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Letter to the Editor

  • The delivery of healthcare in the United States has been static for the past century with care delivered through problem-based visits in an office or hospital setting. This model has not adapted to changing demographics and makes healthcare inaccessible to many. In this model, disparities in healthcare access are multifactorial.

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Letter to the Editor by Niki Cohen and John Zampella to OJIN topic: “Telehealth: Promise or Peril?”

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June 5, 2020

Response by Niki Cohen and John Zampella to OJIN topic: “Telehealth: promise or Peril?” (September 30, 2001)

Dear Editor,

The delivery of healthcare in the United States has been static for the past century with care delivered through problem-based visits in an office or hospital setting. This model has not adapted to changing demographics and makes healthcare inaccessible to many (Basu et al., 2019).  In this model, disparities in healthcare access are multifactorial. Metropolitan areas have a high density of providers across specialties in broad healthcare networks, while residents of rural communities may need to travel hours for care (Douthit, Kiv, & Biswas, 2015). Even within metropolitan areas, income and insurance inequities put healthcare out of reach for many (Dickman, Himmelstein, & Woolhandler, 2017).

A strategy to tackle these systemic barriers is the implementation of telehealth. Telehealth can boost access to care and relieve strain on the healthcare system without a change in outcomes (Langabeer et al., 2016). Unfortunately, the utilization of telehealth programs has not been widely accepted, primarily due to institutional barriers such as lack of reimbursement, poor technological infrastructure, and medicolegal issues.

Failure to implement innovative strategies in telehealth has been underscored during the COVID-19 pandemic. COVID-19 is a novel coronavirus that causes severe pulmonary damage, pneumonia, ARDS, and death, and has recently led to social distancing as a public health mitigation strategy (Huang et al., 2020). In-person visits are discouraged, exacerbating an already strained healthcare access issue. Telehealth has offered an efficient solution for continuity of care during this crisis, and the COVID-19 pandemic has simultaneously provided the impetus to overcome institutional barriers that have previously prevented its implementation. Medicare and many private insurances altered policies and payment mechanisms, allowing for delivery and reimbursement of tele-visits and ushering a wave of virtual visits that have increased access to care (Hollander & Carr, 2020).

This wave of tele-visits has revealed several practice gaps. As most medical systems have not used telehealth regularly across specialties, providers and patients may struggle with the implementation and workflow changes intrinsic to a telehealth visit—issues that many systems are still straining to deal with.

As we look to the future of telehealth as a mechanism to increase quality and access to care beyond the COVID-19 pandemic, strategies to create and implement policies and procedures for its use must be developed and integrated into practice. Currently, little to no data exists on educational curricula for undergraduate and graduate nursing programs. Adding these skills to current educational paradigms will be essential to making telehealth a pillar of our healthcare system. Similarly, educating patients about optimized use of the new technologies will add to the broad acceptance of telemedicine. Here lies a great opportunity for nurse practitioners and doctorally prepared nurses to spearhead the expansion of this technology for patients. We can lobby our healthcare systems, insurance providers, and local governments for continued use and prioritization of telehealth, as well as advocate for our ability to provide the care for patients that they deserve. We must ask ourselves, will telehealth fade as COVID-19 fades, or will we use this global crisis as an opportunity to innovate and create a new, better healthcare system that works to increase quality and access to care for everyone?

Niki Cohen, RN, ACPCNP

John Zampella, MD 

The Ronald O. Perelman Department of Dermatology, New York University, New York, NY
Email: Niki.Cohen@nyulangone.org

References

Basu, S., Berkowtiz, S,. Philips, R., Bitton, A.,  Landon, B., Philips, R. (2019). Association of Primary Care Physician Supply with Population Mortality in the United States, 2005-2015. JAMA Internal Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450307/

Dickman, S,. Himmelstein, D,. Woolhandler, S. (2017). Inequality and the health-care system in the USA. Science direct. https://www.sciencedirect.com/science/article/pii/S0140673617303987?via%3Dihub

Douthit, N., Kiv, S., Biswas, S. (2015) Exposing some important barriers to health care access in the rural USA. Public health. https://doi.org/10.1016/j.puhe.2015.04.001

Huang, C., Wang, Y., Ren, L., Zhao, J., Hu,Y., Zang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W,. Xie, X., Yin, W., Li, H., Liu, M., Xiao, Y., Gao, H., Guo, L., Xie, J., Wang, G., Jiang, R., Gao, Z., Jin, Q., Wang, J., Coa, B. (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. https://www.ncbi.nlm.nih.gov/pubmed/31986264

Hollander, J., & Carr, B. (2020). Virtually Perfect? Telemedicine for Covid-19. The New England Journal of Medicine. Advanced online publication. https://www.nejm.org/doi/full/10.1056/NEJMp2003539

Langabeer, J., Gonzalez, M., Alqusairi, D., Chamoagne-Langabeer, T., Jackson, A., & Persse, D. (2016). Telehealth- Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments. Western Journal of Emergency Medicine. 17, 713- 720. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102597/

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