practical and cultural barriers prior to global implementation. They assert that the largest barriers to telemedicine center on technological knowledge and acceptance in both patients and practitioners. The authors suggest that policies should focus on integrating telemedicine into modes of existing care and training practitioners and patients to use the technology necessary to make global telemedicine a reality. 
• The federal government should create a national license to practice telepsychiatry and adopt preemptive legislation regulating mental health care services through telemedicine, Lisa Parciak argues in a recent article in the West Virginia Law Review. Telepsychiatry, Parciak writes, “creates greater access to mental healthcare by eliminating geographic barriers to care and by providing psychiatric treatment in a non-stigmatizing environment.” She claims, however, that barriers such as state licensure laws, reimbursement issues with telemedicine, and privacy concerns stifle telepsychiatry’s potential to expand. Parciak proposes “reforming Medicare, Medicaid, and private insurance telemedicine reimbursement,” as well as “requiring liability insurance companies to cover interstate telepsychiatry,” to create greater access to mental health care services during a national shortage of psychiatrists.
• As the availability of telemedicine mobile apps has increased, so too have concerns about data protection, confidentiality, and patients’ ability to discern effective apps and tools from less substantive ones. In a recent article in ecancermedicalscience, Chiara Crico and her co-authors discuss the 2018 General Data Protection Regulation, which several European countries introduced to increase uniformity in data protection. The authors argue that with a unified perspective and shared guidelines across Europe, telemedicine mobile apps could become a standard tool of future medical practice.
• In a recent article published in Telehealth and Medicine Today, Sophia S. Albanese, Emily A. Yin, and Sarah J. Timmons of Wellesley College propose reforms that could increase Medicaid recipients’ access to telehealth services. Albanese, Yin, and Timmons highlight that it is difficult to “enact any broad-sweeping policies” to improve access to care due to Medicaid policies and reimbursement rates varying by state, and American medical providers have “historically low acceptance rates of Medicaid patients.” To improve the existing patchwork system, they propose relaxing state licensure laws that “impede the number of physicians who wish to practice out of state using telemedicine,” removing requirements that Medicaid patients “denied access to care by an in-person physician” have a “preexisting patient-provider” relationship in order to receive care through telehealth, and using a “monetary incentive” to encourage medical practices to accept new Medicaid patients.