UNC Lineberger Comprehensive Cancer Center study: Will telehealth services become the norm following COVID-19 pandemic?

The Mayo Clinic explained Telehealth in Telehealth: Technology meets health care: See how technology can improve your health care:

What is telehealth?

Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care. These may be technologies you use from home or that your doctor uses to improve or support health care services.

Consider, for example, the ways telehealth could help you if you have diabetes. You could do some or all of the following:

• Use a mobile phone or other device to upload food logs, medications, dosing and blood sugar levels for review by a nurse who responds electronically.
• Watch a video on carbohydrate counting and download an app for it to your phone.
• Use an app to estimate, based on your diet and exercise level, how much insulin you need.
• Use an online patient portal to see your test results, schedule appointments, request prescription refills or email your doctor.
• Order testing supplies and medications online.
• Get a mobile retinal photo screening at your doctor’s office rather than scheduling an appointment with a specialist.
• Get email, text or phone reminders when you need a flu shot, foot exam or other preventive care.

The goals of telehealth, also called e-health or m-health (mobile health), include the following:

• Make health care accessible to people who live in rural or isolated communities.
• Make services more readily available or convenient for people with limited mobility, time or transportation options.
• Provide access to medical specialists.
• Improve communication and coordination of care among members of a health care team and a patient.
• Provide support for self-management of health care.

The following examples of telehealth services may be beneficial for your health care.

Patient portal

Your primary care clinic may have an online patient portal. These portals offer an alternative to email, which is a generally insecure means to communicate about private medical information. A portal provides a more secure online tool to do the following:

• Communicate with your doctor or a nurse.
• Request prescription refills.
• Review test results and summaries of previous visits.
• Schedule appointments or request appointment reminders.

If your doctor is in a large health care system, the portal also may provide a single point of communication for any specialists you may see.

Virtual appointments

Some clinics may provide virtual appointments that enable you to see your doctor or a nurse via online videoconferencing. These appointments enable you to receive ongoing care from your regular doctor when an in-person visit isn’t required or possible….

Remote monitoring

A variety of technologies enable your doctor or health care team to monitor your health remotely. These technologies include:

• Web-based or mobile apps for uploading information, such as blood glucose readings, to your doctor or health care team
• Devices that measure and wirelessly transmit information, such as blood pressure, blood glucose or lung function
• Wearable devices that automatically record and transmit information, such as heart rate, blood glucose, gait, posture control, tremors, physical activity or sleep patterns
• Home monitoring devices for older people or people with dementia that detect changes in normal activities such as falls…

https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878

Resources:

What is Telehealth?                                                                                                                https://www.aap.org/en-us/professional-resources/practice-transformation/telehealth/Pages/What-is-Telehealth.aspx

What Is Telehealth?                                                                                                             https://www.goodrx.com/blog/what-is-telehealth/

How Does Telemedicine Work?                                                                                                 https://www.webmd.com/lung/how-does-telemedicine-work#1

Science Daily reported in Will telehealth services become the norm following COVID-19 pandemic?

The onset of the COVID-19 pandemic has broadly affected how health care is provided in the United States. One notable change is the expanded use of telehealth services, which have been quickly adopted by many health care providers and payers, including Medicare, to ensure patients’ access to care while reducing their risk of exposure to the coronavirus.

In an article published in JAMA Oncology, Trevor Royce, MD, MS, MPH, an assistant professor of radiation oncology at the University of North Carolina Lineberger Comprehensive Cancer Center and UNC School of Medicine, said the routine use of telehealth for patients with cancer could have long-lasting and unforeseen effects on the provision and quality of care.

“The COVID-19 pandemic has resulted in the rapid deregulation of telehealth services. This was done in part by lifting geographical restrictions, broadening patient, health care professional, and services eligibility,” said Royce, the article’s corresponding author. “It is likely aspects of telehealth continue to be part of the health care delivery system, beyond the pandemic.”

The article’s other authors are UNC Lineberger’s Hanna K. Sanoff, MD, MPH, clinical medical director of the North Carolina Cancer Hospital and associate professor in the UNC School of Medicine Division of Hematology, and Amar Rewari, MD, MBA, from the Associates in Radiation Medicine, Adventist HealthCare Radiation Oncology Center in Rockville, Maryland.

Royce said the widespread shift to telehealth was made possible, in part, by three federal economic stimulus packages and the Centers for Medicare and Medicaid Services making several policy changes in March that expanded Medicare recipients’ access to telehealth services.

The policy changes included allowing telehealth services to be provided in a patient’s home. Medicare previously only paid for telehealth services in a facility in nonurban areas or areas with a health professional shortage. Medicare also approved payment for new patient appointments, expanded telehealth coverage to include 80 additional services, allowed for services to be carried out on a wider assortment of telecommunication systems — including remote video communications platforms, such as Zoom — and modified the restrictions of who can provide and supervise care.

While the potential benefits of telehealth have been demonstrated during the pandemic, Royce said they must be balanced with concerns about care quality and safety….                                                                                        https://www.sciencedaily.com/releases/2020/07/200716144727.htm

 

Citation:

Will telehealth services become the norm following COVID-19 pandemic?

Date:      July 16, 2020

Source:  UNC Lineberger Comprehensive Cancer Center

Summary:

Experts address whether the routine use of telehealth for patients with cancer could have long-lasting and unforeseen effects on the provision and quality of care.

Journal Reference:

Trevor J. Royce, Hanna K. Sanoff, Amar Rewari. Telemedicine for Cancer Care in the Time of COVID-19. JAMA Oncology, 2020; DOI: 10.1001/jamaoncol.2020.2684

Here is the press release from UNC Lineberger Comprehensive Cancer Center:

Home / News from Lineberger / Will telehealth services become the norm following COVID-19 pandemic?

Will telehealth services become the norm following COVID-19 pandemic?

July 16, 2020

The onset of the COVID-19 pandemic has broadly affected how health care is provided in the United States. One notable change is the expanded use of telehealth services, which have been quickly adopted by many health care providers and payers, including Medicare, to ensure patients’ access to care while reducing their risk of exposure to the coronavirus.

In an article published in JAMA Oncology, Trevor Royce, MD, MS, MPH, an assistant professor of radiation oncology at the University of North Carolina Lineberger Comprehensive Cancer Center and UNC School of Medicine, said the routine use of telehealth for patients with cancer could have long-lasting and unforeseen effects on the provision and quality of care.

“The COVID-19 pandemic has resulted in the rapid deregulation of telehealth services. This was done in part by lifting geographical restrictions, broadening patient, health care professional, and services eligibility,” said Royce, the article’s corresponding author. “It is likely aspects of telehealth continue to be part of the health care delivery system, beyond the pandemic.”

The article’s other authors are UNC Lineberger’s Hanna K. Sanoff, MD, MPH, clinical medical director of the North Carolina Cancer Hospital and associate professor in the UNC School of Medicine Division of Hematology, and Amar Rewari, MD, MBA, from the Associates in Radiation Medicine, Adventist HealthCare Radiation Oncology Center in Rockville, Maryland.

Royce said the widespread shift to telehealth was made possible, in part, by three federal economic stimulus packages and the Centers for Medicare and Medicaid Services making several policy changes in March that expanded Medicare recipients’ access to telehealth services.

The policy changes included allowing telehealth services to be provided in a patient’s home. Medicare previously only paid for telehealth services in a facility in nonurban areas or areas with a health professional shortage. Medicare also approved payment for new patient appointments, expanded telehealth coverage to include 80 additional services, allowed for services to be carried out on a wider assortment of telecommunication systems – including remote video communications platforms, such as Zoom – and modified the restrictions of who can provide and supervise care.

While the potential benefits of telehealth have been demonstrated during the pandemic, Royce said they must be balanced with concerns about care quality and safety.

“There is a lot we don’t know about telehealth, and how its rapid adoption will impact our patients,” Royce said. “How will the safety and quality of care be impacted? How will we integrate essential components of the traditional doctor visit, including physical exam, lab work, scans and imaging? Will patients and doctors be more or less satisfied with their care? These are all potential downsides if we are not thoughtful with our adoption.”

He said appropriate oversight of care is critical. There will be a continued need for objective patient assessments, such as patient-reported outcomes, physical examinations and laboratory tests, and to measure care quality and monitor for fraud. There are also a number of standard measures of care quality that can be implemented during the transition to telehealth, including tracking emergency room visits, hospitalizations and adverse events.

Telehealth presents other challenges, as well. Though technology and internet access are now more widely available, they are not universally accessible. Where one lives, their socioeconomic status and comfort level with technology can be barriers to using telehealth services. A reliance on telehealth might lower participation in clinical trials, which can require regular in-person appointments.

“Telehealth can be used to improve access to care in traditionally hard-to-reach populations. However, it is important to acknowledge that if we are not thoughtful in its adoption, the opposite could be true,” Royce said. “For example, will lower socioeconomic groups have the same level of access to an adequate internet connection or cellular services that make a virtual video visit possible? Telehealth needs to be adopted with equity in mind.”

Media Contact: Bill Schaller, bill_schaller@med.unc.edu

 

Mikhail Varshavski wrote in Pros and Cons of Telemedicine & Telehealth:

Advantages of Telemedicine

1. Higher level of flexibility
2. Convenience
3. Reduction of risk for infections
4. Less waiting time
5. Better medical support for rural areas
6. Telehealth is more efficient
7. Telemedicine can reduce doctor’s shortage
8. More patients can be treated on average
9. Information sharing between doctors
10. Reduction in travel expenses
11. Lower costs for minor issues
12. Patients may be more eager to get medical advice
13. Can give doctors a competitive advantage

 

Problems of Telehealth

1. Privacy issues
2. Hacking
3. Technical problems
4. No physical examination possible
5. Doctor’s may have problems to adapt
6. Excessive consultations
7. Specific software and training may be needed
8. Number of wrong diagnoses may increase
9. Doctors may be sued more often
10. Varying levels of regulations regarding telehealth
11. May not be affordable for small doctor’s offices
12. May not be covered by health insurance yet
13. Job losses

 

Resources:

Telemedicine Pros and Cons                                                                                     https://healthresearchfunding.org/telemedicine-pros-cons/

What Are the Benefits and Advantages of Telemedicine?                                                    https://www.healthline.com/health/telemedicine-benefits-and-advantages#1

Clinicians see pros, cons to telehealth                                                                                        ‘We’re doing whatever we can to get the service to our folks’                                                http://www.hmenews.com/article/clinicians-see-pros-cons-telehealth

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