For a number of clear and compelling reasons, telemedicine (also known as telehealth) is rapidly becoming one of the most powerful weapons in the fight against the global coronavirus outbreak and COVID-19, the disease it causes. Telemedicine can reduce the need for in-person or in-hospital visits and, in turn, slow the transmission of the coronavirus among actual or potential patients by reducing the risk of contact with someone carrying the virus. Telemedicine helps protect providers from infection; reduces overall demands for increasingly scarce supplies, equipment, and human resources in a healthcare system already being pushed to its limits; and supports the dissemination of much-needed information regarding the pandemic to epidemiologists, researchers, and government entities.
The immediate benefits of telemedicine have received near-universal recognition. However, the value of telemedicine in the long term must also be recognized. While the COVID-19 emergency is an unwelcome laboratory in which to test this potential, our current situation provides an opportunity to learn more about how telemedicine can function most effectively, and helps us plan for its expanded use to improve the delivery of healthcare services long after this crisis has passed.
Telemedicine Then and Now
Well before the current crisis, a number of forward-thinking public and private health systems and hospitals had begun implementing telemedicine solutions to improve the delivery and quality of care they provide. In its early years, telemedicine was a recognized, natural fit for certain areas of medicine, including radiology, emergency room care for stroke and heart risks, psychiatry, family medicine, allergy, and immunology. Telemedicine has helped reduce the costs of care (important in our current value-based healthcare system) and also proved highly effective in rural areas, where there is a chronic shortage of healthcare personnel and an abundance of physical distance between patients and their providers.
In recent years, telemedicine companies have rapidly expanded the technologies used to support telemedicine. These include home medical tricorders that can quickly measure dozens of vital signs (such as body temperature, heart rate, blood pressure, and blood oxygen levels), and chatbots, trackers, and other communication devices that support ongoing monitoring; private video, audio, and email messaging; and real-time conversations between patients and providers.
One of the most exciting areas of development are the software tools that draw on artificial intelligence (AI) and decision-support systems to help individual physicians and practitioners make effective decisions regarding individual patient care. These AI tools are also quite useful in assisting hospitals, health systems, epidemiologists, and government agencies as they identify community needs, plan for future demand, and respond to emerging disease outbreaks — including the novel coronavirus.
Telemedicine and the COVID-19 Crisis
In the near term, immediately before and following the declaration of a national emergency by US President Donald Trump, federal agencies quickly announced a number of measures loosening restrictions on the use of telemedicine and the technologies that support it. Those agencies have also announced that they are using their enforcement discretion to temporarily decline to enforce certain requirements and to allow certain activities and uses of technology to which they would otherwise object.
These and similar announcements from federal and state agencies on a range of COVID-19-related issues have been collected on Jones Walker’s Disaster Prep & Recovery blog. The following is a short, partial list of policy updates, bulletins, and FAQs that have been recently issued by the federal government with respect to telemedicine and data privacy issues:
- US Food and Drug Administration (FDA) enforcement policy with respect to the use of noninvasive remote monitoring devices. In its March 20, 2020, guidance document, the FDA announced that it would allow manufacturers of certain FDA-cleared, noninvasive vital-sign measuring devices and clinical decision-support software to modify their technology, claims, or functionality to facilitate remote monitoring and home use of such devices without obtaining additional clearance for the modifications or expanded indications.
- US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) guidance on HIPAA privacy issues. In a series of announcements (on March 16, March 17, and March 20, 2020), OCR has provided clarification on its reduced enforcement and waiver of prior regulations governing certain patient data privacy protections, as well as expanded reimbursement for the use of telemedicine and related tools and technologies, during this period of national emergency.
Many states are also issuing policy declarations and statements to support the expanded use of telemedicine during this emergency. For example, on March 23, 2020, the Louisiana Department of Insurance issued Emergency Rule 37, which expands access to telemedicine services, requires insurers to cover mental health services via telemedicine, and waives restrictions requiring patients to conduct telemedicine visits only with providers in the insurer’s existing telemedicine network, among other measures.
Other federal, state, and local agencies — within the United States, the European Union, the United Kingdom, China, and beyond — are also issuing guidance with respect to the use of telemedicine tools in the fight to minimize the spread of COVID-19 and to treat individual patients and families.
It is important to note that these measures are temporary. Government agencies have made it clear in virtually all of their guidance that once the COVID-19 crisis has passed, existing restrictions and enforcement will likely return to pre-pandemic levels. During this time, however, we are not only drawing on telemedicine to address immediate needs — we are learning how to make telemedicine even better.
In a corollary to the stress testing that is part of any technology implementation, the telemedicine industry and its product and software users are engaged in a large-scale experiment. Under real-world conditions, we are gaining important insights into the products, applications, infrastructure, and processes — as well as the regulations — that work.
For example, intensive-care units have typically been seen as places for frontline, hands-on treatment. As a result, telemedicine has not previously gained significant traction in ICUs and other critical-care areas of hospitals. Today, however, as ICUs are beginning to fill with seriously ill COVID-19 patients, physicians and staff are using tablets and teleconferencing tools to communicate with patients and colleagues working within containment areas during interactions that do not require a physical presence. The physician is visible on the other side of physical barriers, but the devices facilitate examinations and discussions necessary to provide effective treatment.
Providers who have adopted telemedicine tools are also collecting and analyzing data that can provide answers to our most pressing questions about the spread and treatment of COVID-19, in particular, and the delivery of healthcare services in general.
In addition to identifying new uses of telemedicine, we are discovering cracks in the system. Under lockdown, quarantine, self-isolation, and other social-distancing regimes, the infrastructure of the World Wide Web and other telecommunications-based systems are feeling the pinch as individuals and businesses increasingly rely on remote solutions for work and entertainment. While we haven’t yet “broken the internet,” we are experiencing slowdowns in the transmission of data. As noted, however, such stress testing fosters the development of solutions that will enable us to provide higher quality, more responsive care in the future.
Telemedicine After the Crisis
Telemedicine technology will undoubtedly follow the same course as most other value-adding tools: it will improve. Our devices will become easier to use, more patient friendly, less expensive (as adoption increases), more robust, and more widespread. Data-security protocols will be further strengthened, particularly as enforcement of HIPAA requirements and other standards and regulations ramps back up to pre-crisis levels.
Among the most exciting areas of telemedicine development is the realm of AI. We know that AI, particularly in times of crisis, can help professionals make more informed, clearheaded decisions. Software algorithms and machine learning will help first responders, healthcare practitioners, researchers, scientists, product developers, and government agencies address individual treatment issues quickly and effectively, and help prepare communities, states, and nations to prevent, prepare for, respond to, and mitigate public health emergencies.
In this hopeful future, data — accurate, real-time data — will be one of the most important commodities. The lessons we are learning today will help businesses work with legislators and regulators to develop and implement healthcare, data privacy, and other policies that support improved uses of telemedicine while protecting individuals.
“May you live in interesting times” is an apocryphal curse — and possibly a backhanded blessing. No one could or would have asked for today’s COVID-19 pandemic. But, this is the hand we have been dealt. We can take advantage of the valuable lessons that we are learning about the benefits of telemedicine and how it can improve the quality of care for all.