AHRQ Views: Blog posts from AHRQ leaders
Asking the Hard Questions About Telehealth
The COVID-19 pandemic revealed much about our Nation’s capacity—and shortcomings—when faced with an urgent health crisis. One positive aspect it exposed is our ability to adapt. A case in point is telehealth.
Like many others, I found the healthcare community’s ability to innovate nothing short of amazing. In February 2020, just before the pandemic emerged, few Americans used telehealth regularly. Typically, it was used for occasional remote patient consultations and monitoring.
When COVID-19 began its spread, patients and healthcare systems turned to telehealth platforms to maintain connection while avoiding unnecessary exposure. Uptake was enabled as the federal government and private payers revised payment policies and suspended HIPAA-related privacy regulations. In April 2020, when the pandemic was surging, nearly 1.3 million Medicare primary care visits per week occurred via telehealth—an estimated 350-fold increase compared to pre-pandemic levels.
I personally benefitted. Through video visits, I continued to receive care from my medical team for a serious and complex condition. In fact, during one visit, a physician let me know he was working from home while he himself was isolating after a mild case of COVID-19. (Thankfully, he has fully recovered.) Telehealth provided me with safe, accessible, convenient, continuous, and quality healthcare over the past months, and I’m grateful.
But even considering the potential benefits of telehealth to increase access, patient-centeredness, and value, I believe a significant measure of caution is warranted. We as a Nation adapted on the fly, appropriately. But as we emerge from the pandemic, it’s time to ask the hard questions. There is much to be learned about telehealth to ensure that its future applications improve quality and value without introducing new safety problems or exacerbating today’s healthcare inequities.
Before the pandemic, AHRQ published two pieces of research on telehealth: a technical brief on the evidence around patient outcomes, and a review of the evidence about remote acute and chronic care consultations. There is research-based evidence that telehealth, in certain settings and for specific conditions, works to improve outcomes. As telehealth’s use expanded exponentially during the pandemic, AHRQ published a primer with practical suggestions for ensuring telehealth was implemented with considerations for patient safety.
This work has been helpful. But we can, and must, do more. We no longer can ask “Should healthcare delivery embrace telehealth?” but instead ask “How can we learn from the use of telehealth today to ensure care is better tomorrow?” Stakeholders across the healthcare landscape—payers, policymakers, clinical professionals, and patients—need reliable information about the ways telehealth can best be integrated into healthcare delivery to drive quality, safety, equity, and value.
We must better understand the dimensions and factors contributing to healthcare’s digital divide. As we recommit ourselves to addressing historical racism and advancing health equity, we must ensure that increased use of telehealth in all its forms does not leave any group of patients, including those with limited Internet access, behind. Like all healthcare innovations, telehealth must be considered with equity in mind. Telehealth has the potential to increase access for people living in rural and frontier communities, and we must ensure that is implemented in ways that do not unexpectedly lead to reduced access to needed in-person care.
We also need to pursue research and monitor potential risks to patient safety associated with telehealth, especially the possibility that a diagnosis might be missed or delayed due to the remote nature of a telehealth encounter. We will also want to understand how virtual visits and remote monitoring are best integrated with in-person care, both at home and in traditional medical settings, to maximize quality and value. More care is not always better care.
Telehealth has and will continue to change the healthcare landscape. It has the potential to enhance access. It may make care more equitable. But we must be intentional about its use. If we want telehealth to work for all Americans, we must make it so. And that means expanding the research and evaluation to understand it better.
AHRQ was an early leader in exploring the possibilities of telehealth, and today we are eager to continue to explore the technology’s promise. AHRQ plays a vital role within the digital healthcare research landscape, and we are eager to use our expertise to help guide the evolution of telehealth. The COVID-19 pandemic ignited the expansion of telehealth. Now that telehealth has shown its potential, we must not rely on assumptions; it is time to ask challenging questions and create the evidence to ensure telehealth drives improvements in quality, safety, equity, access, and value.
Dr. Meyers is Acting Director of AHRQ .