Telehealth in the COVID-19 Era: A Balancing Act to Avoid Harm

J Jeffery Reeves, John W Ayers, Christopher A Longhurst, J Jeffery Reeves, John W Ayers, Christopher A Longhurst

Abstract

The telehealth revolution in response to COVID-19 has increased essential health care access during an unprecedented public health crisis. However, virtual patient care can also limit the patient-provider relationship, quality of examination, efficiency of health care delivery, and overall quality of care. As we witness the most rapidly adopted medical trend in modern history, clinicians are beginning to comprehend the many possibilities of telehealth, but its limitations also need to be understood. As outcomes are studied and federal regulations reconsidered, it is important to be precise in the virtual patient encounter approach. Herein, we offer some simple guidelines that could assist health care providers and clinic schedulers in determining the appropriateness of a telehealth visit by considering visit types, patient characteristics, and chief complaint or disease states.

Keywords: COVID-19; access; coronavirus; efficiency; harm; informatics; patient safety; risk; safety; telehealth; virtual care.

Conflict of interest statement

Conflicts of Interest: JWA owns equity positions in Directing Medicine, Health Watcher, and Good Analytics, which are companies that advise on the use of digital data for public health surveillance. All other authors have no conflicts to declare.

©J Jeffery Reeves, John W Ayers, Christopher A Longhurst. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.02.2021.

References

    1. Moore MA, Coffman M, Jetty A, Klink K, Petterson S, Bazemore A. Family physicians report considerable interest in, but limited use of, telehealth services. J Am Board Fam Med. 2017 May 08;30(3):320–330. doi: 10.3122/jabfm.2017.03.160201.
    1. Mehrotra A, Ray K, Brockmeyer D, Barnett M, Bender J. Rapidly converting to “virtual practices”: outpatient care in the era of Covid-19. NEJM Catal Innov Care Deliv. 2020 Apr;1(2) doi: 10.1056/CAT.20.0091.
    1. Mair F, Whitten P. Systematic review of studies of patient satisfaction with telemedicine. BMJ. 2000 Jun 03;320(7248):1517–20. doi: 10.1136/bmj.320.7248.1517.
    1. Wachter R. The digital doctor: hope, hype, and harm at the dawn of medicine’s computer age. Crit Care Nurse. 2016;36(4):84–5. doi: 10.4037/ccn2016880.
    1. Dorsey ER, Topol EJ. State of telehealth. N Engl J Med. 2016 Jul 14;375(2):154–61. doi: 10.1056/NEJMra1601705.
    1. Saliba-Gustafsson EA, Miller-Kuhlmann R, Kling SMR, Garvert DW, Brown-Johnson CG, Lestoquoy AS, Verano M, Yang L, Falco-Walter J, Shaw JG, Asch SM, Gold CA, Winget M. Rapid implementation of video visits in neurology during COVID-19: mixed methods evaluation. J Med Internet Res. 2020 Dec 09;22(12):e24328. doi: 10.2196/24328.
    1. Reeves JJ, Hollandsworth HM, Torriani FJ, Taplitz R, Abeles S, Tai-Seale M, Millen M, Clay BJ, Longhurst CA. Rapid response to COVID-19: health informatics support for outbreak management in an academic health system. J Am Med Inform Assoc. 2020 Jun 01;27(6):853–859. doi: 10.1093/jamia/ocaa037.
    1. Shachar C, Engel J, Elwyn G. Implications for telehealth in a postpandemic future: regulatory and privacy issues. JAMA. 2020 Jun 16;323(23):2375–2376. doi: 10.1001/jama.2020.7943.
    1. Keesara S, Jonas A, Schulman K. Covid-19 and health care’s digital revolution. N Engl J Med. 2020 Jun 04;382(23):e82. doi: 10.1056/nejmp2005835.
    1. Horton R. Offline: touch—the first language. The Lancet. 2019 Oct;394(10206):1310. doi: 10.1016/s0140-6736(19)32280-9.
    1. Benziger CP, Huffman MD, Sweis RN, Stone NJ. The telehealth ten: a guide for a patient-assisted virtual physical examination. Am J Med. 2021 Jan;134(1):48–51. doi: 10.1016/j.amjmed.2020.06.015.
    1. Tanaka MJ, Oh LS, Martin SD, Berkson EM. Telemedicine in the era of COVID-19: the virtual orthopaedic examination. J Bone Joint Surg Am. 2020 Jun 17;102(12):e57. doi: 10.2106/JBJS.20.00609.
    1. Mammen JR, Elson MJ, Java JJ, Beck CA, Beran DB, Biglan KM, Boyd CM, Schmidt PN, Simone R, Willis AW, Dorsey ER. Patient and physician perceptions of virtual visits for Parkinson's disease: a qualitative study. Telemed J E Health. 2018 Apr;24(4):255–267. doi: 10.1089/tmj.2017.0119.
    1. Kemp MT, Liesman DR, Williams AM, Brown CS, Iancu AM, Wakam GK, Biesterveld BE, Alam HB. Surgery provider perceptions on telehealth visits during the COVID-19 pandemic: room for improvement. J Surg Res. 2020 Nov 13;260:300–306. doi: 10.1016/j.jss.2020.11.034.
    1. Hoenig H, Tate L, Dumbleton S, Montgomery C, Morgan M, Landerman LR, Caves K. A quality assurance study on the accuracy of measuring physical function under current conditions for use of clinical video telehealth. Arch Phys Med Rehabil. 2013 May;94(5):998–1002. doi: 10.1016/j.apmr.2013.01.009.
    1. Yager PH, Clark ME, Dapul HR, Murphy S, Zheng H, Noviski N. Reliability of circulatory and neurologic examination by telemedicine in a pediatric intensive care unit. J Pediatr. 2014 Nov;165(5):962–6.e1. doi: 10.1016/j.jpeds.2014.07.002.
    1. Chowdhury D, Hope KD, Arthur LC, Weinberger SM, Ronai C, Johnson JN, Snyder CS. Telehealth for pediatric cardiology practitioners in the time of COVID-19. Pediatr Cardiol. 2020 Aug;41(6):1081–1091. doi: 10.1007/s00246-020-02411-1.
    1. Powell RE, Henstenburg JM, Cooper G, Hollander JE, Rising KL. Patient perceptions of telehealth primary care video visits. Ann Fam Med. 2017 May;15(3):225–229. doi: 10.1370/afm.2095.
    1. Verghese A. Culture shock — patient as icon, icon as patient. N Engl J Med. 2008 Dec 25;359(26):2748–2751. doi: 10.1056/nejmp0807461.
    1. Lacritz L, Carlew A, Livingstone J, Bailey K, Parker A, Diaz A. Patient satisfaction with telephone neuropsychological assessment. Arch Clin Neuropsychol. 2020 Nov 19;35(8):1240–1248. doi: 10.1093/arclin/acaa097.
    1. Imlach F, McKinlay E, Middleton L, Kennedy J, Pledger M, Russell L, Churchward M, Cumming J, McBride-Henry K. Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences. BMC Fam Pract. 2020 Dec 13;21(1):269. doi: 10.1186/s12875-020-01336-1.
    1. Ramaswamy A, Yu M, Drangsholt S, Ng E, Culligan PJ, Schlegel PN, Hu JC. Patient satisfaction with telemedicine during the COVID-19 pandemic: retrospective cohort study. J Med Internet Res. 2020 Sep 09;22(9):e20786. doi: 10.2196/20786.
    1. What Is Patient-Centered Care? NEJM Catal. NEJM Catalyst. 2017;3(1):1–1.
    1. Patel PD, Cobb J, Wright D, Turer R, Jordan T, Humphrey A, Kepner AL, Smith G, Rosenbloom ST. Rapid development of telehealth capabilities within pediatric patient portal infrastructure for COVID-19 care: barriers, solutions, results. J Am Med Inform Assoc. 2020 Jul 01;27(7):1116–1120. doi: 10.1093/jamia/ocaa065.
    1. Lan F, Wei C, Hsu Y, Christiani DC, Kales SN. Work-related COVID-19 transmission in six Asian countries/areas: A follow-up study. PLoS One. 2020;15(5):e0233588. doi: 10.1371/journal.pone.0233588.
    1. Lentz RJ, Colt H, Chen H, Cordovilla R, Popevic S, Tahura S, Candoli P, Tomassetti S, Meachery GJ, Cohen BP, Harris BD, Talbot TR, Maldonado F. Assessing coronavirus disease 2019 (COVID-19) transmission to healthcare personnel: The global ACT-HCP case-control study. Infect Control Hosp Epidemiol. 2020 Sep 09;:1–7. doi: 10.1017/ice.2020.455.
    1. Centers for Disease ControlPrevention. Following Infection Prevention and Control Recommendations in Healthcare Settings During the COVID-19 Pandemic. Healthcare Facilities: Managing Operations During the COVID-19 Pandemic. [2020-10-01]. .
    1. Gan WH, Lim JW, Koh D. Preventing intra-hospital infection and transmission of coronavirus disease 2019 in health-care workers. Saf Health Work. 2020 Jun;11(2):241–243. doi: 10.1016/j.shaw.2020.03.001.
    1. Coronavirus disease 2019 (COVID-19): situation report, 82. World Health Organization. 2020. [2021-01-21]. .
    1. Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic. Centers for Disease Control and Prevention - COVID-19. 2020. [2020-09-03]. .
    1. Gadzinski AJ, Ellimoottil C. Telehealth in urology after the COVID-19 pandemic. Nat Rev Urol. 2020 Jul;17(7):363–364. doi: 10.1038/s41585-020-0336-6.

Source: PubMed

3
Abonner