By Diana Dahl

Shelter-in-place and social distancing mandates to limit the spread of COVID-19 have rapidly shifted telehealth from an underutilized health care option to an absolute necessity. The ability to provide and receive care from home limits the spread of the virus and the burden placed on emergency departments and urgent care centers. Health systems, care providers, insurers, and legislators are continuing to work to expand the accessibility, capacity, and affordability of telemedicine.

The federal government, along with many state governments, has eased privacy regulations to expand allowable technologies for service provision and the DEA now allows the e-prescription of controlled substances. Medicare coverage now extends to telehealth services and many private insurers voluntarily expanded their coverage of telemedicine. Health systems have implemented new technology equipment, software, and apps that enable remote appointment scheduling, doctor visits, and prescription refill requests. Some health systems have reported that 80% of their visits are now virtual.

Despite these changes, significant barriers continue to limit the expansion of telemedicine. Ramping up telehealth services (e.g., updating policies and procedures, changes in medical equipment, development of phone apps, staff training on virtual service delivery, updating electronic health record systems) requires significant financial and human capital that under-resourced and smaller health practices may find particularly challenging. The eased HIPAA restrictions may promulgate patient concerns about privacy of their information, minimizing their willingness to engage in virtual medical appointments. Older and low-income populations that lack broadband connectivity or computers may struggle to access telehealth services, exacerbating health inequities. Additionally, many of the policy, licensing, and funding changes to broaden telemedicine during this public health emergency are temporary and it is unclear what changes will remain in the long run, making investment in telehealth unpredictable.

While risks and challenges of expanding telehealth exist, the current climate suggests that investments in broadening telehealth services are needed and proving effective. This growth has led to increased traction to concretize telemedicine’s longer-term future in service provision. How can you help with existing telemedicine challenges and make sure telehealth has a lasting future? The sustainability of telemedicine services can be advanced by:

• Continuation in Medicare expansions for telehealth services after the COVID-19 pandemic
• Investments in internet, computers, and/or mobile phones for vulnerable and under-served populations
• Investments in technology infrastructure and staff training on telehealth service delivery for under-resourced regions and smaller health practices
• Clear and up-to-date guidelines for both providers and patients
• Audio-only telehealth options to expand access for patients without the ability or desire to receive care through live video technologies
• Research and evaluation on telehealth utilization and outcomes
• Parity in insurance coverage and reimbursement of telemedicine services
• Advocacy for telemedicine via applicable forums and organizations

While uncertainty remains for the future of telemedicine, its importance is likely to extend beyond this global pandemic. Providers and patients experiencing the benefits and challenges of telehealth have an important role in shaping its future, and the government and insurers should stay tuned into those experiences to inform their future decision making about telehealth.