It’s no secret that telehealth’s explosion is credited to the advent of the COVID-19 pandemic. Until recently, telehealth was historically used to treat patients in rural communities and had various regulatory restrictions, including where the service could occur, licensure and scope of practice limitations. Although telehealth expansion has raised new challenges, telehealth continues to serve a critical role in care delivery during the COVID-19 pandemic and will continue to deliver essential benefits into the post-pandemic future.

Previous research showed that widespread telehealth adoption among physicians and patients had been relatively slow.[i] Fast forward several years to immediately before the COVID-19 pandemic, AMA research showed increased adoption rates by physicians and patients alike but telehealth was still far from mainstream.[ii] Recent payment and regulatory changes during the pandemic were essential to broaden telehealth usage and propelled the technology to become the digital lifeline connecting patients and physicians. [iii] Telehealth ultimately could pave the path forward for improving health outcomes by making it easier for patients to access high-quality care while staying safe at home.

In our recent perspective piece in npj Digital Medicine, we wrote about the advent of digital-native physicians and their role as “influencers” in the consumer technology market. Physicians will continue to play an integral role in providing the clinical voice for innovative digital technologies that will augment telehealth services with remote patient monitoring solutions. Physicians, practices and health systems recognize the importance of implementing and optimizing telehealth in their respective environments. Fueling this necessity is the growth of consumerism in health care, particularly patients’ expectations for convenient and real-time access to services.     

Since submitting our article, it’s clear that telehealth is here to stay but physicians’ key requirements need to be met to ensure sustainability. In a recent study released by the COVID-19 Healthcare Coalition Telehealth Impact Study Work Group, the survey found that:

• 68% of clinician respondents are motivated (agree and strongly agree) to increase telehealth use in their practices;
• 75% of clinicians indicated that telehealth enabled them to provide quality care
• More than 80% of respondents indicated that telehealth improved the timeliness of care for their patients. A similar percentage said that their patients have reacted favorably to using telehealth for care.
• A majority of respondents indicated that telehealth has improved the satisfaction of their work (55%).

And in relation to barriers:

• 73.3% of clinician respondents indicated that no or low reimbursement will be a major challenge post-COVID, impacting an organization’s longer-term investment in HIPAA compliant solutions;
• Over 64% of respondents indicated technology challenges for patients as a barrier to sustainable use of telehealth;
• Perceived barriers for patients included lack of access to technology and internet/broadband, and low digital literacy;
• 58% of physician respondents are not able to currently access their telehealth technology directly from their EHR;
• There were also several anticipated workflow challenges including integration with EHR (30.3%) and other health care technologies (27.9%), building telehealth-specific workflows (25.7%), and lack of technical support (25.3%).[iv]

The AMA collaborated with the Coalition’s telehealth work group in the three-part study which included an analysis of telehealth insurance reimbursement claims before and during the pandemic, a physician survey, and an ongoing survey of patients who have used telehealth services during the pandemic. The study’s data will be used to inform government policymakers and others about the benefits of telehealth and supplying the evidence to make permanent many of the temporary regulations to facilitate telehealth usage during the pandemic.

One of the landmark publications of the past couple of decades, Crossing the Quality Chasm, stated, “information technology must play a central role in the redesign of the health care system if a substantial improvement in quality is to be achieved.”[v] Enacting coverage parity, providing fair payment; requiring insurers to allow all contracted physicians to receive reimbursement for remote visits, expanding broadband, expanding acceptable modalities increasing digital literacy, and addressing geographic and originating site barriers are among the areas that need to be addressed.

[i] Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. N Engl J Med 2017;377:1585-92. https://www.nejm.org/doi/10.1056/NEJMsr1503323

[ii]  American Medical Association, 2020. AMA Digital Health Research: Physician’s motivation and requirements for adopting digital health—adoption and attitudinal shifts from 2016 to 2019. https://www.ama-assn.org/system/files/2020-02/ama-digital-health-study.pdf

[iii] American Medical Association, 2021. Emerging Topics in Professional Satisfaction and Practice Sustainability series: Telehealth policy & coverage: What you need to know for 2021. https://www.ama-assn.org/practice-management/digital/telehealth-policy-coverage-what-you-need-know-2021

[iv] COVID-19 Health Care Coalition, 2021. Telehealth Impact: Physician Survey Analysis. https://c19hcc.org/telehealth/physician-survey-analysis/

[v] Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001. PMID: 25057539.