The Future of Telemedicine. Innovation Must Meet Legal Compliance Challenges.
The future of telemedicine is here due in large part to the COVID-19 pandemic. The pandemic forced many Americans indoors. For these Americans, the best and often the only way to speak with their physician was and is through virtual communication. There are many issues that are changing the telemedicine landscape. Some of these issues focus on access. Some issues focus on the available technology. Legal compliance issues are another major factor.
The growth of telemedicine
Dr. Leo P. Langlois wrote an article, “Reimagining the Future of Telemedicine in a Post-COVID World” for the University of Arizona. Telemedicine grew nearly 43% from February to April 2020. Telemedicine is now seen as a way of “redefining the way in which health systems deliver care, operate, and manage costs.” He predicts that the following telemedicine changes may soon take place:
- Telemedicine will become standard for most health care practices. A study by the Deloitte Center for Health Solutions in collaboration with the American Telemedicine Association (ATA) found that nearly half of healthcare executives think at least 25% of all “outpatient care, preventive care, long-term care, and well-being services will be delivered through telemedicine” by 2040.
The Centers for Medicare and Medicaid Services (CMS) issued waivers during the pandemic making it possible for health providers to start using telemedicine with few restrictions and minimal sources. Even when the pandemic ends, hopefully soon, many legislators will likely think about how telemedicine should be expanded to provide more access – across various specialties.
Telemedicine has proven to be desirable because it helps people with chronic conditions, streamlines primary care visits, and “furnishes robust data security to patients’ health records and other confidential information.”
- Telemedicine will be a viable option for chronic and preventative care. One of the hardest challenges facing healthcare professionals is managing chronic disease. According to the National Institutes of Health, nearly 50% of all adults have a chronic disease and 33% are living with multiple chronic diseases – such as heart disease, cancer, diabetes, hypertension, stroke, pulmonary disorders, and mental illness. The cost of these medical conditions costs the US economy 1.3 trillion annually.
Many physicians are now able to monitor a patient’s health condition using the following technology:
- Mobile devices that can track a patient’s vital signs and monitor a patient’s diet, exercise, and nutrition “boost patient engagement levels and improve patient compliance with medical treatment plans.”
- Live audio and video
- mHealth apps
- Other smart digital tools
Integrating these apps and other telemedicine technology will help doctors make data-driven decisions for their patients.
Dr. Langlois adds that telemedicine should soon be able to help with preventive care too.
- Telemedicine will help patients make medical choices. Patients and health stakeholders will be able to use telemedicine to “advance data interoperability (through EHR integration) and carry out personalized interactions in a remote setting.” This ability will greatly improve provider-patient communication. One recent study found that nearly 83% of patients say that will probably use telemedicine after the COVID-19 pandemic subsides. Telemedicine is expected to become attractive for patients who see it is more convenient to speak with a doctor from the comfort of their home instead of having to wait a long time at their doctor’s office.
Telemedicine is especially useful for patients who are homebound, can’t find the time away from work, or live in remote areas.
As healthcare organizations balance the new technology with functional care, telemedicine should become even more attractive – for both providers and patients.
Telemedicine and nursing
Telemedicine in the future won’t just be limited to doctors. Many nurses will use telemedicine too – provided laws and regulations are in place to ensure nurses are properly supervised by the physicians and that the physicians have the final review and say about medical care. Many states are still reviewing what role non-physician staff such as nurses can have in using telemedicine to care for patients.
According to Purdue (University) Global, telemedicine can help reduce healthcare costs while expanding services. Purdue Global states that:
- 91% of employers are expected to offer telemedicine services to their employees by 2020, according to a First Stop Health survey of midsize to large employers.
- 79% of patients said that scheduling a telemedicine follow-up visit was more convenient than arranging an in-person follow-up, according to Massachusetts General Hospital.
Purdue Global states that telemedicine is especially critical for older people, people in remote places, and communities that don’t have adequate medical care. Patients, using current state-of-the-art technology, can even receive care from doctors and nurses who work/live in different states (again, “assuming” the laws permit cross-state telemedical care) – at a price that’s less costly than office visits.
Telemedicine may be able to reduce the number of ER visits and hospitalizations because many patients can be monitored remotes – before their condition gets too severe. Telemedicine is helping nurses take core of more patients, more often.
“Many services can be provided, including health education, e-consulting, diagnosis and management of an acute condition, and remote monitoring of specific conditions.”
ESTABLISHING THE PHYSICIAN-PATIENT RELATIONSHIP: TELEMEDICINE LAW OFTEN REQUIRES IT, BUT WHAT DOES THIS MEAN?
Establishing the physician-patient relationship is often a requirement of state telemedicine law, but what does it mean that the physician has in fact “established” the physician-patient relationship?
What role does nursing play in telehealth services?
Before the introduction of computer technology, the best nurses could do away from an in-person setting was to provide counseling and education through the telephone. Now information technology lets nurses monitor patients “more closely and accurately” by using many different types of audio-visual systems. Telehealth care by nurses and the use of telehealth software by patients and nurses includes patient interviews and monitoring a patient’s “oxygen levels, heart rate, blood pressure, blood glucose, and more.”
Nurses, in emergency cases, can even tele-triage – informing patients how to treat minor burns or dress wounds until an ambulance or other medical help arrives. Often, nurses can use telehealth for presurgical care and postoperative care.
How will nurses use telehealth services to deliver medical care?
According to Purdue Global, the main ways nurses will use telehealth services include:
- Live video conferencing: This technology is “live, two-way (synchronous) interaction between the nurse and patient.” Video conferencing is often used for minor health problems or to review when the patient should go to the nearest emergency room.
- Store and forward (asynchronous): This technology “is a version of a recorded health history.” The software asks the patient questions and records their answers. The Q and A are then sent to the nurse. Store and forward is useful in remote areas, “where providers want the opinions of specialists or consultants that are not available in the area.”
- Remote patient monitoring: This technology reviews the patient’s personal health information “from one location that is transferred electronically to a nurse or provider, who monitors patients remotely (weight, blood pressure, vital signs, etc.).”
- Mobile health: Many providers and patients will use smartphones, tablets, or computers to send and receive health information. “In hospital settings, a device like this may be used in a patient room as a “safety sitter,” where an off-site nurse or provider watches the patient in real-time and calls a nearby nurse or unit if the patient is at risk of fall or another safety concern.”
Again, the ability for nurses to use telemedicine will have to balance practical medical questions which organizations such as medical boards who will need to review legal questions – about the supervision of nursing care, when and how nurses can provide telehealth care, and other legal questions which an experienced healthcare lawyer can explain.
Some of the questions that telehealth service companies and the medical profession will need to review include:
- “How will health insurance coverage work for telemedicine consultations?
- What are the standards of online care?
- Will a virtual patient-nurse relationship ever be as comprehensive as an in-person visit?
- Can an internet-based service ever be fully confidential?”
- What certification requirements, if any, will be required for nurses and doctors to provide health care through the use of telemedicine.”
How will technology figure into the future of telemedicine?
According to Verizon, in order for telemedicine and telehealth (explain the difference), everyone needs to be able to access the services. There is a digital divide for many Americans. It sounds great the people in remote areas will be able to speak to their doctor or nurse – but you cannot speak if you do not have the technology to access the services.
Verizon expects that:
- “Telemedicine will likely become a mainstream offering for certain specialties and best-fit use cases.
- Access to telemedicine options will influence how patients choose doctors, hospitals, and health systems in the future.
- Telemedicine accessibility will streamline access to specialists and reduce wait times at hospitals.
- Telemedicine can enable better chronic disease management, treatment compliance, and improved care outcomes.”
How great is the digital divide?
Verizon states that nearly 60% of lower-income parents with schoolchildren think their children will have at least one digital difficulty in finishing their work. 25% of seniors (65 and older) say they never go online. Other barriers include “economic stability, neighborhood and environment, social and community context, and education access and quality.” Many minorities, many people in rural locations, and people on Medicare or Medicaid likely to use telehealth services if it is accessible and use-friendly according to the Journal of Telemedicine and Telecare.
Other potential barriers (which are also incentives to healthcare companies to find ways around these barriers) to telemedicine accessibility and telehealth access to care include:
- Broadband access and digital literacy. Telemedicine will need to incorporate video, images, and other information into access to the Internet. Telemedicine will need to expand its geographical range and its ability to address different medical specialties. Telemedicine companies will need to address the digital divide – and how newer less tech-savvy users – can understand how to use telemedicine. The pandemic has clarified how useful telemedicine can be. The challenge is to expand that usefulness across the nation.
- Disability. Telemedicine businesses will need to address some of the challenges people with disabilities have when accessing telehealth services. The software will need to include text, audio, and video for people who can’t see or hear or have difficulties seeing and hearing.
- Under-resourced practices. Telemedicine needs to work for small and solo practices – not just hospitals and multistate medical groups.
What are some of the ways technology will address the digital divide?
A few of the ways to address the digital divide may include:
- Technology that tracks screen time and telemedicine usage will provide incentives for telemedicine providers.
- Telemedicine companies will need to integrate medical care with electronic health record platforms – while ensuring the software and medical practice complies with HIPAA and other federal and state privacy regulations.
- Mobile devices will need to support the bandwidth needed for virtual visits.
Technologies such as 5G and artificial intelligence will be used to help reshape telemedicine access and medical care.
As telemedicine expands and as new innovations increase access and usage, telemedicine companies and medical practices will continually need to review the federal and state compliance issues. While there are many medical benefits to telehealth medicine, the benefits must address issues of privacy, security, medical competence, the unauthorized practice of medicine, ownership, and many other legal concerns.
Most states prohibit the corporate practice of medicine but allow for professional medical corporations. The hiring of doctors by hospitals is mostly illegal in California.