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  • America’s Access to Care Crisis: Telemedicine Provides the Solution

    Melinda Moore Gottschalk, MPAS, PA-C, DMSc, DFAAPA

    As the COVID-19 pandemic swept across the United States in early 2020, telemedicine took a giant leap forward in popularity. Because of the pandemic and under the direction of federal, state, and local government agencies, necessary relaxation of advance practice provider (APP) supervision and insurance rules redefined access to care through telemedicine, giving providers and healthcare systems a new understanding of telemedicine’s potential to meet the needs of their patients.1,2

    The decision to reduce physicians’ supervisory requirements for physician assistants (PA) and nurse practitioners (NP) enabled all healthcare providers to work at the top of their license, education, and experience. Adjustments to insurance reimbursement allowed providers to bill telemedicine encounters at the same rate as in-office visits. Telemedicine benefits were evident. However, barriers to full implementation and continuation of telemedicine still exist.

    The Basics

    Understanding telemedicine terminology

    Understanding telemedicine terminology improves dialogue between providers. Listed below are telemedicine terms (Table 1).3-8 Although some people use the terms interchangeably, doing so increases confusion.

    Table 1. Telemedicine Terminology3-8

    Telehealth A collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies
    Telemedicine Professional services provided to a patient through an interactive telecommunications system with a distant site provider
    Asynchronous 2 or more activities do not happen at the same time
    Synchronous 2 simultaneously activities: for example, a face-to-face telemedicine visit
    Remote patient monitoring The patient uses equipment to transmit data to the provider
    e-Health Electronic process and communication (email and patient portals)
    Virtual e-visits or virtual medicine/care Face-to-face telemedicine visits
    Virtual reality Virtual, augmented procedures; interactive virtual reality simulator
    Augmented reality Simulated educational tools; spherical recordings (or 360º recordings)
    Facilitated care Medical professionals with the patient ensuring adherence to the standard of care Provider present to facilitate blood pressure readings, or other needed information
    Non-facilitated care Direct to the consumer without other healthcare providers needed on-site during the visit

    Waller and Stotler5 described 3 domains of telemedicine: functionality, application, and technology. Functionality describes telemedicine’s utilization. An example of telemedicine’s functionality is a consult between 2 providers on patient care or a specialist interpreting a case remotely. Providers can use this technology to monitor remote equipment (eg, electrocardiogram or glucose monitor) with patients sending the information to their providers. Telemedicine allows specialists to mentor, observe, and advise other providers in real-time.

    Telemedicine applications differ by specialty, disease process, and treatment modality. Telepsychiatry is an example of a specialty utilizing telemedicine, whereas teleasthma is an example of telemedicine used to treat a disease process. Rehabilitation and physical therapy are an application under the treatment modalities.

    Out of date or substandard technology can be a limiting factor in the utilization of telemedicine. The full potential of telemedicine is not possible unless there are adequate connectivity and network support.5

    Telemedicine and Access to Care

    Initially, the appeal of telemedicine was the ability to deliver quality health care to medically underserved areas. Even before the pandemic, the variety of telehealth modalities had expanded to include monitoring, educational opportunities, and training. Bringing virtual reality into telehealth broadened the applications in practice and created 3-dimensional possibilities for procedures.7,8 The need to provide health care to medically underserved areas is an ongoing issue, particularly given the healthcare provider shortage in various parts of the United States. Given recent improvements in the digital infrastructure, telemedicine is starting to meet that need.

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