More than three - quarters of U.S. hospitals are now connecting with patients and medical consultants remotely through video and other technology, according to the American Hospital Association. In a survey conducted during the summer of 2020 by the American Medical Association, 80% of physicians reported that telehealth enabled them to improve the timeliness of care, and 60% credited telemedicine with improving the health of their patients.
Sounds wonderful — and it is wonderful in many respects. But caring for patients virtually involves some unique risks too. We break down the pros and cons of telehealth below and share tips on how to avoid certain risks — and how to set yourself up for success.
What Is Telehealth?
Telehealth, or telemedicine, lets doctors care for patients without an in - person visit. Done primarily by computer, tablet, or smartphone, telehealth allows doctor - patient interactions along with the potential for remote patient monitoring.
Telehealth usage increased dramatically in 2020 and stayed relatively stable in 2021. While the pandemic may have introduced telehealth to significant numbers of patients and providers, adoption rates have stayed high even after medical offices reopened. In fact, as of July 2021 the level of use was 38 times higher than before the pandemic.
Telehealth Pros and Cons
With a recent survey from Berxi saying that 71% of Americans plan to continue using telehealth in the future, it’s important to analyze some of the pros and cons associated with telehealth.
The Pros of Telehealth
For both patients and healthcare professionals, telemedicine benefits are plentiful.
“By delivering healthcare services in the patient’s home, we are able to reduce costs, increase scheduling flexibility, increase the probability of care - partner involvement, and reduce no - show rates,” says Nick Housley, PhD, PT, DPT, neuroscientist and director of clinical research at the Integrated Cancer Research Center. “Telehealth also allows the expertise of specialists to be extended beyond their geographic region, affording those previously underserved populations to gain access to highly specialized providers.”
Dr. Lizz Esther Kinyua, founder and director of Mentor Medics, identifies these seven specific benefits of telehealth.
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Accessibility: Connecting to patients has been made easier through digital platforms.
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Efficiency: Eliminating commutes and time spent in waiting rooms is hugely advantageous to patients. Healthcare providers also have the benefit of less administrative overhead and fewer cancellations, as patients and providers can more easily pivot an in -person visit to virtual.
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Data storage: Storing patient records in a cloud eases accessibility by doctors, nurses, and specialists.
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Convenience: Because patients talk to a provider when it's most convenient for them, they may be more likely to show up for appointments and can access more specialized care that might not normally be available to them.
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Savings for patients: Costs such as travel expenses and parking fees are eliminated.
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Savings for medical centers: Provider overhead costs such as rent and building business permits are reduced.
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More monitoring: Patients are more likely to attend follow - up appointments, giving their providers more insight into the efficacy of the treatments
Another big benefit (especially for patients): Telehealth keeps sick people from coming into contact with others. Keeping contagious people out of a doctor’s office can help reduce the spread of germs.
The Cons of Telehealth
Like anything, however, telemedicine comes with some downsides.
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Lack of access: Not everyone has the technology they need to successfully use telehealth, especially in rural or low - income areas, which can add barriers to telehealth adoption.
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Doctor-patient relationship challenges: One of the telehealth challenges is the impact on the doctor - patient relationship. “Digital communication can hinder the formation of an open patient - provider relationship,” explains Dr. Kinyua. “Thus, the patient may feel the need to withhold information for fear of being judged.”
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Continuity of care: The effect on continuity of care is another possible disadvantage. With telehealth, patients have more options available. If they choose to connect to a random healthcare provider, care continuity can suffer. A patient’s primary care provider may not get the records from the telehealth provider. And each new provider will not have a complete medical history.
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Additional compliance regulations: Healthcare providers need to understand what effect telemedicine has on meeting compliance requirements, writing reimbursement policies, and protecting patient privacy, to name a few considerations. There are state-by-state policies on online prescribing, informed consent, and whether in - person visits are required before telehealth sessions can start.
The Two Main Risks for Telehealth Practitioners
The biggest risks for telehealth practitioners revolve around the diagnostic process and cybersecurity.
1. Misdiagnosis
Telemedicine may increase the “risk of misdiagnosis of patients since there is a high reliance on patients' words and investigations,” says Dr. Kinyua. This risk only increases when patients aren’t forthcoming with relevant health information.
The key is to know the limitations of telehealth appointments and make sure you have the data points you need. “As a clinician, I need to feel comfortable that I have the data required to make a decision,” Joe Kvedar, MD, president of the American Telemedicine Association explains. “You must be comfortable with decisions you’re making. You can’t feel pushed because you are in a virtual environment.”
“Try to use gold - standard tests to support the diagnosis,” advises Farah Naz, MD. “If you think you might not be able to diagnose the case virtually, go for lab tests. Diagnosis based on labs and radiological imaging is hard to deny.”
If you’re not 100% certain, Dr. Naz adds, give the safe medicine for the symptomatic treatment or refer the patient to a healthcare provider who can see the patient in person.
2. Technology & Compliance
Just because you are using telehealth doesn’t mean you can skimp on compliance. Telehealth triggers additional security concerns beyond just HIPAA compliance. Considering Berxi reported that over 25% of surveyed patients refused to use telehealth apps due to security concerns, it will be important to educate people on your approach to cybersecurity.
“Each state also has its own licensing requirements, which health providers must follow regardless of whether they’re operating in - person or virtually,” says Jessica Pei at Clearing, a telehealth platform for chronic pain patients. The American Bar Association identifies one of the most challenging issues for providers as ensuring compliance with state licensing. Physicians must be licensed in the states where they practice, and that doesn’t necessarily allow them to provide remote care if the patient is in another state.
The rapid pace at which practices are adopting telehealth makes them an inviting target for cybercriminals. Systems for managing, storing, and accessing patient data must be locked down. Endpoint security, including medical device monitoring and diagnostics devices connected to telehealth, is also a concern.
“Regardless of the service, ensuring end - to - end encryption and that video or audio data — or any other data for that matter — is stored on an intermediary service (with strong security) are two big checks for any potential telehealth software,” says Dr. Housley.
Specialties With the Highest Telehealth Risk
Not all medical specialties are created equal when it comes to using telehealth. “Despite its promise, telemedicine is not an appropriate model of care for all medical conditions,” according to an article summarizing an AMA report on ethical practice. “For example, telemedicine is inappropriate for encounters when a hands - on physical examination is crucial or critical data can be gleaned only through direct physical contact.” In other words, “telemedicine is not the preferred approach when the technology does not allow physicians to meet established clinical standards.”
Dr. Housley concurs by pointing to his main area of expertise, neurologic rehabilitation: “These domains have traditionally been dominated by hands - on interactions with providers that help a patient learn to move again after a neurologic injury.”
Other specialties that rely heavily on in - person exams, specialized diagnostic equipment, or lab results include ophthalmology, cardiology, audiology, dermatology, and neurology. An ophthalmologist, for example, cannot effectively test a patient’s vision without an in - person exam. And the physical effects of heart disease, such as fluid buildup, are more effectively assessed through a physical exam.
Telehealth & Technology: Setting Yourself Up for Success
When considering telehealth and technology, make sure you have your technology locked in with an industry - specific provider that understands the need for ease of use and robust security. One scholarly article in the Journal for Nurse Practitioners warns that “special attention should be given to prevent errors and omissions, negligent credentialing, breaches of privacy, and interruptions of service during equipment or technology failures.”
“This mix of technology is difficult for both application owners and security assessors because a thorough analysis of every technology is needed. Even for seasoned security experts, this can be a challenging exercise,” says Elliott Frantz, CEO at Virtue Security. “Although HIPAA provides very general guidance for protecting PHI, the mechanics of doing so are often left to interpretation.”
Pei also cautions that patients and providers should expect a learning curve.
“Expect some rough patches in the beginning, but also expect to better meet patients where they are at,” Pei adds. “Studies show that many patient populations, including aging populations, are increasingly adept at using online technology, and are therefore often relatively comfortable with telemedicine. Let your patients know what to expect, provide training materials, let them practice, if necessary, and expect potentially longer time spent in your first telehealth session together as everyone adjusts to the technology. Later, telehealth sessions should start to feel smoother and more manageable.”
Dr. Housley stresses it’s important to develop an intersession plan because there are elements of a typical visit that are not feasible or possible to accomplish with telehealth.
“You may be integrating new technologies or approaches into this delivery model,” comments Dr. Housley. “It can be helpful to develop a plan for communication between regular telehealth sessions. This could be a prescheduled text message, where I summarize the data coming from a robot and give them a ‘waypoint’ on their progress, or it could be an opportunity for my patient to clarify something without having to wait until our next scheduled visit.”
Final Thoughts
While telemedicine saw a surge of use during the COVID-19 pandemic, like most technological advances it is likely here to stay. And it’s becoming more affordable. By July 2020, telehealth advocates helped pass parity laws in more than half of all U.S. states — this means that if private insurance would reimburse an in-person visit, it must also reimburse a telehealth visit.
In the next few months and years, providers will undoubtedly find better and better ways to use technology to give personalized top - quality care to patients. And as that provider, it will be important to make sure your medical malpractice insurance is up to date and covers you for telemedicine, since not all policies do.
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