In response to the COVID-19 epidemic, health systems are increasing their use of virtual tools and telehealth at unprecedented speed and insurers are expanding coverage for the services. These tools have great potential to help consumers access services that may be difficult to do so in-person and help physicians manage patients’ care remotely.
As the pandemic drives rapid development and deployment of these tools to meet pressing needs, policymakers need to consider how best to use these technologies in the long term.
Over the past several months, the National Academy for State Health Policy (NASHP) convened the Telehealth Affinity Group of state policymakers to examine emerging evidence from the Patient Centered Outcomes Research Institute (PCORI) on the use of telehealth to transform health care delivery. Past discussions have highlighted some of the promise and challenges of telehealth tools, including:
- Unconventional uses of telehealth technology;
- Scalability of interventions;
- Effect of patient preferences on behavior adoption; and
- The effect of patient demographics on adoption.
In February, before the pandemic hit the United States, the affinity group met to discuss three PCORI studies. Their discussions offer insights for policymakers and health systems to weigh, along with lessons learned from the current telehealth deployment, as long-term telehealth policies are adapted and implemented.
Clear evidence of effectiveness is ideal, but not always available when needed. While policymakers acknowledge the importance of evidence-based research, it is impractical to wait for multi-year, in-depth studies to release results before implementing a new technology. The current pandemic is a unique example, but even prior to COVID-19, state policymakers recognized that there were situations in which, for financial and practical reasons, virtual tools that deliver medical services needed to be leveraged. State agencies often operate with constrained resources and are frequent innovators that adopt novel approaches, especially if there is promise that the approach will be cost-effective or the best solution available to address an urgent need.
Rapidly changing technology may limit relevance of some telehealth research. Technology is rapidly changing, as is user familiarity with technological tools. As a result, well-crafted research to test the ease of use and the likelihood that a specific technological tool can lead to a promising health outcome can be irrevalent by the time the results are released. For instance, a study that examined technology requiring in-home installation and specialized training for participants in 2014-2016 found that patients who received the intervention reported higher levels of anxiety than those in the control group. The study’s results might be different if conducted today with the newest smart phone devices many people use daily. While it was not reported in the study, affinity group members speculated the invasive nature of the technology partially contributed to the elevated anxiety levels of the intervention group.
While the findings of these point-in-time studies may still generally apply, the constant nature of technical change makes it difficult to justify investment in technology that could change in just a few years even if there had been more conclusive evidence that interventions had been effective. However, as technology improves and patient familiarity with various technologies grows, it is possible that both patient ability and willingness to adopt technologies will improve enabling better results from use of technological interventions.
Questions remain about how efficiently telehealth expands provider networks. A primary concern of policymakers is ensuring access to providers, particularly in rural or underserved areas, but is telehealth effective in expanding provider networks? To date, the studies reviewed by the group offer interesting uses of telehealth technology and the effect of those technologies on patient behaviors, but there is often little examination of effect of the intervention on network availability. For example, members questioned how telehealth interventions could serve to help address workforce needs, including efficient distribution of limited provider resources, especially across both rural and urban settings.
Ultimately, state health policymakers want to find ways to provide lower-cost and/or better-quality services to patients. This a challenge that research into the use of technology interventions in clinicial care may not be able to immediately provide. And, examining the lessons from rapid acceleration of telehealth use during the COVID-19 pandemic may not be able to answer that question either.
NASHP will continue to discuss emerging PCORI research and telehealth policies in the coming months. To learn more, read our prior blogs State Officials Consider Patient Preferences when Evaluating Telehealth Evidence and States Explore Emerging Evidence to Learn New, Innovative Uses of Telehealth.