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The use of telehealth in healthcare has grown exponentially since the onset of the COVID-19 pandemic. From 2019 to 2021, the use of telehealth technology increased for office-based physicians from 15.4% to 85.9%. In 2021, approximately one-third of all Americans had completed a telehealth visit. The landscape shifted dramatically during the pandemic as healthcare systems pivoted to care solutions not requiring in-person interactions. This accelerated the understanding of patients, providers, and health systems about what could be accomplished with telehealth. Today, patients expect to be able to choose telehealth as a part of their healthcare. The evidence to support telehealth as a replacement versus an adjunct to in-person care is beginning to be established for clinical specialties outside of mental health, where its role is firmly established.
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This chapter covers core approaches for successfully engaging in telehealth. As in any area of medicine, clinical judgement for when telehealth is an appropriate modality is necessary. Many medical issues can be addressed by telehealth without additional equipment. More sophisticated tools for remote physical exams by telehealth (eg, using a digital stethoscope or otoscope) can be helpful for certain specialties or where a comprehensive remote exam is needed. The wide array of issues that can be readily addressed without tele-specific equipment will be discussed here. Organ-based telehealth tips for equipment-free examinations have been embedded into the end of most chapters of this book. Any urgent or emergent clinical issues identified during a telehealth visit should be rapidly transitioned to a plan for in-person assessment.
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Telehealth involves the use of technology and telecommunication for the purposes of delivering healthcare by a clinician located remotely from a patient. The American Telehealth Association defines telehealth as “a mode of delivering healthcare services through the use of telecommunications technologies, including but not limited to asynchronous and synchronous technology, and remote patient monitoring technology, by a healthcare practitioner to a patient or a practitioner at a different physical location than the healthcare practitioner.” However, definitions vary according to the source and no single authority exists. Perhaps the broadest definition is 25 USC § 1603, which defines telehealth as “the use of electronic information and telecommunications technologies to support long distance clinical health care, patient and professional health-related education, public health, and health administration.”
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The simplest and likely oldest example of telehealth is that of telephone-based care, but 2-way audiovisual care has existed since the advent of television in the early 1960s. With modern technology, a wide array of care can be delivered. For example, a clinician may complete an assessment for joint pain by video when their patient is at home, while a dermatologist can offer gap coverage to a distant facility, reviewing images taken of a suspicious mole and imparting a likely diagnosis. Of note, remote communications between healthcare providers where the consultant does not engage in direct patient care or ...