What is Telehealth?

What Is Telehealth?

Patients know what it is without being able to explicitly define it; providers get lost in a jumble of changing policies and interpretations that vary by governing body.

Massively important to healthcare during the pandemic and beyond, telehealth is nevertheless difficult to understand.

This guide will introduce you to everything you need to know about telehealth, from telehealth definitions and background information to telehealth applications, modalities, features, and more.

Telehealth During COVID-19

Despite rapidly growing telehealth technologies, telehealth adoption remained relatively low among providers and patients alike — until the COVID-19 pandemic.

As a result of the pandemic, the Centers for Disease Control and Prevention (CDC) advised healthcare facilities to begin social distancing in February of 2020, specifically recommending the use of telehealth.

Telehealth would provide healthcare facilities with a safe way to triage, assess, and care for patients without exposing staff to the virus while also preserving dwindling supplies of personal protective equipment (PPE) and reducing hospital surges.

Policy changes further promoted the use of telehealth by removing barriers to reimbursement.

All of these changes have led to the rapid adoption of telehealth. The number of telehealth visits increased by 50% in the first quarter of 2020 compared to the first quarter of 2019. And in the last week of March 2020 alone, telehealth visits increased by 154% compared with the same period in 2019.

The urgent need to provide safe healthcare has forced many people to try something they had previously been resistant to. Now that society sees that telehealth is both feasible and effective, it is expected to outlast the pandemic and become the new normal in healthcare.

Telehealth in Policy

Keep in mind that telehealth definitions vary by state and from one federal agency to the next. As such, the policies governing telehealth use also vary widely.

Further complicating matters, the COVID-19 pandemic has prompted some jurisdictions to expand their definition of telehealth in order to make it easier to provide virtual care.

Differing terminology can also cause confusion. For example, Medicare reimburses for a group of services called “communications-based” or “technology-enabled” services, which it does not consider to be telehealth but which utilize telehealth technologies to deliver care.

The Center for Connected Health Policy’s (CCHP’s) interactive map of current state laws and reimbursement policies can be helpful in navigating these different policies, with information on state Medicaid policies, regulations, and the 11 different categories of laws related to telehealth.

Telehealth Applications

When we think of telehealth, we tend to think of tele-practice, or the virtual delivery of healthcare. However, this is only one of the primary applications of telehealth.

Tele-Practice

Tele-practice opens up a virtual form of communication between providers and their patients, eliminating the need for patients to visit healthcare settings to receive care. Tele-practice promotes continuity and quality of care while also reducing costs and improving both provider and patient satisfaction.

Tele-Consultation

Tele-consultation gives patients and practitioners alike the benefit of direct access to remote specialists and experts. The ability to have both the primary care provider and the specialist in the visit at the same time opens up opportunities for coordination and collaboration and enhances the quality of care.

Tele-consultation can be especially useful for patients in remote areas without access to specialists. Data suggests that tele-consultation can also reduce costs because of the reduced need for patient transport, including aeromedical transport for emergency consultations.

Tele-Research

Tele-research can be used to promote public health, emergency preparedness, collaboration between researchers, the broadening of population-based studies, the rapid distribution of translational research, and strategies for training future telehealth providers.

These tele-research applications require collaboration between healthcare providers, government agencies, community partners, policymakers, health economists, social scientists, and engineers.

Tele-Education

Tele-education enables physicians to obtain continuing medical education (CME), stay up-to-date with evidence-based medicine, and access educational tools such as clinical care and best practice guidelines. Physicians can also use tele-education to widen their peer groups and develop relationships with other physicians in the academic or community spheres.
Tele-education plays an especially important role in lessening the negative effects of professional isolation for remote and rural healthcare providers.

Both live audio and/or video and stored materials can be used to deliver tele-education. Project ECHO (Extension for Community Healthcare Outcomes) is a great resource for providers interested in engaging in tele-education, and specifically tele-mentoring.

Types of Care Available via Telehealth

What kinds of care are available via telehealth? More than most people realize.

All of the following types of care are commonly provided via telehealth today:

Telehealth Modalities

Live Video

Also called synchronous or real-time video, live video involves two-way interactions between a provider and another provider, a patient, or a caregiver via audiovisual technology. Historically, live video has been the most common telehealth modality, and it is what comes to mind for most people when they think of telehealth today.

When in-person care is not available, convenient, or safe, live video is an ideal substitute. Videoconferencing is an effective telehealth tool for a wide range of applications and services, including consultations, diagnoses, and treatment. For an example of an instance in which live video can save lives, watch Telehealth Saves Lives, a micro-documentary from CCHP.

Devices used for video may include web cameras, video conferencing units, videoscopes, or peripheral cameras. Devices used for display may include computer monitors, tablets, LCD projectors, and TVs.

Remote Communication Technology-Based Services

Within Medicare, “remote communication technology-based services” (sometimes abbreviated as CTBS) are not considered to fall under the bucket of telehealth because they lack an in-person care equivalent. As a result, these services do not have the same restrictions and limitations that Medicare places on telehealth services.

The Centers for Medicare and Medicaid Services expanded their reimbursement for these services substantially in 2019. Then in 2020, remote communication technology-based services saw even further reimbursement expansions as a way to make it easier to provide care during COVID-19.

Types of remote communication technology-based services include, but are not limited to:

• E-visits: Patient-provider communications via an online patient portal
• Remote evaluations of prerecorded patient information: Remote professional evaluations of prerecorded images or videos submitted by established patients to determine if follow-up is necessary
• Virtual check-ins (or “brief communication technology-based services”): Brief, real-time communications between a provider and an established patient to determine whether treatment or a full, in-person evaluation is necessary

Mobile Health

Relatively new to the telehealth arena, mobile health (or mHealth) consists of healthcare services and personal health information (PHI) provided over mobile devices such as cell phones, tablets, and wearable technology. Receiving mHealth often requires users to download apps onto their devices.
Essentially, when someone uses a mobile device or app to further their health goals, that’s mHealth.

Examples of mHealth include watches that track exercise throughout the day as well as apps that track weight loss, nutrition, pregnancy, and illness.

Governing bodies that have jurisdiction over mHealth include:

• The Food and Drug Administration (FDA)
• The Federal Trade Commision (FTC)
• The Federal Communication Commission (FCC)
• The Department of Health and Human Services (HHS)

Remote Patient Monitoring

In remote patient monitoring (RPM), healthcare providers use digital technology in the form of point-of-care monitoring devices to continue to monitor patients after they’ve been discharged home or to a care facility.

The RPM technology collects data at the patient’s location and electronically transmits it to their provider, enabling the provider to assess and make recommendations. In the event of a decline in health, the technology could alert and spur the provider to immediate action.

Point-of-care monitoring technology includes devices such as blood pressure monitors, glucometers, and weight scales. Types of health data transmitted via RPM include:

• Weight
• Vital signs
• Heart rate
• Blood sugar
• Blood pressure
• Blood oxygen levels
• Electrocardiograms

Benefits of remote patient monitoring programs include reduced readmission rates, hospitalizations, and lengths of hospital stays. RPM can also improve health and quality of life for seniors and those with chronic illnesses and disabilities, as they can remain at home for longer rather than move into special care or nursing facilities.

Store-and-Forward

Store-and-forward telehealth involves the transmission of health information — in the form of, for example, documents, digital images, and prerecorded videos — from a practitioner to a specialist via email. This information enables the specialist to provide an evaluation without having to be present at the location or time of the initial consultation.

Because store-and-forward evaluations don’t take place in real time, they are sometimes referred to as asynchronous telehealth.

Information communicated via store-and-forward technology often includes patient data, photos, video clips of exams, MRIs, and X-rays. Store-and-forward technology is most often utilized in radiology, ophthalmology, and dermatology:

• Radiology: In rural or small towns with specialist shortages, primary care providers can send MRIs and X-rays to specialists at large medical centers.
• Ophthalmology: Diabetic retinopathy, a leading cause of blindness in people with diabetes, requires regular eye screenings for early detection. These screenings can be carried out by primary care providers using retinal cameras and then forwarded to ophthalmologists for evaluation.
• Dermatology: Practitioners can send dermatologists photos of their patients’ skin conditions for review to determine whether action is necessary.

Benefits of store-and-forward communications include:

• Patients can receive specialty care when they need it just by visiting their primary care provider. This is especially beneficial for patients in remote areas who would otherwise have to travel long distances to reach a specialist.
• Without the need to coordinate schedules, specialty care wait times are reduced, boosting efficiency and quality of care.
• Specialists can review patient cases at their convenience as well as significantly widen their scope of practice.
• Cultural and language barriers are less of an obstacle because the evaluation is not taking place in real time.

Note that Medicaid policies regarding store-and-forward telehealth vary by state, and private insurers do not always reimburse for these services.

[Related: 10 Signs You’ve Outgrown Your Virtual Care Solution]

Common Telehealth Features

Patient Portal

Many virtual care solutions include a patient portal. Patient portals are websites that allow patients to:

• Communicate with their providers. (This is a superior alternative to emailing, which is insecure.)
• View providers and specialists available to them.
• Schedule appointments.
• Get reminders about upcoming appointments.
• Get updates on routine care and vaccinations that need to be scheduled.
• Download forms.
• Request prescription refills.
• Review summaries of previous visits and test results.
• Pay bills.
• Update contact information.
• Review coverage and benefits.
• Review educational content.

Virtual Appointments.

Many telehealth platforms have capabilities for scheduling and carrying out virtual appointments via videoconferencing. During virtual healthcare appointments, providers walk patients through a series of questions and, based on the responses given, prescribe home care strategies, medications, or additional treatments.

Virtual appointments make healthcare more convenient for patients and providers alike, reducing the need for travel and the strain on hospital facilities. Virtual visits have also grown astronomically during the COVID-19 pandemic as a safe way to provide triage and general care without requiring patients to enter healthcare facilities, which could lead to virus transmission.

Electronic Health Records

Electronic health records (EHRs) are real-time digital versions of patients’ medical records that authorized users can access instantly. EHR systems enable healthcare professionals to:

• View a patient’s medical information and history, including allergies, immunizations, medications, diagnoses, treatment plants, test and lab results, and radiology images.
• Share this information with other providers across multiple healthcare organizations, including pharmacies, specialists, laboratories, and more.
• Access evidence-based tools to facilitate decision-making.
• Streamline and automate treatment plans.

The best telehealth platforms offer EHR integrations so that healthcare facilities can access all their telehealth features in one place.

[Related: How to Choose the Best Telehealth Solution: Comparing and Contrasting Popular Video Conferencing Apps for Telehealth]

Benefits of Telehealth

Benefits of Telehealth for Patients

Benefits of telehealth for patients include:

• Reduces risk of disease transmission: People who are sick pass through healthcare facilities on a daily basis. Visiting these facilities for an appointment may put patients at risk of contracting something, especially concerning for those with a weakened immune system or underlying conditions. On the other hand, patients who are sick and visit a healthcare facility may spread their infection to anyone they come into contact with there. Telehealth has been instrumental in reducing the spread of COVID-19, and it can provide the same benefits during seasonal infections such as the flu.
• Convenience: Patients can access care from wherever is most convenient for them, saving them the time and stress of having to travel to a healthcare facility. This convenience makes it easier for those who live in a remote location, don’t have a reliable source of transportation, can’t take time off of work, or don’t have childcare to receive care.
• Reduced costs: Those who use telemedicine have been shown to spend less time in the hospital, resulting in lower hospital fees. Telehealth may also reduce costs by preventing the need to purchase gas to commute to a healthcare facility or pay for childcare.
• Preventive care: By making it easier for individuals to receive preventive care, and especially those who can’t access quality care due to geographic or financial reasons, telehealth may improve their long-term health. This was the case in a 2012 evaluation of individuals with coronary artery disease, which correlated preventive telemedicine with improved health outcomes.
• Greater accessibility: In addition to making it more convenient for everyone to access care, telehealth improves healthcare accessibility for senior citizens, individuals with disabilities, and those who are incarcerated.

Benefits of Telehealth for Providers

Providers have something to gain from telehealth as well, including:

• Reduced exposure to viruses: Telehealth puts a buffer between providers and sick patients, reducing the likelihood that they will become sick themselves.
• Lower overhead costs: Practitioners who use telemedicine often save money by reducing overhead expenses such as office space and front desk support. Even if telehealth doesn’t eliminate the need for a physical office entirely, the amount of space and support necessary may be reduced.
• Increased revenue: Telehealth may enable providers to see more patients than they would otherwise be able to, increasing their income.
• Improved patient satisfaction: The convenience of telehealth is likely to promote patient satisfaction. Indeed, in a study of 1,000 patients who used telehealth during the pandemic, 75% were satisfied with their visits.

Limitations of Telehealth

Despite telehealth’s many benefits, it also has some limitations for both providers and patients:

• Low acceptance: Both patient and provider acceptance of telehealth was quite low prior to the pandemic due to lack of education and hesitancy to try this new form of care, as well as technological and legal barriers. COVID-19 and the urgent need to provide safe care has gone a long way toward removing these obstacles, but only time will tell whether this greater acceptance will persist after in-person care is no longer so risky.
• Examination obstacles: Telehealth requires practitioners to rely on the information they get from patients in order to determine a course of treatment. Patients may fail to self-report symptoms that the provider could have noticed during an in-person evaluation, potentially jeopardizing treatment.
• Regulatory and insurance obstacles: Laws relating to patient privacy, licensing, and prescribing as well as reimbursement and malpractice insurance restrictions can make providers hesitant to adopt telemedicine.
• Poor usability: Telehealth platforms that are too complicated for providers to set up or for patients to use can prevent virtual care from being carried out. Providers may also be unwilling to use telehealth platforms that are inefficient, since their income depends on having a steady flow of patients.
• Cultural barriers: Cultural norms surrounding healthcare delivery can vary widely across and even within countries, potentially creating obstacles to effective telehealth. For instance, most western countries take for granted that diagnoses are private to the patient, whereas many other countries give families the option to convey or even conceal diagnoses from their loved ones.
• Technological barriers: Providers may struggle to find or set up a digital telehealth platform to enable virtual care. Telehealth may also be less accessible for low-income populations, who may not have access to Wi-Fi or a video-capable device.

The Future of Telehealth

Telehealth’s rapid acceleration during COVID-19 has many people in the industry wondering, how will telehealth fare after the end of the pandemic?

More than 70% of Americans who tried telehealth during COVID-19 said they planned to continue using virtual care after the end of the pandemic according to a 2020 study. This changing patient preference, combined with the many proven benefits of telehealth, indicate that telehealth may be the new normal, pandemic or no pandemic.

But that doesn’t mean that more changes aren’t in store. Telehealth will necessarily continue to evolve to better meet post-pandemic needs and address existing gaps in care, and telehealth offerings and acceptance will continue to evolve as well.

To get a better idea of what these changes might entail, Modern Healthcare asked telehealth providers and healthcare leaders for their input on the future of telehealth. Their responses:

• Telehealth will become a standard service.
• Healthcare facilities that utilize telehealth will grow their business and income.
• Patients will seek out health systems, hospitals, and providers that offer telehealth.
• Telehealth will enable more efficient and convenient preventive care.
• Telehealth will expand access to specialists and reduce hospital wait times.

Telehealth Glossary

Asynchronous: The collection and digital transmission of a patient’s health information to a specialist for further evaluation; also referred to as “store-and-forward”

Distant site: A site where a practitioner who provides telehealth services is located

Electronic health records (EHRs): Real-time digital versions of patients’ medical records that authorized users can access instantly

Mobile health (mHealth): Healthcare services delivered or supported by mobile devices, such as tablets, cell phones, and wearable patient monitoring devices

Originating site: The site where the patient is located during the delivery of telehealth services

Remote communication technology-based services: A group of services that Medicare reimburses for that utilize telehealth technologies, but which Medicare does not consider to be telehealth because they do not have an in-person equivalent

Remote patient monitoring (RPM): The remote monitoring of a patient’s health using digital technologies that collect health data at the originating site and transmit it to the patient’s healthcare provider

Store-and-forward: The collection and digital transmission of a patient’s health information to a specialist for further evaluation; also referred to as “asynchronous”

Synchronous: Live, real-time patient-provider interactions at a distant site

Helpful Telehealth Resources

Bookmark this page for quick access to the following helpful telehealth resources:

American College of Physicians (ACP) – Telehealth Guidance and Resources: Guidance on providing technology-enabled care, including video visits, telephone visits, and remote patient monitoring

American Medical Association (AMA) – State Orders and Directives Chart: A summary of directives to broaden telehealth services to fight COVID-19, including Medicaid activity, directives from the Department of Insurance, and Executive Orders

Center for Connected Health Policy (CCHP) – Current State Laws & Reimbursement Policies: An interactive map of current state telehealth laws and reimbursement policies

Center for Connected Health Policy (CCHP) – The National Telehealth Policy Resource Center: A hub of resources on telehealth, telehealth policy, telehealth projects, and telehealth-related news and updates

Centers for Disease Control and Prevention (CDC) – Using Telehealth to Expand Access to Essential Health Services During the COVID-19 Pandemic: Guidance on using telehealth to provide virtual during the COVID-19 pandemic

Centers for Medicaid & Medicare Services (CMS) – Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19: Information on the new rules and temporary regulatory waivers that the CMS has issued to expand access to telehealth during the COVID-19 pandemic

Health Resources & Services Administration (HRSA) – Telehealth Programs: A list of programs provided by the Office for the Advancement of Telehealth (OAT) to promote telehealth services in rural areas

Medicaid.gov – State Medicaid & CHIP Telehealth Toolkit: Policy considerations to help states expand telehealth adoption in Children’s Health Insurance Programs (CHIPs) and Medicaid during the COVID-19 pandemic

Telehealth.HHS.gov: General information on telehealth for both patients and providers