Tracking Telehealth: COVID-19 ushers in a new era for the industry

The past few months have been like a massive trial for telehealth services which will do wonders for its adoption in the future. But the surge in its usage has also brought the problems with telehealth to light and has certainly eroded believes that telehealth is some magical solution to all problems with healthcare delivery.

The ‘new normal’ theories for healthcare post-COVID-19 have been filled with many buzzing keywords but a particularly interesting one among them is telehealth, which has gained a lot of steam overnight after years of subdued response.

Telehealth allows patients to consult the most relevant doctors without traveling or waiting at clinics around the country, or even around the world, in favorable situations. As discussed in a previous report by the Centre of Excellence on Emerging Development Perspectives (COE-EDP) titled, "Telehealth post-COVID 19: Breaking stereotypes and embracing the potential of technology," many governments have loosened regulations regarding telehealth, which has paved the way for increased adoption as the world adjusts to a new reality where everything from work to education relies on the internet.

For more than a decade, telehealth advocates had been pushing for favorable regulations, similar to what has been adopted in the face of this pandemic. But their efforts had gone largely in vain and telehealth has held a negligible share of healthcare until recent years. Medicare, the national health insurance program in the US, spent approximately $14.4 million on healthcare delivered through telehealth in 2015, which is less than 0.01% of total spending on healthcare services.

Then came COVID-19, which left people with limited choices as healthcare infrastructure started to become overburdened. To counter these issues and ensure continued care for patients suffering from other diseases, telehealth garnered the support of governments as well as international health bodies like the World Health Organization (WHO). As part of their pandemic response plans, many countries around the world found an ally in telehealth and modified regulations to accelerate its adoption.

In the US, changes such as increasing the number of services covered by Medicare, fee parity with in-person care, and, in some cases, allowing physicians to treat patients across state lines without a separate license have driven the increase in adoption. Various telehealth platforms like Teladoc Health and Amwell have also reported a sharp rise in usage as people adhere to social distancing advisories with the help on online consultations.

Australia has also relaxed rules regarding telehealth, most notably expanding claim eligibility under Medicare to include a wide range of healthcare services delivered via telehealth, which facilitated more than 7 million MBS-funded telehealth consultations during the first six weeks after access to telehealth was expanded. Other measures include permitting delivery of healthcare services via digital means even without a pre-existing provider-patient relationship.

The increase in telehealth usage hasn’t been limited to developed countries and several developing countries in Asia have also reaped in the benefits of telehealth to respond to COVID-19. For instance, Indonesia is supporting telehealth startups to cope up with increased demand as the country’s healthcare capacity is far below other populous emerging economies. Since March, more than 7 million users have accessed a COVID-19 special feature launched by an Indonesian telehealth startup Halodoc while its mobile app downloads have increased by 300 percent. The Indonesian government is working with several other telehealth platforms and encouraging people to seek online consultation if their cases are suitable.

In India, the Insurance Regulatory and Development Authority of India (IRDAI) has asked insurers to provide coverage for healthcare services delivered through telehealth.

Digital prescriptions

Another pressing issue, as cited in our earlier analysis, was regarding prescriptions issued through digital means since the regulations around telehealth itself were vague in many countries. In an attempt to address that issue, several governments have made regulatory changes to smoothen the transition towards telehealth.

The Australian government has made regulatory changes making electronic prescriptions a legal form to purchase medicines. While paper prescriptions will still be available, the regulatory changes make them optional and give an alternative to prescribers and patients. In coming months, the Australian government will also launch an Active Script List model to issue electronic prescriptions, which will essentially be a centralized list of prescription that is expected to overcome the issue of lost tokens of e-prescriptions and assist management and adherence, a feature that will be especially useful for patients who are using multiple medicines.

Devices

Many industry insiders believe that the next obvious step is moving towards cheaper, easily accessible medical devices that facilitate telehealth. Such devices weren’t mainstream before COVID-19 but the increase in telehealth usage has spurred the growth of few companies working in the sector, paving way for innovations.

Supportive regulatory stance towards companies making these devices has also come as a buoyant factor for the industry. US Food and Drug Administration (FDA) has issued several Emergency Use Authorizations (EUA) for remote or wearable patient monitoring devices, which are also setting the ground for increased adoption in the future.

A San Jose-based company VitalConnect makes a small, disposable biosensor called VitalPatch that can be glued to a patient’s chest and is capable of measuring heart rate, detect motion as well as body temperature. When connected to other suitable devices, it can also measure blood pressure, blood oxygen levels and respiration to be sent wirelessly to a physician or hospital.

Another technology company Trapollo has seen a surge in demand for its virtual care system as telehealth adoption increased during the COVID-19 pandemic.

Problems with Telehealth

The past few months have been like a massive trial for telehealth services which will do wonders for its adoption in the future. But the surge in its usage has also brought the problems with telehealth to light and has certainly eroded believes that telehealth is some magical solution to all problems with healthcare delivery.

• Cybersecurity

One of the most prominent issues with telehealth is the cybersecurity risk because healthcare data breaches can have serious repercussions and are particularly lucrative to hackers. Even before COVID-19, the healthcare industry had been one of the biggest targets of cyberattacks which include the infamous WannaCry attacks that crippled computers in hospitals across the UK in May 2017. The increased risk has made big hospitals take stringent steps to secure their systems in recent years but the same safeguards aren’t present in small startups foraying in the sector and individual devices used by patients.

Babylon Health, a British app that facilitates a connection between GPs and patients, suffered a data breach amid COVID-19 in early June when one user discovered that dozens of video recordings of other patients’ consultations were accessible to others.

In another incident, video recordings of several Zoom calls, which included telehealth consultations, were found to be publically available on the internet. Reports had claimed that the recordings included one-on-one therapy sessions, a telehealth training session, and other “deeply intimate” conversations.

• Digital divide

Telehealth advocates often cite technology’s potential in improving access to healthcare, especially in remote and rural areas. But the realization of that benefit hinges on access to high-speed internet, something not very common in the rural areas that arguably stands to benefit the most.

The new 5G technology is expected to revolutionize telehealth but access to high-speed internet and digital devices must also be addressed or patients from rural areas and the economically disadvantaged can be left worse off.

• Overuse in unsuitable cases

There are many cases where telehealth can be just as good or even better than in-person visits but it is certainly not suitable for all cases and adequate regulations are required to ensure optimal standards of healthcare are maintained. For instance, cases with pre-existing patient-provider relationships have seen better outcomes compared to those where patients took consultations with a doctor they have never have had an in-person consultation with.

During the pandemic, several cases of practitioners using telehealth in inappropriate cases have been reported but have been largely overlooked because it is still a safer option given the circumstances. But clear and precise regulations on the use of telehealth are required in the post-pandemic period.

Several industry bodies have issued warnings against call center-styled telehealth startups that mislead patients with fake claims and reports about inappropriate billings have also surfaced.

• Education

Despite the notable developments in telehealth in recent years, the curriculums of medical schools haven’t been adequately updated pertaining to the value, use, and implementation of telehealth. Integrating telehealth training in programs hasn’t been a priority for many colleges around the world and even those that do offer such training make them elective for students.

For the industry to thrive, educational institutions must incorporate necessary telehealth training and procedures in undergraduate medical education which will enable students to keep up with rapid advancements and provide quality healthcare to the patients in the future.

Bottom Line

The COVID-19 pandemic has been a boon for telehealth, bringing to light its capabilities as well as shortcomings. The increased usage is helping erode the hype around telehealth and the focus is shifting towards using it in the best possible way to complement in-person healthcare, instead of thinking about telehealth as a magical solution to all the problems with traditional healthcare.

Key stakeholders including WHO and national governments are getting behind telehealth realizing its potential in ensuring continuous care in the face of COVID-19. The positive regulatory stance is opening new doors in ways that telehealth advocates had been trying to lobby for years and the post-pandemic period will be the beginning of a new era for the industry which will ingrain telehealth as a permanent part of the healthcare industry.

Centre of Excellence on Emerging Development Perspectives (COE-EDP) is an initiative of VisionRI and aims to keep track of the transition trajectory of global development and works towards conceptualization, development, and mainstreaming of innovative developmental approaches, frameworks, and practices.