Despite emergency adjustments that have allowed the wide use of telehealth during the pandemic, critical underlying needs must be resolved to ensure that digital health momentum can be sustained after COVID-19 is just a horrible memory.
Liability coverage, data privacy and workflow integration with electronic health record (EHR) systems were identified as physician needs for adoption in AMA surveys conducted in 2016 and 2019 and remain “more relevant than ever,” wrote AMA researchers in “Physician requirements for adoption of telehealth following the SARS-CoV-2 pandemic,” a perspective essay published in npj Digital Medicine.
Just as use of telehealth has grown, so has the list of key questions that must be addressed to ensure the optimization of telehealth moving forward, according to the article. It was co-written by: Michael Hodgkins, MD, AMA senior adviser for digital medicine; Meg Barron, AMA vice president of digital health innovations; Shireesha Jevaji, MPH, an AMA marketing and communications manager; and Stacy L. Lloyd, MPH, AMA director of digital health and operations.
These questions include:
- How can physicians best determine when to use these modalities?
- How do physicians safeguard their patients and practice from liability and privacy concerns?
- How do physicians optimize using these technologies in their practices?
- How can physicians integrate the technology into their EHR and workflows to improve efficiency?
- How will a mix of virtual and in-person visits affect practice revenue and sustainability?
- Will payment continue and at the same rate?
Both physicians and patients are interested in telehealth’s expanded use to continue, but more research will be essential to provide evidence-based guidance to physicians and care teams to optimize telehealth and digitally enabled care in their practices.
In addition to the questions above, there are also barriers with digital literacy and telehealth access.
The authors cited research that found one in three U.S. households headed by seniors do not have computer access and more than half lack a smartphone. In addition, even with access, 52 million adults have difficulty using computers effectively, and uneven access to broadband services in rural areas furthers this divide.
Time to go beyond emergency fixes
The essay notes that the growing use of digital health tools during the pandemic was facilitated by the temporary removal of regulatory barriers that historically have been obstacles to telehealth adoption. Longer lasting regulatory and legislative changes—especially regarding state payment parity laws—could make telehealth even more prevalent.
Many of these concerns are addressed in the bipartisan Telehealth Modernization Act of 2020 (H.R. 8727/S. 4375), which the AMA supports, the essay states.
Also needed are resources that aggregate key steps, best practices and common challenges, while providing case studies that help practices navigate and maximize technology.
To that end, the AMA co-led the Telehealth Initiative—a collaboration between the AMA, The Physicians Foundation, Florida Medical Association, Massachusetts Medical Society and Texas Medical Association—that supports physicians in adopting new telehealth care delivery models.
“The unprecedented increase in telehealth use during the current crisis is both a challenge and an opportunity to assess its impact on access to care, the quality of care, and the financial impact on the health care system,” the authors wrote.
The AMA Telehealth Implementation Playbook walks physicians through a 12-step process to implement real-time audiovisual visits.
Way forward after COVID-19
In an npj Digital Medicine blog post that accompanied the journal article, Jevaji expanded on other issues that require resolution for telehealth to play a central role in improving health care quality.
“Enacting coverage parity, providing fair payment; requiring insurers to allow all contracted physicians to receive reimbursement for remote visits, expanding broadband, expanding acceptable modalities increasing digital literacy, and addressing geographic and originating site barriers are among the areas that need to be addressed,” Jevaji wrote.
Learn how the AMA is advancing telemedicine during the COVID-19 pandemic.