The adoption of telehealth technology continues to expand, with more than 60% of healthcare institutions in the United States now using electronic communication to exchange medical information for purposes of patient care, according to the US Department of Health and Human Services.1
Telehealth is being used for a wide range of purposes and in various settings. Clinicians consult with each other by email or video, for example, and patients consult with physicians by email, video, and telephone. Additionally, patients are using mobile apps, wearable monitors, and other tools to track personal health-related data such as physical activity, diet, and medication adherence.
Overall, provider reimbursement by private, commercial, and public insurers has increased in recent years for telehealth services. For commercial insurers, parity laws in 32 states and the District of Columbia stipulate equal coverage for services provided by means of telehealth and in person.2 However, there are still many limitations in reimbursement, which is a key barrier in the expansion of telehealth, according to Jules Lipoff, MD, assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania.
State of the evidence
In 2016, the Agency for Healthcare Research and Quality (AHRQ) published an evidence map of results from 58 systematic reviews, representing a total of 965 telehealth studies.3 The report demonstrated sufficient evidence for the effectiveness of telehealth for psychotherapy and for remote monitoring and counseling of patients with chronic conditions, particularly cardiovascular and respiratory disease.
There is also an evidence base to support applications in maternal and child health, telehealth consultations, and in intensive care units. The AHRQ states that this research should be the focus of future systematic reviews. Meanwhile, additional studies are needed to assess the use of telehealth in urgent and primary care triage, teledermatology, and the management of serious pediatric conditions.
In a new paper published in October 2017 in the New England Journal of Medicine, the authors outlined 9 key areas that should receive priority in telehealth research.4 “Such research is necessary to fully realize the promise of telehealth to address socially desirable goals such as the quadruple aim in health care: improving the patient experience of care, improving the health of populations, reducing the per capita cost of health care, and improving the experience of providing care,” they wrote.
A summary of their recommendations is as follows:
Physician leadership: The American Medical Association (AMA) Council on Ethical and Judicial Affairs stated that physicians should support further developments in telehealth technology and clinical standards and advocate for telehealth access for patients who may benefit from its use. Additionally, professional “organizations and institutions should monitor telehealth and telemedicine to identify and address adverse consequences as technologies evolve and identify and encourage dissemination of positive outcomes,” the council recommended.5 Research-based evidence will assist in these actions.
Reimbursement: As the focus continues to shift toward value-based reimbursement, telehealth has particular relevance for more efficient delivery of care. A major hindrance in research exploring the economic value of telehealth services is the lack of comprehensive Current Procedural Terminology (CPT) codes, an issue that is now being addressed by professional groups, including the CPT Editorial Panel of the AMA. Studies should also examine how telehealth services affect alternative payment models.