Clinicians overwhelmingly support using telehealth services for outpatient primary care and specialty care visits after the pandemic is over, according to a study out of University of California San Francisco.

As state and federal authorities decide whether to continue reimbursing for telehealth services that were suddenly adopted last spring in response to the coronavirus pandemic, clinicians in the San Francisco Health Network say they want to continue using them.

The results surprised the research team, which includes a number of clinicians at Zuckerberg San Francisco General Hospital & Trauma Center (ZSFG), since they witnessed first-hand the difficulties that many of their colleagues and patients experienced when they had to turn to telehealth overnight. ZSFG is part of the San Francisco Health Network, where the survey was conducted, which also includes clinics run by the San Francisco Department of Public Health.

“That transition was so painful for many people: to find a new way to provide medical care,” said Anjana Sharma, assistant professor of family and community medicine at UCSF. “We were surprised to see that nine out of ten clinicians expressed comfort with providing care by phone and video.”

She said the team was also surprised at the concerns providers expressed over whether they could accurately diagnose patients remotely. Almost 60 per cent of those surveyed questioned the diagnostic safety of providing health care services over the telephone, and 35 per cent had those concerns about diagnosing on video.

And there were other problems. Some 44 per cent of clinicians reported that speech, hearing and cognitive barriers made telephone visits impractical. Significant portions also reported having patients who either did not have access to video (39 per cent) or had no phone at all (38 per cent), while 40 per cent reported seeing patients who had trouble setting up video access because of language or educational barriers, and 35 per cent reported patients without internet.

Still, more than 90 per cent of the clinicians surveyed said they planned to continue using phone and video to care for their patients after the Covid-19 pandemic ended.

For patients who can use the technology, particularly for follow-up care after a diagnosis has already been made, the benefits of telehealth are overwhelming. It saves time and money, especially for people who cannot easily get time off work to see the doctor or who may have childcare responsibilities. And for those with access to video at home, the technology can make it easier to include other family members.

“People have been talking about telemedicine forever, but this transformation would have never happened if not for the pandemic,” Sharma said. “It’s the reimbursement flexibility that drove this to be possible.” 

State and federal authorities are debating whether to lower or potentially eliminate payments for video and telephone visits that have been reimbursed at near similar levels to in-person visits throughout the public health emergency.

“We do believe that video visits are higher quality and are probably safer for patients,” Sharma said. “But we don’t want to leave anyone behind. We’re trying to say ‘both/and’. It makes sense to improve our video capacity for patients. But if telephone reimbursement goes away, that will be devastating for our patients.”

Other authors include Elaine Khoong, Courtney Lyles, Triveni Defries, Urmimala Sarkar, Delphine Tuot, Malini Nigagal, and George Su, all of UCSF.

• Telemedicine will save the healthcare industry globally $21bn in costs by 2025, rising from $11bn in 2021, according to a study by Juniper Research. This represents a growth rate of over 80% in the next four years.

The concept of telemedicine involves the remote provision of healthcare services and includes technologies such as teleconsultations, remote patient monitoring and chatbots.

The research identified teleconsultations, a service that enbles patients and physicians to interact remotely, as a key service that will enable these savings. However, it cautioned that savings would be restricted to developed nations where access to required devices and internet connectivity is prevalent. As a result, it predicted that over 80% of savings will be attributable to North America and Europe by 2025.

The report estimated that over 280 million teleconsultations were performed in 2019. However, this rose to 348 million in 2020, owing to the Covid-19 pandemic. It anticipated that the activities of third-party healthcare service developers will be crucial in accelerating the deployment of emerging telemedicine services, and increasing the uptake among healthcare providers.

However, the report predicted that the significant investment into integrating telemedicine services, and the requirement of data protection, such as Hipaa (Health Insurance Portability and Accountability Act) in the USA, will discourage adoption among smaller healthcare providers. To foster the adoption of telemedicine services, the report recommended that healthcare regulatory bodies continue to deregulate telemedicine services to reduce any remaining barriers to entry for smaller healthcare providers.

“Any deregulation must ensure that patient confidentiality is not undermined,” said research author Adam Wears. “Additionally, we recommend that innovative and emerging teleconsultation services are integrated into existing healthcare technologies, such as electronic health records, to maximise their benefits to healthcare providers.”