Week 5 Reflection

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Reflection Week 5 Telemedicine and the internet- changing the healthcare delivery Model. Name American Military University HCAD501 Technology Application in Healthcare Organizations Dr. Barbara Cliff December 8, 2023

Abstract Healthcare Technology continues to transform the healthcare industry, including how patients experience healthcare. Implementing technologies such as telehealth and telemedicine enables healthcare consumers to have immediate access to healthcare services, eliminating the long wait time and reducing the backlog of in-person patient appointment scheduling. Telemedicine saves both the patient and providers money and time. The ability of telemedicine to streamline the workflow process and the efficiency it presents in care delivery makes it an economical and prudent choice for both healthcare providers and consumers. In addition, telemedicine helps provide accurate healthcare history to physicians through telemedicine technology that helps provide a safe choice of healthcare services to consumers in the comfort of their homes. This paper will discuss how telemedicine was utilized prior to the novel Coronavirus, barriers to use of telemedicine, what allowed for telemedicine's widespread use once the pandemic began, how to address concerns of barriers to use, and the future outlook of telemedicine. How was telemedicine utilized prior to the novel Coronavirus? Prior to the Coronavirus, telemedicine was a core component of healthcare Technology. Arguably, healthcare is one of the industries that have seen the most significant potential for transformation with technology, ranging from the point of care, such as hospitals and clinics, to the point of need, such as patients’ homes. With innovative technologies such as wireless sensors and internet connectivity, healthcare providers and other professionals can gain direct access to the patients and remotely monitor patients’ health while transmitting

patient data to their physicians and other interdisciplinary teams to monitor patient healthcare. Thus, Health issues do not manifest as an emergency requiring an emergency room visit. The power of telemedicine transcends immediate access to care and quick data transmission but also provides benefits such as telemental health service and other telehealth benefits such as prescription refills, all available before and after the COVID-19 Pandemic. Before the COVID-19 pandemic became a Public Health Emergency in March 2020, telemedicine steadily grew in the United States. However, adoption of telemedicine was relatively low, and implementation was complex; healthcare providers who might be interested in telemedicine were often hindered by the insufficient reimbursement for such services, in addition to several government regulations that make the requirement for implementing telemedicine unbearable for most healthcare providers. Healthcare providers and other professionals were also somehow limited from attending to traveling patients by interstate licensing restrictions and several other rules, such as prescription, and type of patients that were or were not acceptable to be seen based on the type of visit; "Despite these hurdles, 76% of US hospital systems used some form of telemedicine as of 2018, with radiology, psychiatry, and cardiology noted as the highest users of the modality" (Shaver, 2022). Prior to the COVID pandemic, patients often preferred to have a face-to-face encounter with their healthcare providers; thus, even when the option of telemedicine is presented to the patient, it is often rejected; the improved communication that patients believed they enjoy during an in-person visit with their physician, and the concern of data security is some of the many reasons healthcare consumers participation remains stagnant prior to COVID-19. It is imperative also to highlight the overall concern of the quality of care and liability attached to telemedicine impairing both providers and healthcare consumer

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participation in telemedicine; prior to the novel Coronavirus, patients and healthcare providers worried less about Hospital-acquired infections (HAI)- nosocomially acquired infections that are often acquired during patient visits to the hospital or hospitalization as such, telemedicine utilization was on the lower end until Coronavirus became a public health emergency issues. Thus, both healthcare providers and patients worry about possible transmission during a person's hospital visits. Barriers & Concern to usage of Telemedicine It is indisputable that using audio and video technology to provide healthcare services to the consumer presents many benefits. While telehealth and telemedicine were initially developed to provide access to healthcare to consumers in rural areas and underserved consumers, the usage rate has significantly increased since the COVID-19 pandemic in 2019- 2020. The continuous growth in access to the wealth gap is one of the significant barriers to the use of telemedicine, in addition to the limitation to performing a comprehensive physical assessment. Regulatory barriers, technological challenges, and data safety are also some of the many barriers that prevent the use of telemedicine; it is also imperative to highlight the fact that telemedicine does potentially affect the continuation of care as most providers are unable to access and review patient history since patients are prone to visit with different providers at each visit as such telemedicine and telehealth are consider to be sufficient for follow up and supplemental visitation. The legal and regulatory guideline are challenges and barriers that contribute to providers confusion in adopting the use of telemedicine, the possible risk and legal implication of data breach and noncompliance with the forever changing regulation are also barriers to usage and implementation. As telehealth and telemedicine rule defers from state to

state and licensure requirement also defers, this creates an unclear standard of operation and regulation among several healthcare groups, "The rapid expansion of telehealth, especially during the COVID-19 pandemic, paired with variable regulations and guidelines creates increased potential for liability and legal issues" (Gajarawala & Pelkowski, 2021) creating a barrier to telemedicine implementation and usage. The lack of Multistate Telemedicine Licensure also presents a significant barrier because licensure laws and regulations differ in every state. Providers must ensure that licensure is maintained according to the patient’s state. While some states allow the operation of nurses based on compact licensure, compact licensure does not apply to nurse practitioners (NPs) as they are licensed under the state boards and not medicine, thus creating a barrier to the usage of telemedicine. Patient privacy and confidentiality are also barriers to telehealth and telemedicine utilization as telemedicine presents data and patient information vulnerability; the concern of data exposure to hackers and patient data privacy is a barrier that most healthcare providers and consumers struggle to overcome. Furthermore, data accuracy and misdiagnosis are barriers that need to be overcome; the possibility of self-diagnosis due to a lack of physician encounters creates a liability issue for patients and healthcare providers. The Provider-patient relationship is also a concern that creates barriers and a lack of interest on the part of the patients. As such, patients feel more connected with their providers when they visit with them in person. However, all the above-stated barriers can be addressed with proper patient education and regulatory changes that make providers’ licensure requirements less complicated. What allowed for telemedicine's widespread use once the pandemic began?

In March 2020, the United States recognized SARS-CoV-2, also known as the novel Coronavirus, as a public health emergency. As a result, many of the prior barriers to telemedicine upended; many patients who would have had a face-to-face provider visit were either isolated, quarantined, or afraid of physically attending a provider's office in fear of possibly contracting the COVID-19 virus. As a result of the COVID-19 pandemic, the US Congress made significant changes to the Medicaid and Medicare billing of telemedicine. An amendment was made to where telemedicine must originate from and what kind of telemedicine and telehealth visits could be reimbursed. The relaxation in interstate practice, reimbursement process, and privacy regulation and requirement dramatically improved providers' adoption and utilization of telemedicine and shortly managed care and other private insurance providers also followed suit, leading to a collective effort to help keep healthcare accessible to consumers and minimize the spread of the COVID infection. Before COVID, the Centers for Medicare & Medicaid Services restricted who could perform and receive telehealth and telemedicine services. Only certain approved licensed providers can provide telemedicine service to the patient with they must have had a preexisting relationship; however, after the CARES Act and the CMS 1135 Waiver was enacted, any type of clinician is now allowed to bill Medicare and Medicaid for telemedicine services without any preexisting relationships required. The CARE Act and CMS 1135 Waiver allow easy billing for telehealth and telemedicine services and allow physicians to conduct telehealth services with their patients in the comfort of the provider's home. Through the waiver program relative to the COVID pandemic, healthcare providers no longer have to eat the cost of providing telehealth service; the COVID pandemic created a pathway for providers to receive.

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How were the concerns of prior addressed? Centers for Medicare & Medicaid Services changes in regulation, and the CMS 1135 Waiver addressed some of the concerns identified previously; prior to COVID-19, patients were required to obtain telehealth at an originating site located in a specific geographic location; however, this restriction was addressed through the regulation review as such all patient can now utilize telemedicine and other telehealth services including but not limited to non-behavioral services, mental health services, and other services without originating site restrictions or requirements. Technological barriers have also been addressed as Medicare and Medicaid providers can now bill CMS for technological equipment that is issued to healthcare consumers who qualify for such equipment based on set requirements, thus breaching the access to technology gap in low-income patients. It is a fair assessment to conclude that COVID has changed how patient accepts the use of technology and how clinician utilizes technology to increase patient satisfaction; the challenges faced prior to COVID were not only addressed out of the fear of exposure to COVID but also through government regulation and support that shrinks the gap between face-to-face care and telemedicine. Government regulations have eliminated challenges that make telemedicine less acceptable, thus improving patient health outcomes for telemedicine and other telehealth services. I also have lacked confidence in the telehealth and telemedicine service before COVID-19. As a result, I would never want to utilize such a service since better care is provided in person by my physician. In addition, my insurance charges a higher copay for telehealth. However, through regulation review and incentives provided to health insurance companies, the higher copay was waived since COVID, and my insurance provider also incentivized me for telemedicine. This approach does not only make telemedicine a

financially better option, but I also started to recognize that my health outcome was better as I was able to have my physician visit sooner than I would have if I needed to visit the physician, my prescription refill was also completed soon than usual. My overall care coordination and outcome were more efficient. The expansion of telemedicine services to include chronic care such as heart failure, chronic obstructive pulmonary disease (COPD), diabetes, hypertension, hyperlipidemia, and asthma make telemedicine a better option even as COVID become less of a public health emergency as healthcare consumers now experience an improved health outcome with the use of telemedicine and other services such as pharmacist- based telemedicine interventions. Future outlook of Telemedicine COVID-19 has significantly increased the use of Telemedicine. Telemedicine has especially improved access to healthcare for those healthcare consumers who face barriers such as distance, lack of transportation, rural geographical residency, compromised immune systems, and lack of caretakers. With Telemedicine, healthcare consumers now have immediate access to healthcare services; "Immunocompromised patients no longer have to risk acquiring infectious diseases" (Jin et al., 2020). The efficiency of Telemedicine has made it possible for the patient to bypass the long wait for an appointment schedule, and now patients can visit their healthcare provider sooner; the fear of patients missing their appointment is now eliminated as the patient can still visit remotely with their healthcare providers and utilize Telemedicine. Telemedicine is the future of healthcare as healthcare continues to move from conventional brick-and-mortar buildings into the homes of healthcare consumers. Telemedicine continues to provide compelling alternatives to chronic and acute health issues management in addition to the increase in consumer satisfaction and improved

clinical outcomes. Telemedicine continues to connect patients with health service providers and close the access to care gap through remote monitoring and improved electronic communications. Telemedicine is the future of healthcare as it continues to ensure patients access to the proper care at the right place and time. Conclusion The COVID-19 Pandemic has impelled telemedicine and other telehealth service, thus providing multitudes of benefits to healthcare consumers and healthcare providers, benefits including but not limited to enhance patient comfort and convenience in accessing healthcare services, expedited control of infectious illness, especially for the immunocompromised and elderly population, provision of better assessment and improved clinical outcomes. However, there are still challenges that face the implementation of telemedicine from different domains, including but not limited to disruption of care delivery, cost of implementation, and disparities in healthcare for rural residents. As such, future efforts should continue to address the barriers to implementation "by redesigning telehealth solutions via a systematic approach such that health care systems can mitigate the negative effects of telehealth and seamlessly realize the benefits and enhanced safety that telehealth provides" (Zhang et al., 2021)

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References Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth Benefits and Barriers. The journal for nurse practitioners : JNP, 17(2), 218–221. https://doi.org/10.1016/j.nurpra.2020.09.013 Jin, M. X., Kim, S. Y., Miller, L. J., Behari, G., & Correa, R. (2020). Telemedicine: Current Impact on the Future. Cureus, 12(8), e9891. https://doi.org/10.7759/cureus.9891 Shaver J. (2022). The State of Telehealth Before and After the COVID-19 Pandemic. Primary care, 49(4), 517–530. https://doi.org/10.1016/j.pop.2022.04.002 Zhang, T., Mosier, J., & Subbian, V. (2021). Identifying Barriers to and Opportunities for Telehealth Implementation Amidst the COVID-19 Pandemic by Using a Human Factors Approach: A Leap Into the Future of Health Care Delivery?. JMIR human factors, 8(2), e24860. https://doi.org/10.2196/24860

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