What is Telehealth: Benefits, Evidence & Services

In-person visits to health and wellness professionals are no longer our only option. New communication channels and wireless technologies have made it easier to be in touch with your healthcare team. Extreme situations – like the current coronavirus crisis – are confirming just how important it is to have the possibility of remote consultations and online connections.

What is telehealth? Telemedicine vs telehealth

Telehealth refers to the delivery of health education or health services through various telecommunication mediums [1]. Although telemedicine is often used as a synonym for telehealth, there is a subtle difference between the two. According to the American Academy of Family Physicians, telehealth is a broader term. It refers to all remote healthcare services and also includes non-clinical services; for instance, an online course on how to change your behavior to increase physical activity.

In contrast, telemedicine covers only clinical services. Carrying out a video consultation with your doctor instead of visiting their office is an example of telemedicine (as well as telehealth).

When is telehealth useful?

Telehealth can be particularly useful when there are barriers to in-person delivery, such as distance, accessibility barriers, time and staff shortage [2]. People who can benefit from telehealth services include those living in rural areas, people with mobility restrictions, older people, people trying to optimize their health budget, as well as people who just want to avoid the frustration of waiting rooms and save time. Telehealth is also helping health professionals, making communication between disperse teams easier and bridging the gap when there is not enough staff.

Telehealth in the time of coronavirus

Recently, the coronavirus preventative measures put additional restrictions on our travel and social contacts, widening the circle of potential telehealth users. For many, telehealth has become a new lifeline, connecting them to their healthcare providers and ensuring their health needs are adequately met.

For the general public, accessing medical services without leaving their homes has become essential in the wake of the pandemic. Doctors around the world are starting to direct people to different telehealth services to avoid non-urgent in-person visits to the hospital that could overwhelm the healthcare system. Amwell, one of America’s direct-to-consumer telemedicine apps, reported a 158% increase in the usage of their app since January 2020.

Health insurance coverage has also changed to adapt to COVID-19 challenges, with both the United States (with Medicaid) and Australia (with Medicare) expanding coverage for certain telehealth services for the good of public health.

What does telehealth include?

Telehealth interventions offer an evidenced-based approach in the areas of patient education, communication and goal setting. The following interventions and technologies can be included in telehealth:

• mobile-based interventions (also known as mobile health or mHealth), conducted via a smartphone or other digital/mobile devices such as Nerva for IBS management or Evia for menopause
• secure text messaging services;
• live videos (videoconferencing) and virtual visits;
• video-based interventions without a live feed; for example, pre-recorded videos that are transmitted online;
• remote patient monitoring with the help of sensors that transmit information;
• data transmission between two health professionals, such as a GP and a specialist.

The benefits of telehealth

Technology is making a massive difference to many people who might otherwise be isolated or could not receive the care they need. Telehealth and telemedicine are considered particularly useful for older people and those with chronic conditions and complex healthcare needs [3]. Mental health is another emerging area of telehealth; for example, offering online psychological interventions in a timely and person-centered manner.

One of the most obvious advantages of telehealth is accessibility, with flexible appointment times, at a place most convenient (or safe) for you. With the help of the latest technology, your care can move out of the health professional’s office and into your home (or another setting of choice), at a time that suits you best.

Virtual visits, an important branch of telemedicine, enable the patient to see and speak with a doctor or other professional remotely, in real-time. This can speed up the assessment and treatment process, contributing to a quicker and more accurate diagnosis. Support is available around the clock, and patient monitoring and education can be performed continuously.

Many telemedicine solutions are more affordable than traditional interventions [4], especially the digital therapeutic branch of telemedicine which can help therapy reach millions of patients for significantly less than in-person interventions.

Co-creating the experience

More and more studies are showing that the appropriate use of health tech increases user satisfaction [5]. Whether you are using a hypnotherapy app, or you are video chatting with your doctor, the experience becomes more user-friendly and promotes patient autonomy.

Many experts argue that telehealth helps shift authority to the patient. We are witnessing a more egalitarian and informal relationship between the user and the healthcare provider and healthcare professionals.

Dr Eric Topol, an American cardiologist and a digital health pioneer, argues that our healthcare needs to enter a digital revolution, which should include relationship adjustments [6]. In other words, the traditional, top-down medical model of care is now being replaced with a fresh perspective. You can take a more proactive role and influence your care by contributing to data collection, monitoring, and knowledge acquisition. Telehealth puts you in the driving seat. You are no longer just a passive recipient of services.

Who uses telehealth?

In 2019, J.D. Power conducted a survey in the US, which showed that one in ten Americans use telehealth. As already mentioned, it is expected that this number will increase drastically with the emergence of coronavirus and further developments of telehealth.

Initially, telehealth was targeting people living with chronic diseases, seniors and people living in remote areas. However, survey results show that usage is more likely among young people and urban dwellers. In America, only 8.7% of rural residents have adopted telehealth services. People aged 18-to-24 years have used telehealth more than any other age group (13.1%), while older people (65+)  have the lowest utilization rate of any age group (5.3%) [7].

Telehealth has a lot of potential to become more widely adopted, with greater involvement from payers and healthcare professionals as regulations and clinical evidence continue to progress.

Does it wWork?

There is a lot of scientific evidence for the use of telehealth. Nonetheless, some people are worried about the safety of this approach. Different regulations have been put in place to protect consumers. For instance, in the US, the Food and Drug Administration (FDA) monitors smartphone applications that pair with medical devices. However, a lot of telehealth devices and apps are not considered medical devices and don’t pose a significant risk if not working as intended, so there is less regulation.

Therefore, it is important for you as a user to vet the device before using it. Angela Hardi of the Washington University School of Medicine in St. Louis compiled a list of questions you can check when deciding on a telehealth device or app:

• Who created the app? What are the designers’ credentials and affiliations?

Tip: A credible mHealth program should probably include doctors and/or health experts.

• What research is the app based on? Are the sources cited?
• Does the app feel like a source of information or an entertainment/advertisement tool?

Tip: The app shouldn’t seem like an advertisement for another product.

For telehealth within mental health, the American Psychiatric Association (APA) is offering a rating system based on the following criteria: background information, privacy and security, evidence, ease of use and interoperability.

When evaluating a telehealth device, program or app, you should also consider if it’s designed in a way that is functional for you; for instance, are you likely to use it over time?

Open questions about telehealth

Experts agree that telehealth is an excellent innovation that can promote our health. However, there is still a gap between the design of evidence-based, pilot telehealth interventions and implementation into practice. Also, it is not easy to design and implement a telehealth program that involves multiple stakeholders.

Dr Johanna Taylor from the Department of Health Sciences at the University of York, UK, mentions some of the barriers to the wider adoption of telehealth such as [8]:

• inability to assess a patient’s telehealth needs,
• technical/legal issues related to sharing protected health information,
• equipment limitations,
• inefficient service delivery resources,
• perceptions of increased staff workload,
• low staff awareness,
• uncertainty regarding remote patient monitoring structures and processes.

Professor Deborah Lupton, an Australian sociologist who focuses on digital health, also warns that before using any online or remote service, it is crucial to understand who can access the data and how this data is being safeguarded [9]. A lot of work is being done to address these issues, so that people can feel more comfortable and empowered when using telehealth services.

The Wrap Up

Telehealth technology is maturing and it is expected that it will soon become a staple in our health industry. Many people could gain from telehealth services, so it is essential that telehealth gets promoted and utilized. However, it's important to ensure that telehealth is handled appropriately and safely, with time taken to overcome the open questions that still surround digital health as a whole. Nonetheless, a balanced combination of digital and in-person services could improve the quality of life for many people, especially in times like these when access to in-person support is less available.