Implications for Clinicians—Telemedicine and the Virtual Clinic

As the COVID-19 pandemic struck in the spring of 2020, most hospitals, outpatient facilities, doctor’s offices, and many other facilities that offer medical and mental health services came to a grinding halt. Needless to say, though this was necessary in the short-term, it is not a viable option for the health care industry or public hospitals, as they provide critical resources to the community and provide essential and necessary services. This abrupt loss of some services required an immediate shift in thinking and an innovative approach to find solutions to continue providing essential health care services to those in need. Consequently, telehealth and telemedicine became necessary during the COVID-19 pandemic. Telehealth allowed some health care workers a means of working remotely during the pandemic, while telemedicine allowed clinicians to safely meet with patients and comply with social distancing guidelines, especially when providing nonemergency care. In March 2020, the federal government eased many restrictions that had previously made the use of telemedicine cumbersome. These changes, in conjunction with the need to avoid unnecessary interactions to reduce the spread of SARS-CoV-2, accelerated the adoption of the telemedicine platforms during 2020 and into 2021, and this was particularly true in the field of mental health. While there are major benefits to the use of telemedicine, critics are justified in noting that it remains an
untested medium and that issues of accessibility, privacy concerns, and quality of care remain among the most notable reasons why it should be considered one tool among many rather than a panacea.

COVID-19 and Telemedicine

Though the words “telemedicine” and “telehealth” may sometimes be used interchangeably, they are not the same. Introduced by Thomas Bird in the 1970s, the word “telemedicine” refers to the use of telecommunication technologies to allow clinicians to provide “healing at a distance.”¹ Beyond allowing a more convenient means of communication between patients and their doctors, telemedicine also cuts down on travel, can reduce wait time, and allows doctors to monitor patients’ vital signs or behaviors. At its most sophisticated, telemedicine can facilitate the virtual presence of medical personnel through wearable technology or allow a surgeon to use a semiautonomous robot during a procedure even when the two are hundreds of miles away from one another.²^, ³ At its least sophisticated, it can mean picking up the phone and calling a patient. “Telehealth” is broader and refers to the delivery of health or health-related services via telecommunication or digital communication technologies and includes all services or activities pertaining to health care—including not just medical care to patients but also health care education, provider-to-provider communication, and the use of wearable devices to monitor one’s own health.⁴

No surprise, telemedicine and telehealth have become extremely popular during the COVID-19 pandemic. With respect to telehealth, administrative staff from hospitals as well as health care administrators have mirrored trends in other industries with respect to working remotely. With respect to telemedicine, more patients have sought consultations and nonurgent care through the use of telemedicine and even some forms of artificial intelligence. Social distancing protocols during the height of the pandemic made telemedicine the best option for many patients, particularly seniors and individuals with weakened immune systems. Because millions of Americans had been placed in lockdown and were unable or unwilling to leave their homes, pivoting to telemedicine was not just driven by expediency; it was driven by necessity.

The surge in usage was aided by a federal response. Recognizing that eliminating regulations regarding telemedicine would make it easier for clinicians to evaluate patients and provide care to patients from the safety of their homes, Congress authorized the U.S. Department of Health and Human Services (HHS) to temporarily waive “certain Medicaid restrictions
and requirements regarding telehealth services during the coronavirus public health emergency” by passing H.R. 6074—Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, which was signed into law on March 6, 2020.⁵ Despite extreme partisanship in Washington, only three members of Congress voted against the bill.

HHS later announced it would temporarily ease the enforcement of some regulations created by the Health Insurance Portability and Accountability Act (HIPAA) of 1996.⁶ These rules were waived for patients covered by private insurers, as well as all beneficiaries of Medicare and Medicaid. Previously, they were typically only waived for beneficiaries living in rural areas who often lacked access to specialists.⁷ As of March 17, 2020: