Welcome to Telehealth Roundup, highlighting news and features about emerging trends in telemedicine and telehealth.
‘Patients Will be Hurt’
Telehealth may face major cybersecurity challenges in 2021, experts at the American Telemedicine Association’s EDGE policy conference said.
Leaders reiterated the importance of telehealth security as a patient safety issue, especially with the “explosion of connected devices in conjunction with the rising value of digital medical records and an increasingly remote workforce,” reported Health IT News.
It’s not enough to know security may be a problem; the real task is working collaboratively to address the dangers, Health IT News noted.
Even before the COVID-19 public health emergency, healthcare “had a cyber target on its back,” said Christopher Logan, director of healthcare industry strategy at the software company VMware. “We’ve been measuring the risks and the threat for telemedicine-type services for many years.”
The question is not one of computer literacy, but whether basic security measures are in place, added Northwell Health’s chief quality officer and deputy chief medical officer, Mark Jarrett. Providers associated with larger hospitals may have the privilege of an additional layer of security, while smaller or medium-sized providers “are basically on their own,” he said.
This is magnified by rising telehealth use, especially remote patient monitoring devices, which often rely on a patient’s own network security, Jarrett added: “What we’re trying to [do] … is look at it from the patient viewpoint and the provider’s viewpoint. I don’t love overregulation, but this is an area where we have to be careful, because patients will be hurt.”
Both privacy and patient safety are on the line as evidenced by the recent rash of ransomware cases, one of which was linked to a patient’s death in Germany. “At the end of the day, ‘adequate security’ is not enough when you think about what we’re trying to accomplish,” Logan said.
Video Visits and Cancer Care
Do oncology professionals think video visits are effective? A small qualitative study tried to find out.
“We found that respondents often had conflicting opinions regarding the clinical efficacy, quality of patient experience, accessibility, and financial impact of telehealth,” wrote Nathan Handley, MD, MBA, of Thomas Jefferson University in Philadelphia, and co-authors, in JAMA Network Open.
The researchers conducted interviews with 29 medical oncology health professionals at Thomas Jefferson University Hospital, including 20 physicians and nine advanced practice professionals. All but one survey was conducted between October 30 and November 22, 2019.
The research stemmed from JeffConnect, a system-wide telehealth program launched in 2015 to help doctors and patients use video visits. All Jefferson health professionals were offered relative value unit equivalents and end-of-year bonuses to encourage virtual appointments. While Jefferson offers training in performing virtual physical exams, “to our knowledge no research or practice advisories have been published regarding the technique of a virtual physical examination for cancer care,” the researchers noted.
Some oncology professionals raised concerns in the study that discordance between the physical exam and patient history could cause potentially important missed findings. Respondents said the lack of effective physical examinations made telehealth inappropriate for certain visit types, including first appointments, patients seen only every 6 to 12 months, and patients who are symptomatic or sick.
While nearly all surveys were conducted before the COVID-19 public health emergency, “concerns regarding the clinical efficacy of a telehealth physical examination are the most commonly reported challenges for the virtual management of cancer during the COVID-19 pandemic,” the researchers observed.
Some views may have changed with experience: telehealth appointments at the Jefferson cancer center rose from 1.0% of all visits in February 2020 to 52.4% in April 2020. A new study with oncology physicians and advanced practice professionals is underway.
Teladoc in the Post-Pandemic World
The virtual care company Teladoc is positioning itself to be the dominant telehealth leader after the worst of COVID-19 subsides, STAT reported from the 2021 JPMorgan Healthcare Conference.
Teladoc’s patient visits more than doubled in the past year, from 4.1 million in 2019 to an estimated 10.6 million in 2020, according to a slide shared at the conference. The company also doubled revenue from $553 million to an estimated $1 billion and added four major clients to its portfolio in 2020, including the Pennsylvania-based Geisinger health system.
As telehealth visits soared in the U.S. during the pandemic, primary care visits declined and screenings for cardiovascular risk factors and chronic diseases like diabetes fell sharply, in part because physicians couldn’t monitor some conditions remotely. That’s where Teladoc may have an advantage: when it acquired chronic virtual care company Livongo last year, it inherited a suite of connected devices including blood pressure cuffs and glucose meters that could help patients avoid lapses in care and some doctor visits.
This doesn’t guarantee Teladoc an easy path, STAT said. The company will need to prove it can reduce healthcare spending by helping patients avoid expensive procedures and that it can successfully manage a variety of conditions through telehealth.
In addition, there’s “a series of nationwide regulatory questions that could tip the balance for or against virtual care, including whether the Biden administration will make permanent the regulatory changes that increased its availability and whether the government will move to make broadband more readily available in rural and low-income parts of the country,” STAT noted.