Barriers to Telehealth

Original Editor - Arnold Fredrick D'Souza Top Contributors - Arnold Fredrick D'Souza, Kim Jackson and Angeliki Chorti

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Introduction

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

Categories of barriers to telehealth practice

Most barriers can be categorized under the following:

Ethical

Due to widespread social media usage, there is generally a great awareness of data privacy and confidentiality issues associated with being online. These issues are more pressing when 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.

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 clinican's or organization's credentials before accepting or paying for any telehealth intervention.

Economical

Despite evidence to the contrary, the perceived cost is one of the important barriers that prevents the use of telehealth. This is more prominent in low-resource settings. Broadband expenses and the cost of telehealth equipment is a concern for most. 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.

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 need to be determined. In its absence, alternate means must be identified in consensus with the client prior to commencement.

Regulatory

Telehealth practice, depending on the country and state (as in the case of 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.

Socio-cultural

Prior to the COVID-19 pandemic, the general perception and attitude of clinicians and patients towards telehealth was usually negative to mixed. 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.

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. Broadband coverage and speeds are set to improve in the future. Furthermore, the rollout of 5G around the world will make telehealth easier due to the exponentially higher data transfer speeds. There has already been considerable improvement seen globally in the past decade. 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.