But many devices don’t communicate with a patient’s electronic health record.
For many practices, telehealth used to be something like a treadmill — not the kind at the gym; the kind a person buys based on a late-night infomercial, which then sits in the corner of the basement collecting dust. It’s there. It’s functional. But it rarely gets used.
Though now a common buzzword, the concept of telehealth is decades old. Originally, the term referred to telephone-based check-ins, but over time it evolved to include face-to-face video visits using personal computers and eventually smartphones. As video technology improved, the opportunity for telehealth became too lucrative to dismiss, setting off a cascade of telehealth startups, as well as partnerships with health systems, insurers and tech firms. Even as telehealth became big business, many practices still treated the technology like a novelty. Then along came COVID-19, and telehealth was a novelty no more.
“I do believe telehealth is here to stay,” says Steven Waldren, M.D., M.S., vice president and chief medical informatics officer at the American Academy of Family Physicians (AAFP). He says insurers have indicated an intention not to revert to their pre-pandemic reimbursement levels, and it’s likely that many patients won’t go back to all in-person visits either. The technology is popular with both patients and providers, Waldren says. “There is evidence that patients like virtual visits (because they are) more convenient,” he says.
Last September, AAFP surveyed its members and found that 71% wanted to continue to offer telehealth services even after the pandemic. Victor Camlek, M.L.I.S., principal analyst at Frost & Sullivan, a consultancy, says he also believes telehealth will be a durable part of patient care, although it will take time to see exactly where it slots in. “I think (telehealth) definitely has a good chance to be more visible as we move forward than it was prior to the pandemic,” he says. “But I would like to see more studies that come out and give conclusive evidence that show value and effect.”
So if telehealth is like the treadmill that finally gets used, the question is: Will using it actually lead to something more meaningful than convenience? Will people’s health actually improve?
So smart. But how useful?
Camlek’s question is an important one because, unlike a Zoom video call, the call itself is not the goal of a telehealth visit. Rather, the goal is to diagnose and monitor the health of the patient. In a traditional in-person office visit, that would require a battery of tools and devices, from a thermometer to a pulse oximeter to an electrocardiogram. These days, versions of each of those tools can be purchased to use at home, offering physicians a way to extract and act upon data whether meeting in person or electronically. Although the new arsenal of at-home “smart” medical devices is built around communication with a patient’s smartphone, most of these devices don’t yet communicate with a patient’s electronic health record nor is it clear that most physicians would utilize the data even if they had direct access to the data.
Just like telehealth before the pandemic, digital health tools are not being widely embraced in medical practices, despite their wide availability. Camlek says a number of barriers are holding back the full integration of digital health tools into routine clinical practice. For one thing, a line has to be drawn between devices that are for personal use and those that are truly medical. “So there are things underway that will separate telehealth solutions into two categories: those that are endorsed by a body that has stature and the others that are more consumer oriented that you can use but not necessarily rely on for medical-grade precision,” he says.
In the case of the former, regulators, payers and providers will need to decide on clear standards. Ultimately, Camlek predicts providers will want to see evidence “that we were able to achieve similar results to a normal scenario when a patient was treated in person.”
Waldren says that additional data are also needed to know which types of devices are best for each particular practice and, drilling down further, for each particular patient. He says it’s not just data that are needed but also metrics by which to evaluate such data — measurement of measurement. “There is a lack of evidence on how to compare the different offerings in these spaces so that practices can know which are the right solutions for them,” he says, adding that best practices are also needed to standardize effective and efficient operation of such tools.
One of the areas in which digital health integration into patient care has made the biggest strides is in the remote patient monitoring, where digital technology can be used to provide regular, or even constant, monitoring of the status of patients with chronic conditions. Even though the number of remote monitoring devices and services has soared in recent years, Waldren says obstacles remain to integrating such devices fully into regular patient care, telehealth or otherwise. “On the remote monitoring front, we need further standardization of data and their transmission and integration into the (electronic health record),” Waldren observes. “It is still a significant administrative burden to manage multiple devices from multiple companies due to the lack of interoperability and standardization.”
Interoperability has been an important topic in the digital health sector because new federal rules start coming into effect this year. The rules are designed to make it easier for data to travel to and from consumers, their smart devices and providers, but some hospital and payer groups are worried about about privacy and security. They may, however, also be operating out of self-interest; it’s no accident that data tend to get hoarded and siloed.
Waldren says the main patient privacy law, the 25-year-old Health Insurance Portability and Accountability Act, is outdated and not in step with the times and people’s attitudes about sharing data. “I think many patients are willing to share their data, not only to help themselves but to advance science and understanding,” he says. “But it needs to be clear what, to whom and for what purposes the data (are) being shared and that rules are in place to ensure that entities follow those rules.”
He points to the eHealth Initiative, a consortium of healthcare companies and associations, including AAFP, as one place in which those conversations are happening. Camlek agrees that privacy concerns and patient concerns about tracking will be an important. The trade-offs associated with digital health will be crucial conversations, but he says those conversations will differ depending on the health of the patient, the particular condition, and the nature and rigor of the tools in use.
“Things like the number of steps you have taken, it shows you’ve been active, but it’s not a critical decision,” he says. “But if you’re tracking weight remotely and a patient has congestive heart conditions, that could be very important as an indicator that fluid is building up.”
Knowing which tools are available, valid and suitable for a clinical workflow will become critical if telehealth graduates from being an add-on communication tool to being a whole new way of delivering healthcare. Camlek says both patients and clinicians need to be considered: “We need a repertoire of solutions that includes tools that make the patient much more capable of participating in the clinical assessment and the physicians able to interpret data that (they) feel confident in.”
Jared Kaltwasser is a freelancer writer in Iowa.