Sunlight in the Darkness: Emergence of Telehealth as a Positive Unintended Consequence of COVID-19
COVID IN FOCUS: PERSPECTIVES ON THE LITERATURE
This CHEST series highlights specific studies in the COVID-19 literature that may warrant discourse or reading for members of the chest medicine community. Articles are written by members of CHEST Networks. You can read additional articles in this series.
NOTE: The perspectives shared in this article are those of the author(s) and not those of CHEST.
Sunlight in the Darkness: Emergence of Telehealth as a Positive Unintended Consequence of COVID-19
By: Tyler Church, DO; Jason Unger, MD; and Bathmapriya Balakrishnan, MD
Occupational and Environmental Health Network
Published: August 9, 2021
In London from 1849 to 1854, cholera rained havoc in the city until John Snow determined that contaminated water was the source of the outbreak. This discovery forever changed modern cities by the development of sewer infrastructure and water purification systems that would eliminate waterborne pathogens. COVID-19, like cholera, has led to change within the public health sector by the implementation and widespread use of a new infrastructure: Telehealth. This change has fundamentally improved access to health care for many patients.
By the end of May 2020, 42 states had issued stay-at-home orders, inciting widespread concern among the population.1 Initially, the pandemic decreased access to care due to fear and logistical difficulties, as many forms of public transportation had been temporarily shuttered. The need for continued care of chronic health conditions forced health care systems to abandon traditional health care models of in-person care and adopt a hybrid model, offering telehealth in addition to usual care.
Historical barriers to telehealth were largely legal in origin, but as states declared public health emergencies due to the COVID-19 pandemic, many state medical boards suspended or changed telehealth regulations to allow continuation of care.2 The major limitation that was at least temporarily set aside was the need for clinicians to have a license in the state in which the patient was receiving the telehealth visit, unlike the usual care model in which the physician was required to hold licensure in the state in which they were practicing.
The flexibility in state requirements has been associated with a dramatic rise in telehealth utilization. For example, one institution saw a rapid rise from a weekly volume of 100 encounters per day to more than 2,200 per day due to the pandemic.3
Telehealth offers several benefits for patients. They are able to receive health care with minimal interruptions in their workday. They are also able to seek second opinions without extensive travel, which is especially important in rural areas where the number of specialists may be limited. Telehealth could also result in increased enrollment in clinical trials, as subjects may not need to travel to academic medical centers for participation.
Despite its heavy use during the COVID-19 pandemic, the question remains whether the robust use of telehealth is here to stay. Flexibility of reimbursement and regulations will expire as we move beyond the acute needs invoked by the pandemic. This possibility is driving policy efforts, with the reintroduction of the Protecting Access to Post-COVID-19 Telehealth Act in January 2021.4 This bill looks to eliminate geographic restrictions on Medicare coverage, as well as to mandate a telehealth study to better understand the use of technology during public health emergencies.
*Disclaimer: The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of the Army/Navy/Air Force, Department of Defense, or US Government.
References
- Moreland A, Herlihy C, Tynan MA, et al. Timing of state and territorial COVID-19 stay-at-home orders and changes in population movement — United States, March 1–May 31, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(35):1198-1203.
- Slomski, A. Telehealth success spurs a call for greater post–COVID-19 license portability. JAMA. 2020;324(11):1021-1022. doi:10.1001/jama.2020.9142
- Contreras C, Metzger GA, Beane JD, et al. Telemedicine: patient-provider clinical engagement during the COVID-19 pandemic and beyond. J Gastrointest Surg. 2020;24(7):1692-1697. doi: 10.1007/s11605-020-04623-5
- Wicklund, E. Lawmakers reintroduce post-COVID-19 telehealth bill, hoping for a better outcome. mHealthIntelligence. January 26, 2021. https://mhealthintelligence.com/news/lawmakers-reintroduce-post-covid-19-telehealth-bill-hoping-for-a-better-outcome
Tyler Church, DO
Dr. Church is a Pulmonary and Critical Care Fellow at Walter Reed National Military Medical Center, Bethesda, MD, and is interested in occupational health, sarcoidosis, and graduate medical education. He is a Fellow-in-Training member of CHEST’s Occupational and Environmental Health Network Steering Committee.
Jason Unger, MD
Dr. Unger is a Pulmonary and Critical Care Fellow at Walter Reed National Military Medical Center, Bethesda, MD, and is interested in clinical care, research, and education in military medicine. He is a Fellow-in-Training member of CHEST’s Occupational and Environmental Health Network Steering Committee.
Bathmapriya Balakrishnan, MD
Dr. Balakrishnan is an Assistant Professor in the Section of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, at West Virginia University in Morgantown. She is dedicated to advancing the care of patients with interstitial lung disease, pulmonary hypertension, and ARDS. Dr. Balakrishnan is a member of CHEST’s Occupational and Environmental Health Network Steering Committee.
Read more COVID in Focus: Perspectives on the Literature:
Lessons Learned About Aerosol Drug Delivery in the Era of COVID-19
Thromboembolism and COVID-19
Lung Transplantation for the Treatment of COVID-19 Fibrosis
Immunomodulation Therapy in Severe COVID-19 Infection: Where Do We Stand?