Overview
Even before the COVID-19 pandemic, emerging technologies that facilitated video calling ushered in a new era of medicine: telehealth. Telehealth (sometimes referred to as “telemedicine”) is defined as “using telecommunication technologies to provide and support health care at a distance” [1]. Telehealth can include the use of different technologies by any member of the medical team for consultation, collaboration, and the sharing of medical data. Let’s examine how this practice is expanding collaboration amongst healthcare professionals to benefit patients, and the technical challenges and ethical considerations of providing healthcare at a distance.
Telehealth and Its Expanding Role in Collaborative Care
Though indispensable during the pandemic, telehealth remains a viable option for many patients. Indeed, according to some estimates, telehealth may account for as much as 10% of all outpatient visits in the United States [2]. Though the ease with which patients can access healthcare providers is a benefit, this practice also positively impacts patient care by facilitating provider interaction. Improvement in patient care can be seen in data from two large healthcare organizations; data showed a positive impact of telehealth on patient outcomes that rely on remote monitoring (such as high blood pressure), as well as those that require the intervention and/or expertise of specialists, such as cancer treatment [3].
Key Benefits of Remote Physician Collaboration
Snoswell and colleagues, in their review of over three dozen meta-analyses examining the efficacy of telehealth on patient outcomes, found that telehealth was “as effective, if not more, than usual care” regardless of the specialty examined [4]. These patient benefits are likely due, in part, to an expansion of the network of professionals with whom any given provider can consult about cases. For example, telehealth has great potential to meet the needs of underserved populations, such as those in rural communities, by allowing physicians to discuss challenging cases with experts from urban centers more likely to house a greater density of academics and specialists [5]. Though not directly related to patient care, the use of the internet for consultations and patient meetings has also been shown to significantly reduce the impact that would otherwise be associated with travel, thus conferring societal benefits, as well [6].
Technologies Driving Telehealth Collaboration
Though artificial intelligence may someday play a more significant role in telehealth, the main advances in telehealth have been due to increased access to broadband internet (with greater basic download and upload speeds) and the proliferation of HIPAA-compliant video meeting and messaging platforms. Though these technologies serve as the backbone of most telehealth interactions, emerging technologies allow healthcare professionals to interact virtually in more sophisticated ways. For example, telerobotic surgical procedures allow specialists to practice from a distance. Telemonitoring provides teams of healthcare professionals from across the globe with patient updates as they are available, enabling them to confer about next steps in real time [2]. In addition, pharmacists can now collaborate with physicians and other clinicians through technology-facilitated comprehensive medication management (CMM), which holds promise to positively impact patient outcomes. [7]
Challenges and Ethical Considerations
Despite demonstrations of its efficacy and utility, telehealth has challenges. First, not all patients are equally comfortable, conversant, or ready to take advantage of telehealth as illustrated by studies showing that its utilization is influenced by age (lower with younger patients), geography (lowest in the Midwest), and insurance (less likely for the un- and under insured) [2]. Second, although it does not appear to be a pervasive issue, the lack of physical interaction with a patient could lead to missed symptoms or other considerations if the healthcare provider doesn’t ask the right questions of the patient or her colleagues or the patient presents differently when on camera than in person. Indeed, the lack of physical proximity can create issues through no fault of the provider if emergent circumstances arise. For example, the remote treatment of mental health (i.e., teletherapy) has its own share of ethical challenges and standards, such as what to do when a patient expresses suicidal ideation [8]. To this end, practitioners must be mindful that not all medical conditions may be appropriately treated via telehealth. Finally, platform or technological issues complying with HIPAA or other privacy regulations, as well as technical glitches (e.g., video buffering), are still issues that must be addressed [5].
Best Practices for Implementing Telehealth Collaboration
As identified above, several challenges must be reviewed when considering telehealth as an option. One resource for navigating everything from quality assurance to what to do if there is an online data breach may be found at https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-accreditation/clinical-and-technical-standards
Training Recommendations
The competencies necessary to effectively implement telehealth amongst a team of providers include technological understanding, the ability to work in teams, and the ability to engage in collaborative or shared leadership. Furthermore, when collaborating with other practitioners, the roles of various professionals must be identified [9]. Healthcare providers who are thinking about expanding existing practices to offer telehealth or who want to stay abreast of current training may want to look into two different training programs available from CITI Program:
Summary
Telehealth is becoming an increasingly viable option for both patients and providers. Due to technological advancements, this practice can now improve health outcomes by providing patients with access to specialized healthcare regardless of geographic constraints. These same technologies are also facilitating the advent of more sophisticated ways for members of healthcare teams to interact with one another. Though a powerful innovation, many challenges are associated with implementing telehealth, including the security, compliance, capabilities, and reliability of platforms, the challenges of virtual collaboration, and the ethics of remote healthcare.
References
1. Ezeamii, Victor C., Okelue E. Okobi, Hassana Wambai-Sani, Gamamedaliyanage S. Perera, Shakhnoza Zaynieva, Chinwe C. Okonkwo, Mohamed M. Ohaiba, Pamela C. William-Enemali, Okiemute R. Obodo, and Ngozika G. Obiefuna. “Revolutionizing Healthcare: how Telemedicine is improving patient outcomes and Expanding Access to Care.” Cureus 16, no. 7 (2024).
2. Anawade Sr, Pankajkumar A., Deepak Sharma, and Shailesh Gahane. “A comprehensive review on exploring the impact of telemedicine on healthcare accessibility.” Cureus 16, no. 3 (2024).
3. https://hbr.org/2022/05/the-telehealth-era-is-just-beginning
4. Snoswell, Centaine L., Georgina Chelberg, Keshia R. De Guzman, Helen M. Haydon, Emma E. Thomas, Liam J. Caffery, and Anthony C. Smith. “The clinical effectiveness of telehealth: a systematic review of meta-analyses from 2010 to 2019.” Journal of telemedicine and telecare 29, no. 9 (2023): 669-684.
5. Haimi, Motti. “The tragic paradoxical effect of telemedicine on healthcare disparities-a time for redemption: a narrative review.” BMC Medical Informatics and Decision Making 23, no. 1 (2023): 95.
6. Ravindrane, Ramyadevi, and Jay Patel. “Infrastructure: The environmental impacts of telemedicine in place of face-to-face patient care: A systematic review.” Future Healthcare Journal 9, no. 1 (2022): 28-33.
7. Amundson, Collin, Srujitha Marupuru, Mary Ann Kliethermes, David R. Axon, Terri L. Warholak, Jacques Turgeon, and Jennifer M. Bingham. “Comprehensive medication management services provided via telehealth or hybrid models: A scoping review.” Journal of the American College of Clinical Pharmacy 6, no. 1 (2023): 53-72.
8. Sheperis, Donna S., and Arielle Smith. “Telehealth best practice: A call for standards of care.” Journal of Technology in Counselor Education and Supervision 1, no. 1 (2021): 4.
9. Poitras, Marie-Eve, Yves Couturier, Priscilla Beaupré, Ariana Girard, Francois Aubry, Vanessa T. Vaillancourt, Jean-Daniel Carrier et al. “Collaborative practice competencies needed for telehealth delivery by health and social care professionals: a scoping review.” Journal of Interprofessional Care 38, no. 2 (2024): 331-345.
