The pros and cons of telehealth

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Telehealth has been anointed as one of the safest and most effective ways to deliver remote health services.

Around the world, healthcare providers big and small are using telehealth technology to connect with patients in a COVID-safe manner. Telehealth has become so useful and ubiquitous that industry pundits – and their patients – tell us it is here to stay.

However, while telehealth is convenient and cost effective for providers and patients alike, it is not applicable to all health settings, and it is important to note that there are benefits and challenges when it comes to using this form of technology.

Pros of telehealth

  • Improves accessibility to convenient healthcare
  • Convenient and efficient healthcare
  • Improved patient care and health outcomes
  • Environmentally friendly
  • Lower costs
  • Culturally appropriate healthcare
  • Enables telementoring

Cons of telehealth

  • The digital divide
  • Lack of clarity around telehealth policies, guidelines and reimbursement rules
  • Training and equipment requirements
  • Security of personal health data – both real and perceived risks
  • Fewer in-persons visits

Let’s take a look at the pros and cons of telehealth in more detail.


PRO

Improves accessibility to convenient healthcare.

Whether a patient lives in a rural or metropolitan location, telehealth makes healthcare services accessible.

Regional hospitals, isolated communities, and work sites typically have fewer health services and specialists: telehealth extends access to remote medical specialists and referring physicians, making it possible to deliver a wide range of high-quality health services to the point of need.

Geographically remote patients can easily access health and allied health specialists via video conference, while patients with mobility issues – including people with a disability, or elderly residents in aged care – can use the technology to avoid travel and time delays associated with face-to-face appointments.

Telehealth technology also enables timely, convenient, and effective e-triage solutions, reducing unnecessary emergency department visits.

Telehealth solutions are just as applicable in busy metropolitan hospitals requiring a collaborative model of healthcare that involves multiple health specialists consulting together to perform evidence-based patient diagnoses.

PRO

Convenient and efficient healthcare.

According to McKinsey analysis from July 2021, in the United States, consumer and provider willingness to use telehealth has greatly increased since pre-pandemic times; there have also been regulatory changes to enable greater access and reimbursement.

For patients, telehealth has become a convenient way to access healthcare professionals at a time and a location that suits them. Due to its remote nature, telehealth has reduced the risk of COVID-19 infection as well as other contagious viruses and proved particularly useful for follow-up appointments with clinicians.

For health and allied health providers, telehealth services greatly reduce the number of patient no-show appointments, as evidenced by a US patient study conducted at the start of the pandemic in 2020.

Telehealth technology also enables asynchronous or ‘store-and-forward’ telehealth services: Clinicians can capture clinically important patient images, video, and data in a device at one location, and send it back to a remote physician at a later time. The physician can review the patient data and images at a convenient time through their standard software interface.

Asynchronous telehealth can be used to access medical expertise outside regular operating hours, and it supports clinicians who perform hospital rounds and off-site patient visits to areas with poor internet connectivity.

Importantly, telehealth also delivers productivity gains for healthcare providers due to reduced travel costs and greater flexibility in where and when they provide services.

CON

The digital divide.

When establishing telehealth services, the digital divide should be considered as a social determinant of health (SDOH) according to a 2021 article held by the US National Library of Medicine.

The article’s author says issues such as decreased internet connectivity, a lack of wi-fi and video chat/webcam in both urban and rural areas can hinder the effectiveness of telehealth to its full capability, especially among communities of colour, the poor, and medically underserved. Addressing policy changes to address the digital divide as a SDOH may strengthen existing health care and public health systems.

Likewise, a 2021 study published by the United States’ Centre for Disease Control and Prevention (CDC) found that while accessibility of telehealth increased during the pandemic, inequities have also raised concern.

The study found that Medicare beneficiaries aged 65 and older, with low incomes and those living in non-metropolitan areas or Southern US states (which have the lowest median household income and the highest percentage of people living in the poverty) were less likely to report accessibility of telehealth during the COVID-19 pandemic than their counterparts.

PRO

Improved patient care and health outcomes.

A community survey of 1369 participants about their experience of telehealth consults was conducted in Australia in mid-2020. Sixty-one percent of respondents stated that their telehealth experience was “just as good as” or “better than” their traditional in-person medical visit experience.

Telehealth enhances the sharing of patient information between health providers including medical history, test results, patient imaging, diagnoses, medications, and allergies. It enhances the coordination of care between primary healthcare providers and specialists, and it has the potential to improve screening rates, social and emotional wellbeing, and clinical outcomes.

The growing interest in artificial technology and machine learning, remote patient monitoring models, and self-diagnostics will only continue to improve the diagnosis, management, and treatment of health conditions.

Telehealth is particularly useful in treating chronic conditions that require continued care, and/or shared care, over the long term. Telehealth enables a patient with a chronic condition to see multiple healthcare providers from anywhere they have internet connection. Telehealth also enhances the provision of hospital-at-home, and post-acute health services.

CON

Lack of clarity around telehealth policies, guidelines and reimbursement rules.

The pandemic resulted in a surge of telehealth; now, as the emergency eases, health providers need to assess and strategise their telehealth service for it to remain sustainable in the long term.

Providers need to understand the regulatory environment in which they practice; they need to create telehealth guidelines that set out the scope of their telehealth practice; staff roles and responsibilities; a privacy policy; service delivery approach; and service assessment methods etc.

Providers need to redesign workflows, so that telehealth integrates seamlessly into the day-to-day running of a health practice. Integration improves ease of use and reduces the cost and time requirements required for clinic staff to administer and monitor telehealth services. Integration also enhances the storage and sharing of important patient health data.

As the pandemic slows and governments reassess health policy, there is also uncertainty ahead over the fate of telehealth reimbursement practices globally. Health providers need to be ready to deal with these changes.

For example, the Australian Department of Health is currently considering a new model of telehealth reimbursement as part of its 10-year plan to reform primary healthcare. The proposed change would see Medicare Benefits Schedule (MBS) funding for telehealth consultations with a general practice, contingent on the patient being registered with the practice. The plan also aims to support an increased uptake of video for telehealth service delivery in preference to telehealth consults via telephone.

PRO

Environmentally friendly.

Telehealth is both good for patients and good for the environment because it significantly reduces the need for travel associated with health visits.

The results of a six-year study published in The Journal of Climate Change and Health found that increasing telehealth use in an integrated health system in the Pacific northwest of the United States, corresponded to a dramatic decrease in ambulatory visit carbon intensity.

The 2015-2020 study tracked greenhouse gas (GHC) emissions resulting from transportation to and from visits for primary care, specialty care, and mental health care.

In-person outpatient visits increased an average of 1.5 percent per year through to 2019. However, during 2020, COVID-19 caused visits to decline by 46.2 percent, yielding an overall decline during the study period of 43 percent.

At the same time, telehealth visits, which had been growing consistently every year, jumped by 108.5 percent in 2020.

The result was a 51 percent reduction in the carbon intensity of outpatient visits from 8.03kg CO2-eq per visit in 2015 to 3.95kg CO2-eq in 2020.

Researchers believe the real reduction in GHC was even greater as the study did not factor in the number of health professionals who had forgone commuting to work in favour of working remotely from home.

CON

Fewer in-person visits.

Telehealth should never be considered as a replacement to in-person visits. Rather, it is an adjunctive to in-person care.

It is important that healthcare professionals use their expertise and discretion to gauge when, and if, a telehealth consultation is suitable, or if an in-person consultation is required.

In Australia, general practitioners, medical specialists, allied health providers, mental health professionals and nurse practitioners are all authorised to provide telehealth services to patients.

The Royal Australian College of General Practitioners recommends that on-demand telehealth services should ideally be provided by a patient’s usual GP or practice and only provided when deemed appropriate by the GP. This ensures a patient has a stable and ongoing relationship with their general practice, which provides continuous and comprehensive care.

On-demand telehealth services can complement traditional consultation methods, helping to facilitate the partnership between individual patients, their usual GP and extended healthcare team. This may allow for better-targeted and effective coordination of clinical resources to meet patient needs and can facilitate the provision of acute, preventive, and chronic disease care, ultimately supporting quality healthcare and healthcare system efficiency.

Moving forward, the current industry ‘buzz’ is around the concept of ‘hybrid care’, which combines virtual and in-person care models with the potential to improve consumer experience/convenience, access, outcomes, and affordability.

PRO

Lower costs.

From a patient perspective, telehealth almost always results in cost savings because it reduces travel costs and loss of income associated with in-person visits.

A hospital procedure typically involves pre- and post-event visits with a specialist: Telehealth consultations mitigate this need. This is particularly important for rural and remote communities: For example, research by the Australian Institute of Health and Welfare shows that Australians who live in rural and remote areas typically experience higher rates of disease and injury, and a lower life expectancy than those in urban areas. They also have lower levels of access to health services.

There is still much analysis to be done to understand the scalability of telehealth services and its impact on costs. However, a 2020 study in Australia published in the Journal of Medical Internet Research found that 53 percent of telehealth cost minimisation studies reported telehealth to be cost saving compared with conventional care.

The study also revealed that around 12 percent of the studies found telehealth to be more expensive than conventional care. For telehealth providers, there is the cost of investing in new technology as well as staff training. Telehealth also requires employing additional health staff to assist with patient-end services.

The report suggests that alternate funding models have the potential to save the health system money in situations where the consumers pay out of pocket to receive telehealth services.

CON

Training and equipment requirements.

Delivering an effective telehealth service requires the purchase, installation, and integration of sophisticated hardware and software solutions. It also requires an appropriate level of staff training to use them. Providers need to acquire IT support, as well as change-management support, to help a practice transition smoothly to a telehealth model.

Practice administrative processes also need to be adjusted to accommodate telehealth: how do you plan to book telehealth appointments, deliver patient information forms, medical certificates, e-prescriptions, and process payment methods?

A telehealth system should be regularly reviewed to ensure that it is meeting key performance indicators and delivering the best possible health service to patients.

As with all new technology, as time progresses, new telehealth innovations will evolve. This process typically sees service levels improve and costs decline.

According to McKinsey analysis from July 2021, in the United States, investment in virtual care and digital health more broadly, has skyrocketed, fuelling further innovation with triple the level of venture capitalist digital health investment in 2020, than it had in 2017.

PRO

Culturally appropriate healthcare.

Telehealth enables the provision of health services that are more culturally sensitive to the needs of unique populations such as indigenous communities.

A 2018 Australian telehealth study assessed the perspectives of staff at an Aboriginal Community Controlled Health Service (ACCHS), and found that culturally appropriate healthcare may be enhanced by the use of telehealth because it allows care to be provided in the supportive environment of an ACCHS. It allows the community member to have the advocacy and assistance of an Indigenous health worker and reduces the burden of travel and dislocation from community and family.

A telehealth model can be applied to indigenous communities around the world to improve health outcomes. According to the World Health Organisation, there are more than 370 million indigenous people spread across 90 countries. Indigenous people, while they account for only five percent of the world’s population, account for 15 percent of the world’s extreme poor.

CON

Security of personal health data – both real and perceived risks.

According to McKinsey analysis from July 2021, some barriers – such as perceptions of technology security – remain to be addressed to sustain consumer and provider virtual health adoption.

Privacy risks involve a lack of control over the collection, use and sharing of data. Any transfer of data offers the potential for a security break. For a telehealth service to be successful, patients and providers need to trust the security of the system.

It is vital that healthcare and allied health providers provide a telehealth service that complies with local, and if relevant, international data privacy and security regulations.

Two of the most well-known privacy regulations are the United States’ Health Insurance Portability and Accountability Act (HIPAA) and the European Union’s General Data Protection Regulation (GDPR).

The key difference between GDPR and HIPAA is the focus: GDPR focuses on protecting all of an EU citizens’ personally identifiable information (PII), regardless of whether they are living in the EU or not. Therefore, any organisation that operates in a health setting and handles an EU patient’s information can be subject to GDPR regulations.

Who must comply with GDPR regulations? Any entity that has a base of operations in the EU; offers goods or services to people in the EU; or monitors the behaviour of people who are in the EU, whether the entity is established in the EU or not.

In contrast, HIPAA is focused on organisations that handle protected health information (PHI) within the United States.

Who must comply with HIPAA regulations? All “covered entities”; this includes:

  • Health plans – including health insurance companies, health maintenance organisations (HMOs), company health plans, and certain government programs that pay for health care, such as Medicare and Medicaid.
  • Most healthcare providers – those that conduct certain business electronically, such as electronically billing your health insurance – including most doctors, clinics, hospitals, psychologists, chiropractors, nursing homes, pharmacies, and dentists.
  • Healthcare clearinghouses – entities that process non-standard health information they receive from another entity into a standard (ie standard electronic format or data content), or vice versa.

HIPAA also applies to many business associates and subcontractors of covered entities.

Find out more information about HIPAA and GDPR.

PRO

Enables telementoring.

An underexplored area is the use of telehealth technology to engage with and mentor clinical staff. Specialists can share their skills and experience in real time via teleconferencing.

In 2009, The University of New Mexico Health Sciences Center in the United States, formalised the use of telementoring with the creation of the Extension for Community Health Outcomes project – or Project ECHO.

Project ECHO is a telementoring approach that brings expertise to patients in medically underserved areas, using video conferencing technology to connect speciality physicians (at academic medical centres, or ‘hubs’) to train primary care physicians (the ‘spokes’) about the most effective ways to tackle complex diseases.

Read more about Project ECHO here.

Logo for telehealth and telementoring Project ECHO out of the University of New Mexico

Visionflex – telehealth for evidence-based confidence care.


Feature image by Martin Sanchez on Unsplash