Telehealth, telemedicine and related terms generally refer to the exchange of medical information from one site to another through electronic communication. The Centers for Medicare and Medicaid Services (CMS) defines telehealth as a two-way, real-time interactive communication between a patient and a physician or practitioner at a distant site through telecommunications equipment that includes, at a minimum, audio and visual equipment.
Telehealth is not interchangeable with the term “telemedicine.” According to the Health Resources Services Administration, telehealth refers to a broader scope of remote health care services than telemedicine. While telemedicine has historically referred to remote clinical services, telehealth can refer to broader services including synchronous and asynchronous communications.
The AMA STEPS Forward® toolkit “Telemedicine: Facilitate Access to Care for Your Patients” points to various benefits that telehealth brings to both patients and physicians, including:
- Reducing the burden of travel to access care
- Enhancing timely delivery of health care services
- Increasing compliance with treatment plans
- Improving communication with health care practitioners
- Lowering the cost of care.
An AMA survey showed that the vast majority of doctors—85%—are still telehealth to deliver patient care and most said their organization will continue to use telehealth in their practice.
Access to care during COVID-19 & beyond
During the COVID-19 pandemic, telehealth has facilitated safer access to care that is quick, efficient and, most of all, remote – for people all over the world.
The pandemic presented a challenge to physician practices and health systems that had to quickly pivot to the telemedicine model to care for patients.
“I think we were preparing for it on our own, but this is a venture, which would in a typical non-pandemic era would take a six to 12 months of thoughtful planning. But we did it in three weeks,” said Dhrumil Shah, MD, chief medical information officer at COMPASS Medical during an interview for the March 18, 2021 edition of the “AMA COVID-19 Update.”
In the Jan. 27, 2021, edition of the “AMA COVID-19 Update,” Brian Garibaldi, MD, associate professor of medicine at Johns Hopkins University School of Medicine, talked about going beyond video and audio for telemedicine.
“The other thing I would love to see is us taking advantage, not just in the video and the audio, but beginning to use other technologies that we're already using in the hospital, point-of-care devices that can tell you your pulse oximetry, that can tell you your heart rate ... maybe even digital stethoscopes that we can deploy in the home or even ultrasound machines that can guide the patients actually get additional information. I think there's a whole host of untapped resources that we can apply to telehealth.”
Telehealth in practice
In the March 18, 2021, edition of the “AMA COVID-19 Update,” physicians discussed “The Telehealth Initiative,” a collaboration between the AMA, The Physicians Foundation, and several state medical associations, which supports physician practices in adopting and adapting to telehealth.
“If you're not sure, or you need a quick jumpstart, use The Telehealth Implementation Playbook, that'll really help you get started,” said Corey Howard, MD, founder and director of Physicians Life Centers. “Understanding how to integrate it, how to select a vendor, how to code properly and give you the confidence to explore what telehealth can really do for your practice.”
The AMA Telehealth Immersion Program provides ongoing support to physicians, practices and health systems in adopting and optimizing telehealth at their organizations. Through this series of webinars, interactive peer-to-peer learning sessions, virtual discussions, bootcamp, and resources, the program amplifies available education on telehealth, builds the evidence base supporting telehealth use in providing patient care, and facilitates a network of collaboration and sharing of best practices.
Challenges presented by telemedicine & ethical practice
Despite the benefits telehealth may bring, in its May 2014 issue the AMA Journal of Ethics says it is also important to anticipate and address four possible pitfalls:
- Erosion of the patient-doctor relationship
- Threats to patient privacy
- Forcing one-size-fits-all implementations
- Temptation to assume that new technology must be effective
To realize telehealth’s full potential, the AMA brief “Equity in Telehealth: Taking Key Steps Forward” (PDF) asks that those developing and implementing telehealth solutions prioritize partnerships with historically marginalized and minoritized populations to ensure that solutions are designed to be accessible and work well for all. The AMA also urges that health plans be required to cover telemedicine-provided services on the same basis as in-person services, and not limit coverage only to services provided by select corporate telemedicine providers.
What the Code says about physicians & telehealth
The AMA Code of Medical Ethics Opinion 1.2.12 states that physicians “must assure themselves that telemedicine services have appropriate protocols to prevent unauthorized access and to protect the security and integrity of patient information at the patient end of the electronic encounter, during transmission, and among all health care professionals and other personnel who participate in the telehealth/telemedicine service consistent with their individual roles.”
In addition, the Code says that physicians “who participate in telehealth/telemedicine have an ethical responsibility to uphold fundamental fiduciary obligations by disclosing any financial or other interests the physician has in the telehealth/telemedicine application or service.”
- The AMA Digital Health Playbook Series: Telehealth Implementation Playbook
- Return on Health: Moving Beyond Dollars and Cents in Realizing the Value of Virtual Care
- AMA Telehealth Resource Center
- AMA Telehealth Quick Guide
- AMA policies on telehealth
- AMA Ed Hub™: Telemedicine: Providing Safe Care During Coronavirus Pandemic
- AMA Ed Hub™: Telemedicine: Facilitate Access to Care for Your Patients
- AMA Journal of Ethics: Telemedicine's Challenges for the Medical Profession
Reviewed by: Meg Barron, vice president, Digital Health Innovations, AMA
Reviewed on: June 7, 2022