Telehealth has been a part of the medical field for several decades, but its use is markedly increasing with the advent of the COVID-19 outbreak. Because it offers the capacity to provide care from a distance, it fills a critical need. The most important advantage is that it reduces human contact, which lowers the risk of contracting the infection. Other benefits include saving time and affording greater convenience for both practitioners and patients.
What exactly are telehealth and telemedicine?
Telehealth is the use of telecommunication technologies for health education, health administration and clinical care. It employs such modalities as video conferencing, remote patient monitoring and streaming media. Live video conferencing involves a two-way audiovisual connection between a care provider and patient. Remote patient monitoring utilizes electronic tools to record health data on patients that a practitioner can review in a different location.
What is the difference between telehealth and telemedicine? Telemedicine refers strictly to clinical applications, whilst telehealth is a broader term that includes uses such as provider training and continuing medical education. For example, wound care doctors can use telemedicine to provide continuing care for wounds, whilst online wound care certification courses to improve the expertise of wound care nurses would come under the wider bracket of telehealth.
How access to telehealth is expanding in the COVID-19 crisis
On March 27, 2020, a $2 trillion stimulus bill designed to help the U.S. cope with the COVID-19 crisis became law. One of the intents of the legislation is to encourage Medicare and Medicaid services to foster greater use of telehealth. However, the bill doesn’t create a means for direct payment.
This could change soon, when an emergency bill making its way through the U.S. Office of Management and Budget becomes law. Under this legislation, providers could potentially receive compensation for telehealth services. The emergency bill would also permit home health agencies to assess patients remotely, which would grant beneficiaries a way to receive care without increasing the risk of the virus to themselves or those providing the care. For patients who don’t have internet access, virtual visits from healthcare workers could be conducted over the phone.
Federal telehealth oversight relaxes during COVID-19 threat
As with all aspects of medical care, the privacy and security of health information is highly regulated by the federal government. Privacy regulations fall under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Recently, the Office for Civil Rights (OCR) at the Department of Health and Human Services, which is responsible for enforcing these regulations, announced that they would relax enforcement during the COVID-19 health emergency. The announcement stated that covered health providers governed by the HIPAA rules may speak to patients and render services through technologies that facilitate remote communications. Some of the technologies and the means with which they are used may not be in full compliance of HIPAA rules. Nonetheless, effective March 30, OCR won’t impose penalties against non-compliant healthcare providers offering telehealth.
Specifically, healthcare providers who use video or audio communication technology for telehealth services are now allowed to use any non-public facing remote device that is available to speak to patients. The relaxation of the OCR’s rule enforcement applies to telehealth services offered for any medical issue, even those unrelated to COVID-19.
To illustrate how this would work, healthcare providers might examine patients with COVID-19 symptoms through use of a video chat. This would permit providers to assess more patients while eliminating the risk of infection from in-person consultations.
In the announcement, OCR added that video chats could be conducted via popular applications, including Skype, Google FaceTime, Zoom, Google Hangouts Video and Facebook Messenger Video Chat. The statement also encouraged providers to enable encryption modes during use and to let patients know that the applications carry privacy risks.
States pass emergency laws to boost use of telehealth
Just as the federal government has moved to increase the use of telehealth during the pandemic, so also have the governments of Washington D.C. and 18 states. They recently passed new laws or amended existing laws to allow doctors and patients to connect using the technology, including phone calls. Because states are closing non-essential services and often issuing stay-in-place orders, state lawmakers are trying to remove barriers to telehealth to reduce the strain on clinics. Most of the changes will expire once the COVID-19 threat is over.
In California, the Center for Connected Health Policy (CCHP) says that states have been easing Medicaid rules, including permitting telehealth to serve as the vehicle of a doctor-patient relationship. Some states have waived rules to allow residents access to mental health care from their homes. The CCHP also updates a list of telehealth coverage policies daily.
Efforts to expand telehealth take an array of forms in different states. Texas governor Greg Abbott issued a disaster declaration to let state providers use telemedicine to treat patients. Massachusetts governor Charlie Baker ordered state health plans and commercial insurers to cover telehealth services. Authorities in West Virginia also issued declarations to boost the use of audio-visual telehealth for certain services, including mental health and medical care offered in rural clinics.
Coinciding with the changes, health oversight agencies are releasing telehealth information. The U.S. Drug Enforcement Agency issued guidelines governing how care providers may prescribe controlled drugs through telemedicine. Moreover, the American Medical Association published information on the use of telemedicine in practice.