Telemedicine

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Introduction
The outbreak of the coronavirus pandemic
significantly accelerated the adoption of
telemedicine across the world. As a result, many
patients have shown an increased preference for
seeking healthcare services through digital
methods than in-person appointments. This can be
attributed to the low costs, convenience, and
increased efficiency of care services linked to
telemedicine. Telemedicine is mostly used to
conduct patient assessments, write or renew
prescriptions, and offer certain medical services
such as psychological treatment (Kichloo et al.,
2020). The integration of telemedicine in the
healthcare system has been linked to shorter
hospital stays and decreased readmissions and
hospital mortality rates. Legislative initiatives
implemented during the Covid-19 pandemic promoted
the widespread adoption of telemedicine. The
Utilization of Telemedicine Prior to the Novel
Coronavirus? Before the onset of the coronavirus,
the utilization of telemedicine in the United
States had been experiencing a rapid increase.
Between 2010 and 2017, the percentage of
hospitals using video and other electronic
technologies to administer patient care rose from
35 to 76 (Kichloo et al., 2020). In addition,
from 2016 to 2017, telemedicine insurance claims
had increased by 53. Neurologists have largely
used telemedicine to provide care to stroke
patients. The shortage of neurologists in the
United States inspired the invention of
telestroke, which offers care services to stroke
patients (Hyder Razzak, 2020). Over the years,
Tele-stroke has been used by neurologists to
communicate with stroke patients or emergency
physicians to recommend appropriate treatment
approaches. Telemedicine has considerably been
used in radiology to transmit radiological images
from one place to another, a process known as
teleradiology. Reports or images gathered through
telemedicine or in-person examinations were
transferred remotely to radiologists whose
clinical
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assessments would be sent to the patient's
physician or other care providers to inform
treatment plans. Research indicates that in 2014,
teleradiology accounted for over half of the
telemedicine services in the United States (Hyder
Razzak, 2020). Thus, telemedicine has been
pivotal in providing care services long before
the onset of the Covid-19 pandemic. Telemedicine
has significantly been used to administer mental
health assessments and services, a process
referred to as telepsychiatry. Through
telepsychiatry, psychiatrists can directly
interact with patients through video conferencing
or telephone to evaluate and diagnose different
mental disorders. Telepsychiatry has also been
instrumental in providing individual, family, or
group therapy to clients suffering from various
mental illnesses. For instance, the University of
Rochester in New York invented a telepsychiatry
program to manage mental health disorders,
including Parkinson's disease (Hyder Razzak,
2020). The program has been conducting over 2000
telepsychiatry consultations annually for over a
decade (Hyder Razzak, 2020). Equally important,
telemedicine has been utilized for remote patient
monitoring, also referred to as telemonitoring.
Through this process, healthcare professionals
could track a patient's activities and vital
signs from their homes to manage chronic
conditions such as congestive heart failure and
diabetes, among other cardiopulmonary diseases
(Hyder Razzak, 2020). Telemonitoring assisted
care providers in detecting anomalies in a
patient's blood pressure, sugar levels, and pulse
rate and recommended when to visit a
physician. Prior to the coronavirus pandemic,
telemedicine use in rural areas was slightly
higher than in urban regions. This can be
attributed to the inadequate healthcare providers
in rural areas, which necessitated patients in
remote areas to seek care virtually or through
other electronic means. A study indicates that
between 2012 and 2019, there were 7 visits per
1,000 patients in the urban regions compared to
11 telemedicine visits per 1,000 patients in the
rural areas (Chu et
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al., 2021). Therefore, before the coronavirus
outbreak, healthcare providers utilized
telemedicine to offer various care services,
particularly to patients in remote areas. The
Barriers to Telemedicine Use and Existing
Concerns That Prevented Its Use Legal and
regulatory challenges have long obstructed the
use of telemedicine. The variations in policies,
laws, and regulations regarding telemedicine
across the states have greatly limited the
practice. The lack of multistate licensure was a
significant barrier to the telemedicine practice.
The state licensure rules dictated that
physicians and other care providers could be
licensed in the states where their patients are
located (Gajarawala Pelkowski, 2020). This made
it difficult for healthcare professionals to
offer clinical services to patients across other
states. In addition, limited coverage and payment
posed greatly hindered the telemedicine practice.
The law restricted most telemedicine services to
patients in rural regions and specific settings
such as hospitals. There were also limitations to
the number of services and the nature of
communication the policies only allowed
real-time and two-way video conference methods
except for telestroke (Gajarawala Pelkowski,
2020). Regarding payment, Medicare and other
private payers had greatly limited the
reimbursement of telemedicine services.
Medicare's reimbursement was limited to
nonmetropolitan regions and certain institutions
(Gajarawala Pelkowski, 2020). Thus,
restrictions on licensure and limited coverage
and payment hindered the adoption of
telemedicine. The standards set by the Centers
for Medicare and Medicaid (CMS) in regards to
credentialing and privileging significantly
obstructed the telemedicine practice. The CMS
conditions stipulate that hospitals should have a
credentialing and privileging procedure for care
providers offering clinical services to the
hospital's patients, including those providing
telemedicine services (Rheuban Krupinski,
2017). Although credentialing by proxy was
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feasible, it was restricted to telemedicine
services offered by practitioners located at a
Medicare-linked distant site hospital or a
telemedicine services entity. Similarly, the
credentialing by proxy necessitated that the
originating site hospital signs a contract with
the distant site hospital or the telemedicine
entity ascertaining that credentialing and
privileging procedure met the CMS standards,
among other requirements (Rheuban Krupinski,
2017). Such lengthy conditions considerably
hampered the provision of telemedicine
services. The telemedicine practice was greatly
impeded by regulations on internet-based
prescribing. Even though states differed in their
online prescribing policies, most states required
an in-person visit to be conducted before
engaging in telemedicine follow-ups. As a result,
some states prohibited the issuance of
prescriptions solely based on internet
questionnaires, consultations, or phone
consultations (Fields, 2020). This considerably
deterred the provision of telemedicine services
across different states. Similarly, telemedicine
was barred by federal and state regulations on
privacy and security of patient information.
Complying with such regulations presented a great
challenge to care providers who could not
guarantee the safety of patient information due
to the susceptibility of electronic mediums to
cyber threats. Additionally, telemedicine was
also hindered by laws regarding medical liability
in regards to informed consent, supervision
requirements for non-physician providers, and
practice protocols and standards (Gajarawala
Pelkowski, 2020). Moreover, the federal fraud and
abuse laws, including the Stark and Anti-kick
statutes, have considerably impaired telemedicine
practice (Gajarawala Pelkowski, 2020). Thus,
regulations on online prescribing, privacy and
security, and fraud and abuse restricted the
telemedicine practice. The Factors That Allowed
for Telemedicine's Widespread Use During the
Pandemic
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The government restrictions on public gatherings
and interactions greatly influenced the adoption
of telemedicine during the Covid-19 pandemic. The
need to access healthcare services amid an
epidemic obliged many individuals to resort to
telemedicine. This is because telemedicine
lessened the risk of exposure for both the
patients and the care providers (Monaghesh
Hajizadeh, 2020). In addition, during the
pandemic, many healthcare facilities prioritized
healthcare services to patients suffering from
the virus. As a result, patients suffering from
other chronic diseases such as cancer, kidney
diseases, diabetes, and other cardiovascular
ailments were forced to adopt telemedicine to
ensure continued care. Similarly, due to the
constant lockdowns that considerably limited
people's movements, care providers were obliged
to use telemedicine channels to follow up with
their patients and expand access to care for
other individuals in dire need of care services
(Monaghesh Hajizadeh, 2020). The need for
healthcare providers to lessen patient demand on
care facilities was a major drive toward
telemedicine. The coronavirus exerted a lot of
pressure on the available healthcare resources,
which necessitated health professionals to find
alternative means to deliver care to the rest of
the population. The government's efforts to slow
the spread of the coronavirus significantly led
to the increased use of telemedicine. The federal
and state governments eased many regulatory
policies on telemedicine to encourage its use
among the public. For instance, many states
adopted a multistate licensure approach where
care providers could offer clinical services to
patients across the state lines (Busch et al.,
2021). Furthermore, the need to monitor the
progress of Covid-19 patients placed under
quarantine in different locations also encouraged
the widespread use of telemedicine (Monaghesh
Hajizadeh, 2020). During the corona pandemic,
some patients suffering from the virus would
self-isolate in their homes. Hence, healthcare
professionals would
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use telemedicine channels such as video
conferencing to monitor the recovery progress of
such patients. Therefore, the need to lower and
slow down the risk of coronavirus and to lessen
patient demand on healthcare facilities
considerably enhanced the adoption of
telemedicine. How the Concerns of Prior Were
Addressed Due to the Covid-19 pandemic, some
changes were introduced to the federal and state
regulations and health plan reimbursement
directives that significantly lessened the
existing telemedicine barriers. Some of the
concerns that have been addressed include the
licensure issues where states have now permitted
out-of-state care providers to provide clinical
services to patients across state lines (Busch et
al., 2021). Additionally, the states have eased
their regulations on online prescribing and now
allow authorized care providers to prescribe
medications through telemedicine even without an
in-person clinical evaluation (Busch et al.,
2021). Regarding the issue of coverage and
payment, Medicare has expanded the list of
telemedicine services and types of care providers
who can administer telemedicine (Busch et al.,
2021). It has also included the coverage for
phone visits while increasing the charges for
telemedicine visits to equal those of in-person
appointments (Kichloo et al., 2020). Such
modifications have extensively promoted the use
of telemedicine services across the country. The
government has eased telemedicine's Health
Insurance Portability and Accountability Act
(HIPAA). The waiver of certain federal privacy
and security standards has enhanced telemedicine
practice (Busch et al., 2021). In addition,
states have also diversified the originating and
distant sites from which patients can receive
telemedicine services (Busch et al., 2021). In
this case, patients' homes can now act as
originating sites, making the health delivery
process convenient. Additionally, physicians and
care providers can offer clinical care from
different locations without any restrictions.
Similarly, some states have eased their patient
consent
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restrictions by allowing verbal consent. Equally
important, some states have permitted federally
qualified health centers or rural clinics to
offer telemedicine services. Moreover, various
private insurers have stretched telemedicine
coverage (Busch et al., 2021). Thus the
modifications made to the regulatory policies
regarding licensure, online prescribing,
originating sites, coverage, and payments have
significantly increased the telemedicine practice
across the country. The Future Outlook of
Telemedicine The use of telemedicine has the
potential to continue growing to become an
integral part of healthcare service delivery in
the future. Research indicates that by 2020, 76
of health facilities in the United States had
already adopted some telemedicine approaches to
connect with their patients (Hyder Razzak,
2020). Thus, with the widespread acceptance of
telemedicine, the number of healthcare facilities
and care providers using telemedicine may
increase significantly. The continuous growth may
be attributed to its low costs, comfort and
convenience, and improved patient care access
(Gajarawala Pelkowski, 2021). In addition, the
reduction in overhead expenses, less exposure to
diseases, and increased revenue may encourage
care providers to expand their telemedicine
services. There is also a big possibility that
telemedicine will continue expanding to link care
providers and patients globally. Thus
telemedicine will evolve to become a critical
part of the healthcare system. Telemedicine will
grow to serve a crucial role in healthcare
delivery for patients in rural areas. Research
indicates that about 85 of individuals living in
rural regions in the United States have internet
connections, while 71 of rural residents have
smartphones (Kichloo et al., 2020). Many
individuals living in rural or remote areas often
experience challenges in accessing care partly
due to their geographical locations or inadequate
healthcare staff at local clinics. However,
telemedicine can promote the provision of primary
and secondary care to individuals
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in remote and marginalized regions. Additionally,
the Association of American Medical Colleges
(AAMC) estimates that the country will have a
deficit of about 122,000 physicians by 2032
(Kichloo et al., 2020). Even though the shortage
is likely to affect the entire nation, the rural
and underserved populations may be the most
affected. Currently, the proportion of primary
care providers (PCPs) to patients in rural
regions is 39.8 per 100,000 individuals compared
to 53.3 per 100,000 in urban areas (Kichloo et
al., 2020). This proves that telemedicine will
play a key role in healthcare delivery to
patients in remote places, thus improving patient
outcomes. Conclusion Even though telemedicine
existed for several years, its use increased
tremendously during the Covid-19 pandemic.
Telemedicine's reduced costs, increased access to
healthcare, and convenience has benefited many
patients. However, before the coronavirus
outbreak, its use was greatly impeded by
regulatory and legal constraints. The lack of
multistate licensure and limitations to online
prescribing and credentialing and privileging
hindered telemedicine use before the onset of
Covid-19. Nevertheless, the government's effort
to slow down the spread of the virus and the need
to relieve pressure on healthcare resources
prompted the increased adoption of telemedicine.
Consequently, many federal and state regulations
were eased to encourage widespread telemedicine
use. Telemedicine has the potential to become an
integral part of healthcare system delivery
because it has been linked to a considerable
decrease in readmission rates, shorter hospital
stays, and reduced mortalities. In addition,
telemedicine can narrow the gaps in healthcare
delivery by providing increased access to care
services to people living in marginalized
regions. Therefore, the changes in telemedicine
regulations should not be temporary they should
be long-term to promote its use in the future.
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References
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