How Telehealth is Changing Health Care

COVID-19 has introduced unprecedented challenges to health care. As people seek to manage their care in new and different ways during the pandemic, telehealth has proven to be a particularly successful innovation—something that comes as a pleasant surprise to some physicians.

Telehealth is the delivery of healthcare services through digital communications. This could involve direct medical care, patient education, and/or health information services facilitated through methods like video conferencing, text messages, mobile health apps, and remote patient monitoring systems.

“I like to think of it as a way to speak with my patients and help to manage their care when in-person visits might not be an option or necessary for the check-in,” Brian LaMoreaux, MD, a rheumatologist and medical director at Horizon Therapeutics in Chicago, Illinois, tells Verywell.

Right now, telehealth is exploding. At The Ohio State University Wexner Medical Center alone, virtual visits went from 96 in February to a total of more than 202,900 from March through July. But virtual health care isn’t a new concept. In fact, the earliest documented use of hospital-based telehealth was in the late 1950s and early 1960s, when the Nebraska Psychiatric Institute connected with the Norfolk State Hospital to provide psychiatric consultations via closed-circuit television.

Of course, technology has come a long way since then, and, nowadays, you can connect with all kinds of providers, from medical doctors and mental health specialists to physical therapists and nutritionists, using only your phone.

Telehealth 101

Ultimately, it’s up to each individual practice to determine how their telehealth delivery will work, but all applications typically involve various Health Insurance Portability and Accountability Act (HIPAA) approved electronic communication services.

At The Ohio State University Wexner Medical Center, clinicians utilize a combination of video visits, telephone calls, and detailed questionnaires about medical history and current symptoms that are sent through secured servers. The provider will then outline a care plan and/or recommend follow-up appointments.

If there's testing that needs to be done, clinicians can order lab work or have certain testing kits sent directly to your home. As for insurance, many companies will cover telehealth visits just as they would regular visits, but the details come down to what’s covered in your individual policy.

Advantages of Telehealth

Patient and clinician convenience is one of the biggest benefits of telehealth. It’s especially advantageous for older adults, homebound individuals, or anyone with a busy schedule that makes it hard to find time for an in-person doctor’s visit.

Some of the other benefits of telehealth include:

• Improved access to—and quality of—health care: With access to remote practitioners, you’re no longer limited to healthcare services within driving distance of your home. This is especially beneficial for people who live in rural areas with limited quality of care.
• Reduced travel time: Telehealth visits can be done right from your living room, so there's no travel involved at all. The Ohio State University Wexner Medical Center patients saved 12.2 million miles in travel from March to July.
• Decreased costs: Sometimes, but not always, telehealth appointments are less expensive than in-person visits. You also save money on fuel costs.
• Fewer missed appointments: At The Ohio State University Wexner Medical Center, the overall no-show rate for in-person visits was 9% prior to the pandemic. It was 12.2% for Medicaid patients. Once telehealth was implemented, those rates dropped to 5.8% and 9.6%, respectively. 
• Allows more flexibility for patients and clinicians: Generally, in-person office visits have to be done within certain office hours. This limits access for working professionals or those who have schedules that don't allow them to make appointments during these hours. With telehealth, it's easier to schedule an appointment at any time.
• Ensures patient and staff safety: Telehealth appointments are especially beneficial for high-risk patients who may be at an increased risk of contracting infections, like COVID-19. They can continue their care from the comfort of their own home, without worrying about exposure.

“In times like now with a pandemic, [telehealth] also affords the opportunity to maintain distancing when appropriate, as with diagnostic testing for COVID-19 itself,” Doug Elwood, MD, the chief medical officer of PWNHealth in New York, tells Verywell. “Through an integrated approach that is overseen by physicians, testing has been moved to drive-thrus and other venues, including at-home kits, that allow people to get tested without endangering themselves or others, a critical fact with winter and flu season fast approaching.”

Jessica Myszak, PhD, a licensed child psychologist in Illinois and the director of the Help and Healing Center, tells Verywell that telehealth is extremely helpful for providing care to individuals with certain conditions, such as social anxiety, PTSD, agoraphobia, and autism.

"I have noticed that being able to talk to individuals in their own homes allows them to feel more comfortable and be more open with me," she says. "I do early autism testing with young children, and I have found it extremely beneficial to be able to observe children in their own home. Kids act differently in new and strange environments, and being able to see how they react to their parents in the home over a video call helps me identify problematic behaviors."

There Are Some Disadvantages, Too

There are some disadvantages that come with remote health care, especially as people learn to adjust to new technology.

While most practitioners are on board with incorporating telehealth as part of an overall treatment plan, some are concerned that you can’t build the same rapport with new patients as you can in a face-to-face appointment.

Other disadvantages include:

• Lack of physical testing: While some testing can be ordered remotely, in-person visits are still necessary for other tests, like MRIs, X-rays, or CT scans.
• Exacerbates inequities in health care: Telehealth is typically done through video or phone calls, so it's necessary to have access to the devices required to run those services. Some of the most vulnerable and at-risk populations lack access to that technology.
• There's a learning curve: All you have to do for an in-person visit is show up. However, telehealth requires the use of technology that many may not be familiar with. This is especially difficult for older adults who aren't familiar with more advanced technology.
• Communication can be more difficult: Some people aren't verbal communicators, which is a necessary factor for telehealth services. In these cases, clinicians rely on body language and other non-verbal cues during in-person visits. Many of these non-verbal cues are missed with telehealth.
• Less stringent guidelines: Some companies are able to provide telehealth services without licensed clinicians. Because of this, it's important to make sure you're seeking out licensed professionals when necessary.
• Technical issues: With technology, there will always be technical problems, like connectivity issues, that can get in the way of proper care.

Elwood also adds that some diagnoses are simply not amenable to a telehealth approach. “Since the individual is not in front of you, some signs and symptoms may be missed,” he says. “States have specific telehealth rules and regulations for this reason."

Diagnosing Through Telehealth

LaMoreaux agrees certain conditions are more difficult to diagnose without a physical exam, but it is possible. “Just as each in-person visit is different, each virtual visit comes with its own unique challenges,” he says. “We need to adjust and meet our patients where they are—whether that is modifying technology choices, adjusting approaches, or restructuring conversations.”

Ultimately, it all comes down to proper communication by both clinician and patient. Since there's no physical exam, telehealth visits typically require a more lengthy question and answer session that allows the clinician to get to the root of the problem and make an accurate diagnosis.

Of course, not all diagnoses can be made virtually, there are conditions, like cancer, that require in-person visits. Symptoms that signal potential emergencies, like chest pain, also require immediate hands-on care.

Is Telehealth Here to Stay?

Although there are some downsides, most clinicians, and patients, seem to agree telehealth is here to stay. While it may never completely take the place of in-person visits, at the very least, it can serve as a great adjunct to traditional health care.

“Even connecting over the phone can help with continued care of chronic conditions, as we’re able to discuss symptoms and additional evaluations, as necessary," LaMoreaux says. “While in-person visits will always be an important part of patient care, telehealth has become an integrated part of managing patient health.”

As the world changes, it's important for clinical practices to adapt to ensure that patients are receiving the proper care and support necessary to manage their conditions.

“I believe the way we are treating patients has changed and telehealth is a big part of that shift," he says. “Being able to maintain care for patients is our top priority and as physicians, we are committed to whatever platform is best for their individual situation.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.