COVID‐19 and telemedicine: A revolution in healthcare delivery is at hand

As the COVID‐19 pandemic grows internationally, healthcare systems are dramatically altering healthcare delivery, shifting as many services as quickly as possible to telemedicine. Telemedicine has been heralded ¹ as a primary way to forward triage and screen potentially early symptoms of COVID‐19, protecting patients, providers, and the community from additional exposure. But now, health systems and clinics across the world are additionally rapidly deploying a telemedicine approach for primary care, mental health, OBGYN, and many other outpatient specialty appointments to reduce exposure risk. Relegated for many years to the fringe of routine healthcare delivery, with only 15.4% of physicians working in practices that use telemedicine for patient interactions, ² it is now being thrust into mainstream healthcare through a crisis of medical necessity. It is no hyperbole to say that a literal revolution in healthcare delivery is at hand. Telemedicine's future is now; its value is no longer a matter of debate and the times demand that the broader medical field finally take telemedicine seriously as a viable and enduring component of healthcare service, training, and policy. The global COVID‐19 pandemic underscores not only the potential of telemedicine to reach patients unable to attend their medical appointments in person, but also its absolute necessity as an integral form of healthcare delivery and the surmountable nature of many previously noted barriers to its adoption.

The immediate enactment of pro‐telemedicine policies demonstrates the far‐reaching implications of telemedicine beyond the current watershed events. The U.S. Centers for Medicare & Medicaid Services (CMS) has dramatically expanded access to telemedicine services, ³ with Medicare now paying at the same rates as in‐person visits for telemedicine visits across the country and in patients' homes, and permitting a wider range of providers to offer telemedicine services including physicians, nurse practitioners, clinical psychologists, and licensed clinical social workers. Similarly, the U.S. Department of Health & Human Services Office of Civil Rights is waiving penalties for Health Insurance Portability and Accountability Act private health information confidentiality violations by healthcare providers for telemedicine visits using non‐encrypted technologies such as FaceTime or Skype during the COVID‐19 crisis. The U.S. Drug Enforcement Administration is also empowering practitioners by allowing them to prescribe Schedule II to V substances after a patient evaluation conducted via telemedicine, temporarily suspending the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 requirement of an in‐person evaluation before issuing a valid prescription. Other policies that should be considered amidst the COVID‐19 pandemic involve a federal mandate—or guidance encouraging state licensing boards—to temporarily remove barriers to interjurisdictional telemedicine practice for healthcare providers and trainees practicing under their licenses. Also, the requirement—often by state boards—of written informed consent from patients to receive treatment via telemedicine should be temporarily waived in favor of verbal consent. Health insurance companies should consider immediately following CMS's lead, reimbursing providers for telemedicine visits at the same rates as in‐person visits, at least until the pandemic's end and, possibly, beyond.

Providers and educators interested in the rapid adoption of telemedicine need to ensure that they are doing so ethically and competently by consuming succinct but comprehensive guidelines and training materials that are widely available. The American Medical Association has articulated a number of guidelines ⁴ for the ethical practice of telemedicine with which providers should be familiar before they engage in telemedicine visits. Additionally, office and technology checklists ⁵ for telemedicine practice are extremely helpful for aiding in screening patients to determine whether videoconferencing services are appropriate for them, ensuring providers are using appropriate technology, setting up an office conducive to telemedicine service provision, handling pre‐appointment considerations, and engaging in the telemedicine visit. More comprehensive online training programs and videos exist for providers wanting a strong exposure to telemedicine approaches, such as that from the University of Redlands ⁶ and Texas A&M University, ⁷ addressing topics like Telehealth 101, Multicultural Aspects of Rural Health, and Laws and Ethics of Telehealth.

As the telemedicine revolution is gaining exponential momentum, the practices adopted during this pandemic will reverberate throughout the halls of clinics and hospitals for the foreseeable future. They will have long‐term implications for medical training, routine practice, service delivery, and policy. As healthcare policymakers and providers rely on telemedicine as an immediate solution to the threats and challenges imposed by the COVID‐19 pandemic, they prove that telemedicine can be mainstream, and it can no longer be construed as a specialty treatment approach. The arguments proponents have made for years about its potential for reaching hard‐to‐reach patients are now realized. Issues of inequity in telemedicine service reimbursement are coming to the forefront, and coverage is being expanded in ways that many never thought possible. Further, if some of these new reimbursement policies remain after the COVID‐19 pandemic, it will reconfigure how governments think about healthcare infrastructure. Once telemedicine's patients, providers, administrators, and policy makers see that this model works, it cannot be undone. It will be expected as part of routine and integrated service provision, medical training, and the profession of medicine, and its widespread adoption will bring healthcare delivery into the 21st century.

CONFLICT OF INTEREST

The authors report no conflicts of interest.

AUTHOR CONTRIBUTIONS

Conceptualization: Paul B. Perrin, Timothy R. Elliott

Supervision: Paul B. Perrin

Writing—original draft preparation: Paul B. Perrin, Bradford S. Pierce

Writing—review and editing: Paul B. Perrin, Timothy R. Elliott

All authors have read and approved the final version of the manuscript.