The nonprofit American Telemedicine Association (ATA) celebrated its second annual Telehealth Awareness Week last week with a series of 14 webinars and other events highlighting the expanding roles of telehealth in clinical care in this country and around the world.
The webinars, which were recorded and will be made available for free viewing on the ATA website, touched on a wide range of topics, including the use of telehealth in aging, rehabilitation medicine, and emergency medicine; telemental health for adolescents and at-risk populations; and more.
These sessions can provide journalists with a good primer on what’s happening in the field and offer a springboard for story ideas and knowledgeable sources to interview. For example, one session hosted by the ATA’s advisory group on using telehealth to eliminate disparities and inequities described a model they built to evaluate how digital infrastructure interacts with life expectancy. The model indicated that for every 1% increase in households with no broadband service in a community, there is a corresponding .029-year decrease in life expectancy.
Here is a summary of some information presented in a few sessions.
What is asynchronous telehealth?
Synchronous telehealth is what we are familiar with, where a patient and clinician are engaged in real-time communication via video or a phone call. But asynchronous telehealth also can be valuable. In this situation, a patient can log into a telehealth platform and provide information relevant to why they are on the platform (such as reporting clinical symptoms, filling out a medical history, or potentially uploading a lab result or image). Then, at a later point, a clinician can review that information and engage with the patient through the platform or a chat function to obtain more information.
The clinician then can determine if they can treat the patient via telehealth, in which case they can write a prescription, provide another treatment, or recommend instead that the person be seen in person or in a synchronous forum. It provides another tool for clinicians to connect with patients and can be used to gather information on chronic disease patients day by day or monitor for signs of infection in patients following surgery, for example. The work has to fall within state regulations, however. Several states do not permit asynchronous care or have specific requirements for the technologies to be used.
Reaching the unreachable: connecting to patients past the Wi-Fi signal
About 6% of the population (around 19 million Americans) are in areas of the country with limited or no broadband access, and 14.5 million of them lack that access because they reside in rural areas. For some of these patients, telephone calls continue to be the main form of telehealth. Another option used by some health centers where bandwidth is an issue is an e-visit, which could consist of an emailed form a patient fills out online and sends in for symptom checks or other concerns, which a provider can check at their leisure and then respond and update a prescription or escalate care.
Additional options used by some providers include text and chat-based programs, and cellular extenders that can boost a weak cell phone signal in mobile telemedicine kits. Another is a store and forward telehealth program, which allows a health worker to go into a community and engage with a patient and create notes for an encounter. When that worker travels to an area where they can get a cell signal or email, they can send the information to another expert to help interpret, and then return to the community and re-engage with the patient using the response received from the expert.
Telehealth companies also sometimes make use of low- or mid-earth orbit satellites, geosynchronous satellites, microwave radio antennas, or shortwaves to relay data. There are methods to separate out a video stream so that audio communication stays even if a video is of poor quality or pixelated.
Leveraging telehealth in decentralized clinical trials for recruitment and retention of diverse participants
Decentralized clinical trials are those directed by investigators at one or several centers, but which open participation to anyone meeting the study criteria, regardless of geographical location. Another area where telehealth may help is with the recruitment, retention, and engagement of more diverse study participants.
Many potential trial participants have smartphones or other devices but don’t necessarily have transportation access to the nearest participating health center where investigators or their staff typically perform assessments of potential participants before enrolling them in trials. Telehealth and other online platforms could provide a means to conduct participant assessments and provide online forms through which patients can fill out surveys or submit other data, relieving participants of some of the burdens of travel and logistics. Patient navigators could work with participants asynchronously through portals or conduct video visits and assessments.
Those who don’t have a smartphone or computer may still be able to participate in trials. Investigators can use telephones to interact with such participants and supply them with remote monitoring devices outfitted with SIM cards that can send patient-generated health data to research teams with the push of a button.
Additional webinars covered telehealth and home testing; virtual nursing and the digitally enabled clinical workforce of the future; telehealth policy and remote monitoring. For more information, contact Gina Cella, an ATA spokesperson, at email@example.com.