Population, Stakeholders, and Current Practices

Hospitals and clinics are expected to provide quality healthcare to patients. In situations where in-person visits are difficult or impossible, telehealth can fill this role. Therefore, it is important for hospitals and clinics to give support and resources that provide up-to-date technology and training to healthcare providers in order to maintain a high quality of care for these patients (Thomas et al., 2020).

Doctors, physician’s assistant, nurse practitioners, nurses, and all other providers who interact with patients through telehealth should feel competent and comfortable in their abilities to address any issues that arise during the visit (Jin et al., 2020). This includes having the knowledge, skills, and attitudes required for telehealth.  Knowledge includes the ability to operate the telehealth software, understanding the general workings of computer operating systems, and what telehealth can and cannot be used to accomplish. Skills include the ability to create a rapid rapport with patients over the computer or phone, the ability to explain the technical side of telehealth, and the ability to read and assess a patient with limited interaction or visibility.

At the same time patients need to feel that they're getting the same level of care and attention from their providers as they would if they were in a clinic, hospital, or doctor's office. They should also be aware of the benefits and limitations of telehealth technology and a telehealth visit.  Patients should always be able to make decisions about and changes to their care plan regardless of whether they are face-to-face with a provider or meeting with them on the computer (Thomas et al., 2020).  Patient populations that are most commonly grouped together are the general public, underserved populations, minorities, rural populations, urban populations, minors, and geriatrics.

A number of other groups and organizations are also stakeholders and play key roles in the provision and regulation of telehealth.  These stakeholders include lawmakers, telehealth companies, medical device companies, cell phone companies, and internet service providers, to name a few (Jin et al., 2020; Thomas et al., 2020).  Each has their own view of how to best utilize, organize, and regulate telehealth.

Currently, due to the COVID-19 pandemic, some regulations that may have been barriers limiting the widespread adoption of telehealth have been suspended. The Department of Health and Human Services (DHHS, 2021) is providing waivers for the Healthcare Insurance Portability and Accountability Act (HIPAA) to providers for telehealth visits so that they may use programs that are not encrypted, including Skype, zoom, FaceTime, Messenger, etc.  Additionally, the Centers for Medicare and Medicaid Services (CMS, 2021b) have temporarily allowed patients to have at-home telehealth visits, which had previously only been allowed on a very limited basis prior to the pandemic.  CMS (2021b) also allowed providers to practice remote care across state lines to patients and they stated that they would bill all telehealth visits (video and audio-only) as though services were being provided in-person.  There has also been a temporary expansion of telehealth which allows federally qualified health centers and rural health clinics to function as distant telehealth sites, which can provide telehealth to patients at home (CMS, 2021b; DHHS, 2021).

Prior to 2020, Medicare did not allow for telehealth visits (CMS, 2021a).  Additionally, audio-only telehealth was not reimbursed at the same rate as visits that took place by video.  The need to physically visit a provider meant that the state boarders were not an issue because the visit was taking place in a physical location where the provider was licensed to operate and the laws they followed were those of that state.