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Research Spotlight

Expanding Telehealth During the COVID-19 Pandemic to Keep Patients and Healthcare Providers Safe and Ensure Continuity of Care

In communities across the Nation, telehealth and technologies to support collection of patient-generated health data (PGHD) emerged as a lifeline for care during the COVID-19 pandemic. These rapidly advancing technologies connected patients to healthcare services in ways that may have been unimaginable to many just 18 months ago.

Primary care physicians and advanced practice providers were able to evaluate patients who feared they had developed early symptoms of COVID-19. Pediatricians maintained connections with parents concerned about their children’s physical and emotional development. Providers were able to remotely monitor their patients with chronic diseases through mobile devices and other technology that collected PGHD, providing continuity of care during the pandemic, while keeping themselves and their patients safe. Disease experts were able to educate, train, and support healthcare professionals in underserved communities.

Initially, telehealth models of care focused on using video for visits. Yet, as the pandemic unfolded, other models of care that integrated PGHD—defined as health-related data created, recorded, or gathered by or from patients (or family members/ other caregivers) to help address a health concern—grew. Providers were motivated to use telemonitoring technologies for symptom monitoring, collecting these data from patients remotely to ensure continuity of care, while keeping patients at home.

With the pandemic, when patients are not doing well with their asthma, we don’t want them to come in for in-person visits, but they can still be managed remotely. It is important to get them the treatment that they need in a timely manner, because otherwise they might end up in the emergency room, which during a pandemic is the worst place for the patients. The benefit of telemonitoring with patient-generated health data is that it can be done with some relatively simple remote monitoring and a telehealth visit.”
– Dr. Robert Rudin

While telehealth has been used for decades in rural areas where specialty care is limited, its use was hampered by technology and broadband limitations and, most importantly, lack of reimbursement. In March 2020, the Federal Government expanded Medicare and Medicaid payments for a wider array of virtual office, home, and hospital visits—as well as mental health counseling and preventive health screenings—with most private insurers following. Loosening of regulations and funding allowed healthcare organizations to establish or expand telehealth programs quickly. There is now great momentum; telehealth is now considered part of the mainstream of healthcare delivery, and we must ensure that its use is effective, safe, affordable, accessible, and equitable. Telehealth is not just for rural areas anymore. It can be used in schools and correctional facilities, as well as in patients’ homes, nursing homes, doctors’ offices, and hospitals.

To do so, we must learn how to update technology in rural healthcare organizations, train physicians, advanced practice providers, and other members of the healthcare professional team how to conduct telehealth appointments, and teach patients how to take advantage of virtual appointments when they cannot see a provider in person. Today, in response to these evolving advances in healthcare, AHRQ’s Digital Healthcare Research program is supporting initiatives to address vital questions about telehealth’s potential to support patient care that’s effective, safe, affordable, accessible, and equitable. These activities include research that:

While the COVID-19 pandemic accelerated the use of digital healthcare, AHRQ has a long history of supporting research on innovative telehealth technology that improves access to care for patients, most notably supporting and championing the early Project ECHO work—a program that allows rural primary care clinicians to learn from specialists at urban medical centers by video. Specialists can educate, train, and support rural primary healthcare providers and community health representatives on the best practice treatment protocols for complex diseases over a telehealth network. The quality of care is improved by increasing the skills of the healthcare professionals already based there. Today, Project ECHO is in widespread use in the United States: 250 hubs in 48 States and another 130 hubs around the world. The project now trains clinicians on management of 70 diseases, covering diabetes, HIV, mental and substance use disorders, chronic pain, opioid use disorder, and more.

AHRQ’s other foundational research has shown that telehealth has increased patient access to services in such fields as urgent care for children, psychiatry, speech telerehabilitation, chronic care management, and dermatology, while delivering the same quality of care. This research by AHRQ laid the groundwork to support the healthcare system’s transition to virtual care during the pandemic.

Despite these known benefits to providers and patients, there are still unanswered questions on the impact and unintended consequences of using these technologies. Even though telehealth has become more mainstream during the pandemic, challenges persist. It remains inaccessible in areas without broadband internet. Accessibility for people with disabilities and older adults continues to be a challenge in telehealth. And there is still a lot of uncertainty about how using telemedicine more would affect insurers’ and hospitals’ bottom lines over time, not to mention, patient outcomes. AHRQ wants to find out how telehealth technologies can be integrated into healthcare safely, and to support broader, and smarter, dissemination of these innovations. This research will inform how to evolve post-pandemic patient care to ensure the highest quality of care, support changes in payment regulations, reduce the health disparities that are currently present with the delivery of telehealth services, and promote equal access for all. This newly funded research includes:

How do we help our patients either identify and/or manage chronic illness? When somebody isn't coming into the practice, you can't take their blood pressure. During the pandemic, federally qualified health centers that serve more underserved patients in the U.S. received grants to buy and distribute blood pressure cuffs. Then they helped patients use them, so that they could continue diagnosing and manage hypertension. These were patients that were at higher risk of contracting COVID-19 and having more negative effects, so it was important that they could be monitored at home."
– Dr. Deborah Cohen

During the pandemic, the ability to monitor patients remotely while they were at home reduced the need for patients to be seen in person. Many hope that this remote care will continue, especially for those patients with medical conditions who have difficulty accessing in-person care. However, not all practices have the knowledge and resources to successfully implement a remote monitoring care model. Creating value from PGHD requires investment, commitment, and an understanding of the variables that influence the success of and challenges to PGHD integration that can improve patient outcomes, care coordination, quality, and cost-effectiveness. Telehealth and other technologies that allow for collection and use of PGHD are already redefining how care will be delivered in the future. Millions of Americans have learned to use these new technologies during the COVID-19 pandemic with several studies reflecting early indications of both successful PGHD collection and integration and patient satisfaction. It is critical that policymakers, health systems professionals, and patients and caregivers understand not only the benefits of telehealth and telemonitoring via PGHD, but also the enormous impacts that may come from their expansion. We firmly believe that these technologies will become a key tenet of 21st century care, especially post- pandemic. Understanding how best to incorporate virtual technologies holds the possibility of providing continual care as opposed to the episodic care that is our current norm. Our research on telehealth and other new technologies that allow for collection and use of PGHD continues to broaden the research and medical community’s understanding of training, mentoring, diagnosis, and treatment opportunities that benefit healthcare providers and consumers alike.