1. Frith, Karen H.

Article Content

Telehealth/medicine applications include a wide range of services for health, including remote home monitoring, delivery of patient care, consultation, mHealth devices, health consultation, and education. When the COVID-19 pandemic spread into the United States, the Centers for Medicare & Medicaid Services (CMS) allowed CMS-approved health care providers to bill for telehealth services regardless of where providers and patients were located (Health Resources & Services Administration [HRSA], 2020a). This emergency regulation, along with public health advice to mitigate exposure to the virus, dramatically increased the use of telehealth services (Castellucci, 2020).


Press Ganey, a vendor for administering Hospital Consumer Assessment, distributed 23,000 telehealth surveys in the second quarter of 2019; in the second quarter of 2020, the company administered nearly 20 million surveys (Press Ganey, 2020). The massive growth was a function of necessity, but there are lessons to learn from the sudden, widespread use of telehealth, such as the need to improve technology infrastructure and the patient experience.



Providers turned to videoconferencing as the leading telehealth option because of its ability to mimic office visits (Press Ganey, 2020); however, many providers found bandwidth a problem. The federal government recommends speeds between 4 Mbps for single-provider offices and 25 Mbps for multiprovider offices (HRSA, 2020b). Lack of broadband Internet is even more problematic on the patient side (Zhai, 2020). Attention to health disparities is a critical and complicated factor in building a robust telehealth infrastructure (Cooper, 2020).


Other infrastructure needs include the use of Food and Drug Administration-approved digital medical equipment and imaging devices to promote focused physical exams (HRSA, 2020c). Meeting the technical standards for telehealth is complex and requires HIPAA-compliant security standards, firewalls, end-to-end encryption, device-to-device connectivity, and redundancy in critical systems (HRSA, 2020c). Providers can manage few of these technical standards, so it is imperative to have available, dependable, and capable technical support staff (HRSA, 2020c).



With access to telehealth medical care during the pandemic, the patient experience was varied. A report released by Press Ganey (2020) showed an interesting dynamic among patient age, satisfaction with provider, and perception of technology. Young adult patients (ages 18 to 34 years) had the lowest ratings of satisfaction with the provider and their experience with the technology. They rated the ease of scheduling appointments the highest among all age groups. Patients ages 35 to 64 years rated their satisfaction with providers higher than the young adults, and they were slightly more satisfied with the technology. Patients 65 years and older had the reverse experience: They were satisfied with their providers but not the ease of making appointments and using the technology.


The results from the Press Ganey report give important clues to needed improvements in the patient experience. Young adults need more connection with their providers through telehealth, and the technology needs to be "familiar" to them. Telehealth applications need to adhere to universal design principles so the interface is easy and feels like current applications. Older adults typically have established relationships but are more limited than younger patients in their ability to overcome technology barriers.



Telehealth, as it exists, is limited: low bandwidth on the provider side, low bandwidth or no access on the patient side, low uptake of mHealth-connected devices, limited use of home monitoring systems, and complicated user interfaces. Prudent investment in technology infrastructure and attention to the patient experience could make telehealth a mainstream delivery modality for health care beyond the pandemic.




Castellucci M. (2020). Fine-tuning telehealth. Modern Healthcare, 50(37), 20. [Context Link]


Cooper T. (2020, April 6). Widespread telehealth adoption in rural communities requires widespread broadband availability. Broadband Now.[Context Link]


Health Resources & Services Administration. (2020a). Billing and reimbursement during the COVID-19 public health emergency.[Context Link]


Health Resources & Services Administration. (2020b). What is the recommended bandwidth for different types of health care providers?[Context Link]


Health Resources & Services Administration. (2020c). What are the technical infrastructure requirements of telehealth?[Context Link]


Press Ganey. (2020, May 19). The rapid transition to telemedicine: Insights and early trends.[Context Link]


Zhai Y. (2020). A call for addressing barriers to telemedicine: Health disparities during the COVID-19 pandemic. Psychotherapy and Psychosomatics, 1-3. [Context Link]