Barriers to Telehealth: Difference between revisions

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== Introduction ==
== Introduction ==
[[Introduction to Telehealth|Telehealth]] practice is increasing globally, partially in response to the sudden disruption brought upon by the [[Coronavirus Disease (COVID-19)|COVID-19]] pandemic.<ref>Seivert S, Badowski ME. The Rise of Telemedicine: Lessons from a Global Pandemic. INNOVATIONS. 2021 Feb.</ref> Telehealth usage is not without significant barriers<ref>Gajarawala SN, Pelkowski JN. Telehealth benefits and barriers. The Journal for Nurse Practitioners. 2021 Feb 1;17(2):218-21.</ref>, specific to the setting, which needs to be clearly identified beforehand and may necessitate the development of individualized strategies to address them appropriately.
[[Introduction to Telehealth|Telehealth]] practice is increasing globally, partially in response to the sudden disruption brought upon by the [[Coronavirus Disease (COVID-19)|COVID-19]] pandemic.<ref>Seivert S, Badowski ME. The Rise of Telemedicine: Lessons from a Global Pandemic. INNOVATIONS. 2021 Feb.</ref> Telehealth usage is not without significant barriers<ref>Gajarawala SN, Pelkowski JN. Telehealth benefits and barriers. The Journal for Nurse Practitioners. 2021 Feb 1;17(2):218-21.</ref>, specific to the setting, which needs to be identified beforehand and may necessitate the development of individualized strategies to address them appropriately.


== Categories of barriers to telehealth practice ==
== Categories of barriers to telehealth practice ==
Line 9: Line 9:


=== Ethical ===
=== Ethical ===
Due to widespread social media usage, there is generally a great awareness of data privacy and confidentiality issues associated with being online.<ref>Isaak J, Hanna MJ. User data privacy: Facebook, Cambridge Analytica, and privacy protection. Computer. 2018 Aug 14;51(8):56-9.</ref> These issues are especially important since it concerns health records and other private information related to treatment. These fears might discourage some from accepting telehealth as an alternative mode of availing healthcare services. Telehealth systems that incorporate data encryption and similar cyber-security measures must be employed.<ref>Hall JL, McGraw D. For telehealth to succeed, privacy and security risks must be identified and addressed. Health Affairs. 2014 Feb 1;33(2):216-21.</ref> Clinicians must seek informed consent from their clients before each telehealth consultation.  
Due to widespread social media usage, there is generally a great awareness of data privacy and confidentiality issues associated with being online.<ref>Isaak J, Hanna MJ. User data privacy: Facebook, Cambridge Analytica, and privacy protection. Computer. 2018 Aug 14;51(8):56-9.</ref> These issues are critical since it concerns health records and other private information related to treatment. These fears might discourage some from accepting telehealth as an alternative mode of availing healthcare services. Telehealth systems that incorporate data encryption and similar cyber-security measures must be employed.<ref>Hall JL, McGraw D. For telehealth to succeed, privacy and security risks must be identified and addressed. Health Affairs. 2014 Feb 1;33(2):216-21.</ref> Clinicians must seek informed consent from their clients before each telehealth consultation.  


=== Economical ===
=== Economical ===
Despite evidence to the contrary<ref>Kane A, Katebi C, Subramanian M. Telehealth Saves Money and Lives: Lessons From the COVID-19 Pandemic. 2021. The Progressive Policy Institute.</ref>, the perceived cost is one of the perceived barriers that prevent the use of telehealth. This is more prominent in low-resource settings. Investing in telehealth infrastructure such as broadband and other telehealth equipment in addition to personnel training is a concern for most.<ref>Jang-Jaccard J, Nepal S, Alem L, Li J. Barriers for delivering telehealth in rural Australia: a review based on Australian trials and studies. Telemedicine and e-Health. 2014 May 1;20(5):496-504.</ref> The costs can be minimized by selecting the most appropriate telehealth delivery methods for the intervention, setting, and population. For example, clinicians can use SMS or other asynchronous methods instead of real-time videoconferencing. The modern smartphone is a comparatively inexpensive and self-sufficient device for most telehealth use cases.<ref>Scott RE, Mars M. Telehealth in the developing world: current status and future prospects. Smart Homecare Technology and TeleHealth. 2015 Feb 2;3:25-37.</ref>
Despite evidence to the contrary<ref>Kane A, Katebi C, Subramanian M. Telehealth Saves Money and Lives: Lessons From the COVID-19 Pandemic. 2021. The Progressive Policy Institute.</ref>, the perceived cost is one of the perceived barriers that prevent the use of telehealth. This is more prominent in low-resource settings. Investing in telehealth infrastructure such as broadband and other telehealth equipment in addition to personnel training is a concern for most.<ref>Jang-Jaccard J, Nepal S, Alem L, Li J. Barriers for delivering telehealth in rural Australia: a review based on Australian trials and studies. Telemedicine and e-Health. 2014 May 1;20(5):496-504.</ref> The costs can be minimized by selecting the most appropriate telehealth delivery methods for the intervention, setting, and population. For example, clinicians can use SMS or other asynchronous methods instead of real-time videoconferencing. The modern smartphone is a comparatively inexpensive and self-sufficient device for most telehealth use cases.<ref>Scott RE, Mars M. Telehealth in the developing world: current status and prospects. Smart Homecare Technology and TeleHealth. 2015 Feb 2;3:25-37.</ref>


Another area of concern is billing and financial reimbursement for telehealth services. There might be guidance provided by the government or other regulatory body for billing for telehealth. Insurance coverage for telehealth services needs to be determined. In its absence, alternate means must be identified in consensus with the client prior to commencement.<ref name=":0">Baker DC, Bufka LF. Preparing for the telehealth world: Navigating legal, regulatory, reimbursement, and ethical issues in an electronic age. Professional Psychology: Research and Practice. 2011 Dec;42(6):405.</ref><ref>Gilman M, Stensland J. Telehealth and Medicare: payment policy, current use, and prospects for growth. Medicare & medicaid research review. 2013;3(4).</ref>
Another area of concern is billing and financial reimbursement for telehealth services. The government or other regulatory bodies might provide guidance for billing for telehealth. Insurance coverage for telehealth services needs to be determined. In its absence, alternate means must be identified in consensus with the client before commencement.<ref name=":0">Baker DC, Bufka LF. Preparing for the telehealth world: Navigating legal, regulatory, reimbursement, and ethical issues in an electronic age. Professional Psychology: Research and Practice. 2011 Dec;42(6):405.</ref><ref>Gilman M, Stensland J. Telehealth and Medicare: payment policy, current use, and prospects for growth. Medicare & medicaid research review. 2013;3(4).</ref>


=== Regulatory ===
=== Regulatory ===
Telehealth practice, depending on the country and state (as in the case of the United States of America), may be under the purview of the law of the land. Clinicians may need to obtain the mandated licence and meet other legal requirements as stipulated by law. In countries without clear legal requirements, the presiding professional body may have set certain guidelines in place that may assist clinicians in setting up their practice. The law may also impose strict data privacy requirements for patient safety.<ref name=":0" />
Depending on the country and state (as in the case of the United States of America), telehealth practice may be under the purview of the land law. Clinicians may need to obtain the mandated licence and meet other legal requirements as stipulated by law. In countries without clear legal requirements, the presiding professional body may have set certain guidelines in place that may assist clinicians in setting up their practice. The law may also impose strict data privacy requirements for patient safety.<ref name=":0" />


On the other hand, the internet could also enable quacks and other bad actors to defraud people for telehealth services. Patients should be educated to look up their service providers' credentials before accepting or paying for any telehealth intervention.<ref>Canady VA. Survey finds telehealth services raise the potential for fraud. Mental Health Weekly. 2020 Nov 9;30(43):3-4.</ref>
On the other hand, the internet could also enable quacks and other bad actors to defraud people for telehealth services. Patients should be educated to look up their service providers' credentials before accepting or paying for any telehealth intervention.<ref>Canady VA. Survey finds telehealth services raise the potential for fraud. Mental Health Weekly. 2020 Nov 9;30(43):3-4.</ref>


=== Socio-cultural ===
=== Socio-cultural ===
Prior to the COVID-19 pandemic, the general perception and attitude of clinicians and patients towards telehealth was usually negative to mixed, probably motivated in part by the perceived lack of contact.<ref>Sahin E, Kefeli U, Cabuk D, Ozden E, Cakmak Y, Kaypak MA, Seyyar M, Uygun K. Perceptions and acceptance of telemedicine among medical oncologists before and during the COVID-19 pandemic in Turkey. Support Care Cancer. 2021 Dec;29(12):7497-7503.</ref><ref>Holtz BE. Patients perceptions of telemedicine visits before and after the coronavirus disease 2019 pandemic. Telemedicine and e-Health. 2021 Jan 1;27(1):107-12.</ref> Although the acceptability might have increased after the pandemic, certain populations, especially in rural settings might still express concerns about the use of telehealth for their healthcare needs. Increasing awareness through education can help mitigate these concerns.<ref>Alexander DS, Kiser S, North S, Roberts CA, Carpenter DM. Exploring community members' perceptions to adopt a Tele-COPD program in rural counties. Exploratory Research in Clinical and Social Pharmacy. 2021 Jun 1;2:100023.</ref>
Before the COVID-19 pandemic, clinicians and patients' general perception and attitude towards telehealth were usually negative to mixed, probably motivated in part by the perceived lack of contact.<ref>Sahin E, Kefeli U, Cabuk D, Ozden E, Cakmak Y, Kaypak MA, Seyyar M, Uygun K. Perceptions and acceptance of telemedicine among medical oncologists before and during the COVID-19 pandemic in Turkey. Support Care Cancer. 2021 Dec;29(12):7497-7503.</ref><ref>Holtz BE. Patients perceptions of telemedicine visits before and after the coronavirus disease 2019 pandemic. Telemedicine and e-Health. 2021 Jan 1;27(1):107-12.</ref> Although the acceptability might have increased after the pandemic, certain populations, especially in rural settings, might still express concerns about the use of telehealth for their healthcare needs. Increasing awareness through education can help mitigate these concerns.<ref>Alexander DS, Kiser S, North S, Roberts CA, Carpenter DM. Exploring community members' perceptions to adopt a Tele-COPD program in rural counties. Exploratory Research in Clinical and Social Pharmacy. 2021 Jun 1;2:100023.</ref>


=== Technological ===
=== Technological ===
These are usually associated with the technological requirements for conducting telehealth. They may include lack of broadband coverage or low bandwidth, lack of user-friendly telehealth hardware or software, and poor digital literacy.<ref>Triana AJ, Gusdorf RE, Shah KP, Horst SN. Technology literacy as a barrier to telehealth during COVID-19. Telemedicine and e-Health. 2020 Sep 1;26(9):1118-9.</ref> Broadband coverage and speeds are set to improve in the near future. The rollout of 5G around the world will make telehealth easier due to the exponentially higher data transfer speeds.<ref>Siriwardhana Y, De Alwis C, Gür G, Ylianttila M, Liyanage M. The fight against the COVID-19 pandemic with 5G technologies. IEEE Engineering Management Review. 2020 Aug 18;48(3):72-84.</ref> Globally, there has already been considerable improvement in internet accessibility in the past decade. Although, developing countries still have a long way to go in contrast to the rest of the world.<ref>Poushter J. Internet access growing worldwide but remains higher in advanced economies. Pew Research Center Global Attitudes and Trends.</ref> Clinicians must collaborate with engineers and designers must develop telehealth devices and software applications keeping in mind the needs of the target population. Poor digital literacy can be overcome with good design, besides patient education.<ref>Pires G, Lopes A, Correia P, Almeida L, Oliveira L, Panda R, et al. Usability of a telehealth solution based on TV interaction for the elderly: the VITASENIOR-MT case study. Universal Access in the Information Society. 2022 Jan 17:1-2.</ref>
These are usually associated with the technological requirements for conducting telehealth. They may include lack of broadband coverage or low bandwidth, lack of user-friendly telehealth hardware or software, and poor digital literacy.<ref>Triana AJ, Gusdorf RE, Shah KP, Horst SN. Technology literacy as a barrier to telehealth during COVID-19. Telemedicine and e-Health. 2020 Sep 1;26(9):1118-9.</ref> Broadband coverage and speeds are set to improve soon. The rollout of 5G worldwide will make telehealth easier due to the exponentially higher data transfer speeds.<ref>Siriwardhana Y, De Alwis C, Gür G, Ylianttila M, Liyanage M. The fight against the COVID-19 pandemic with 5G technologies. IEEE Engineering Management Review. 2020 Aug 18;48(3):72-84.</ref> Globally, there has already been considerable improvement in internet accessibility in the past decade. Although, developing countries still have a long way to go in contrast to the rest of the world.<ref>Poushter J. Internet access is growing worldwide but remains higher in advanced economies. Pew Research Center Global Attitudes and Trends.</ref> Clinicians must collaborate with engineers, and designers must develop telehealth devices and software applications keeping in mind the needs of the target population. Poor digital literacy can be overcome with good design, besides patient education.<ref>Pires G, Lopes A, Correia P, Almeida L, Oliveira L, Panda R, et al. Usability of a telehealth solution based on TV interaction for the elderly: the VITASENIOR-MT case study. Universal Access in the Information Society. 2022 Jan 17:1-2.</ref>


{{#ev:youtube|pOjXJ5ASIhw}}
{{#ev:youtube|pOjXJ5ASIhw}}
<ref>MedBridge. Removing Patient Barriers to Telehealth - Jared Vagy | MedBridge [Internet]. Youtube.com. 2020 [cited 2 February 2022]. Available from: <nowiki>https://www.youtube.com/watch?v=pOjXJ5ASIhw</nowiki></ref>
<ref>MedBridge. Removing Patient Barriers to Telehealth - Jared Vagy | MedBridge [Internet]. Youtube.com. 2020 [cited 2 February 2022]. Available from: <nowiki>https://www.youtube.com/watch?v=pOjXJ5ASIhw</nowiki></ref>


This video discusses the barriers to telehealth practice and suggests two methods to overcome them. First, it suggests discussing the benefits of telehealth with the client. Secondly a it describes a process called 'shared informed decision-making' as a possible solution to make a decision on telehealth for your client. It offers a paper by [https://dx.doi.org/10.1007%2Fs11606-012-2077-6 Elwyn et al.] <ref>Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, et al. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017 Nov 6;359:j4891.</ref>as reference material for the same.
This video discusses the barriers to telehealth practice and suggests two methods to overcome them. First, it suggests discussing the benefits of telehealth with the client. Secondly, it describes a process called 'shared informed decision-making' as a possible solution to decide telehealth for your client. It offers a paper by [https://dx.doi.org/10.1007%2Fs11606-012-2077-6 Elwyn et al.] <ref>Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, et al. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017 Nov 6;359:j4891.</ref>as reference material for the same.


== References ==
== References ==
<references />
<references />
[[Category:Telehealth]]
[[Category:Telehealth]]

Revision as of 06:38, 2 February 2022

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (2/02/2022)

Introduction[edit | edit source]

Telehealth practice is increasing globally, partially in response to the sudden disruption brought upon by the COVID-19 pandemic.[1] Telehealth usage is not without significant barriers[2], specific to the setting, which needs to be identified beforehand and may necessitate the development of individualized strategies to address them appropriately.

Categories of barriers to telehealth practice[edit | edit source]

Most barriers can be categorized under the following:

Ethical[edit | edit source]

Due to widespread social media usage, there is generally a great awareness of data privacy and confidentiality issues associated with being online.[3] These issues are critical since it concerns health records and other private information related to treatment. These fears might discourage some from accepting telehealth as an alternative mode of availing healthcare services. Telehealth systems that incorporate data encryption and similar cyber-security measures must be employed.[4] Clinicians must seek informed consent from their clients before each telehealth consultation.

Economical[edit | edit source]

Despite evidence to the contrary[5], the perceived cost is one of the perceived barriers that prevent the use of telehealth. This is more prominent in low-resource settings. Investing in telehealth infrastructure such as broadband and other telehealth equipment in addition to personnel training is a concern for most.[6] The costs can be minimized by selecting the most appropriate telehealth delivery methods for the intervention, setting, and population. For example, clinicians can use SMS or other asynchronous methods instead of real-time videoconferencing. The modern smartphone is a comparatively inexpensive and self-sufficient device for most telehealth use cases.[7]

Another area of concern is billing and financial reimbursement for telehealth services. The government or other regulatory bodies might provide guidance for billing for telehealth. Insurance coverage for telehealth services needs to be determined. In its absence, alternate means must be identified in consensus with the client before commencement.[8][9]

Regulatory[edit | edit source]

Depending on the country and state (as in the case of the United States of America), telehealth practice may be under the purview of the land law. Clinicians may need to obtain the mandated licence and meet other legal requirements as stipulated by law. In countries without clear legal requirements, the presiding professional body may have set certain guidelines in place that may assist clinicians in setting up their practice. The law may also impose strict data privacy requirements for patient safety.[8]

On the other hand, the internet could also enable quacks and other bad actors to defraud people for telehealth services. Patients should be educated to look up their service providers' credentials before accepting or paying for any telehealth intervention.[10]

Socio-cultural[edit | edit source]

Before the COVID-19 pandemic, clinicians and patients' general perception and attitude towards telehealth were usually negative to mixed, probably motivated in part by the perceived lack of contact.[11][12] Although the acceptability might have increased after the pandemic, certain populations, especially in rural settings, might still express concerns about the use of telehealth for their healthcare needs. Increasing awareness through education can help mitigate these concerns.[13]

Technological[edit | edit source]

These are usually associated with the technological requirements for conducting telehealth. They may include lack of broadband coverage or low bandwidth, lack of user-friendly telehealth hardware or software, and poor digital literacy.[14] Broadband coverage and speeds are set to improve soon. The rollout of 5G worldwide will make telehealth easier due to the exponentially higher data transfer speeds.[15] Globally, there has already been considerable improvement in internet accessibility in the past decade. Although, developing countries still have a long way to go in contrast to the rest of the world.[16] Clinicians must collaborate with engineers, and designers must develop telehealth devices and software applications keeping in mind the needs of the target population. Poor digital literacy can be overcome with good design, besides patient education.[17]

[18]

This video discusses the barriers to telehealth practice and suggests two methods to overcome them. First, it suggests discussing the benefits of telehealth with the client. Secondly, it describes a process called 'shared informed decision-making' as a possible solution to decide telehealth for your client. It offers a paper by Elwyn et al. [19]as reference material for the same.

References[edit | edit source]

  1. Seivert S, Badowski ME. The Rise of Telemedicine: Lessons from a Global Pandemic. INNOVATIONS. 2021 Feb.
  2. Gajarawala SN, Pelkowski JN. Telehealth benefits and barriers. The Journal for Nurse Practitioners. 2021 Feb 1;17(2):218-21.
  3. Isaak J, Hanna MJ. User data privacy: Facebook, Cambridge Analytica, and privacy protection. Computer. 2018 Aug 14;51(8):56-9.
  4. Hall JL, McGraw D. For telehealth to succeed, privacy and security risks must be identified and addressed. Health Affairs. 2014 Feb 1;33(2):216-21.
  5. Kane A, Katebi C, Subramanian M. Telehealth Saves Money and Lives: Lessons From the COVID-19 Pandemic. 2021. The Progressive Policy Institute.
  6. Jang-Jaccard J, Nepal S, Alem L, Li J. Barriers for delivering telehealth in rural Australia: a review based on Australian trials and studies. Telemedicine and e-Health. 2014 May 1;20(5):496-504.
  7. Scott RE, Mars M. Telehealth in the developing world: current status and prospects. Smart Homecare Technology and TeleHealth. 2015 Feb 2;3:25-37.
  8. 8.0 8.1 Baker DC, Bufka LF. Preparing for the telehealth world: Navigating legal, regulatory, reimbursement, and ethical issues in an electronic age. Professional Psychology: Research and Practice. 2011 Dec;42(6):405.
  9. Gilman M, Stensland J. Telehealth and Medicare: payment policy, current use, and prospects for growth. Medicare & medicaid research review. 2013;3(4).
  10. Canady VA. Survey finds telehealth services raise the potential for fraud. Mental Health Weekly. 2020 Nov 9;30(43):3-4.
  11. Sahin E, Kefeli U, Cabuk D, Ozden E, Cakmak Y, Kaypak MA, Seyyar M, Uygun K. Perceptions and acceptance of telemedicine among medical oncologists before and during the COVID-19 pandemic in Turkey. Support Care Cancer. 2021 Dec;29(12):7497-7503.
  12. Holtz BE. Patients perceptions of telemedicine visits before and after the coronavirus disease 2019 pandemic. Telemedicine and e-Health. 2021 Jan 1;27(1):107-12.
  13. Alexander DS, Kiser S, North S, Roberts CA, Carpenter DM. Exploring community members' perceptions to adopt a Tele-COPD program in rural counties. Exploratory Research in Clinical and Social Pharmacy. 2021 Jun 1;2:100023.
  14. Triana AJ, Gusdorf RE, Shah KP, Horst SN. Technology literacy as a barrier to telehealth during COVID-19. Telemedicine and e-Health. 2020 Sep 1;26(9):1118-9.
  15. Siriwardhana Y, De Alwis C, Gür G, Ylianttila M, Liyanage M. The fight against the COVID-19 pandemic with 5G technologies. IEEE Engineering Management Review. 2020 Aug 18;48(3):72-84.
  16. Poushter J. Internet access is growing worldwide but remains higher in advanced economies. Pew Research Center Global Attitudes and Trends.
  17. Pires G, Lopes A, Correia P, Almeida L, Oliveira L, Panda R, et al. Usability of a telehealth solution based on TV interaction for the elderly: the VITASENIOR-MT case study. Universal Access in the Information Society. 2022 Jan 17:1-2.
  18. MedBridge. Removing Patient Barriers to Telehealth - Jared Vagy | MedBridge [Internet]. Youtube.com. 2020 [cited 2 February 2022]. Available from: https://www.youtube.com/watch?v=pOjXJ5ASIhw
  19. Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, et al. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017 Nov 6;359:j4891.