The concept of telehealth, delivery of health-related services via technology, can be tracked all the way to the late 1800s when an article published in 1879 by Lancet discussed using telephones to reduce unnecessary office visits.
 
Science and Invention magazine portrayed a doctor diagnosing a patient by radio in 1925, and likely one of the first adopters of telehealth was NASA, which used a home monitoring system during the Mercury space program to perform physiologic monitoring remotely, according to a report from the National Academy of Medicine.
 
Since then, though, telehealth has transcended from a novel notion to a full-fledged reality that saw a growth spurt during the coronavirus pandemic.
 
According to an impact study by the American Medical Association and the COVID-19 Healthcare Coalition – made up of more than 1,000 health care organizations, telehealth saw an increase in 2020 with the number of telehealth claims in the U.S. spiking to more than 12 million in April 2020. Since then, claims have decreased but continue to surpass pre-pandemic numbers with 8.8 million claims in December 2020 compared to about 480,000 claims in December 2019.
 
In North Carolina, there were about 10,000 telehealth claims in December 2019, compared to about 168,000 the same month in 2020.
 
The COVID-19 Telehealth Impact Study looks at the rapid growth of telehealth in the United States during the COVID-19 pandemic through claims data trends and surveys. It also explored physician and patient sentiment toward using telehealth.
 
The study found that among those surveyed, most physicians agreed or strongly agreed that telehealth enables them to deliver quality care for COVID-19, acute care, chronic disease and preventative care. They also agreed that telehealth has improved the health, safety and timeliness of care for their patients.
 

Physician Sentiment

 
When the COVID-19 pandemic set on in much of the world, many physicians experienced their first time delivering care via video connection, the study stated.
 
This was the case for Cecile Robes, a doctor of osteopathic medicine with Coastal Family Medicine at New Hanover Regional Medical Center.
 
“I have personally only worked with telehealth during the past year to year-and-a-half due to the pandemic,” Robes said. “I definitely have done many more telehealth visits during the pandemic, some of which I am continuing to this day.”
 
There are many advantages to using telehealth, Robes said.
 
“It is easily accessible for individuals who are moderately accomplished with technology, and for the most part, efficient, easy to schedule, no transportation issues, less uncomfortable for patients, and straightforward medical issues can be easily resolved,” she said.
 
Robes said telehealth works best for certain scenarios, such as for healthy people or people with well-controlled chronic diseases who have a severe or sudden issue and people with emotional or psychiatric concerns, among others.
 
Michelle Jones, a doctor and family medicine division chief with Wilmington Health, said about 95% of providers at Wilmington Health started using telehealth in March 2020.
 
For the local health care provider, however, plans to use telehealth began even before the beginning of COVID-19.
 
“Prior to the pandemic, telehealth was already part of our company’s strategic plan to better improve convenience and access to care for our patients,” said Desirae Hrynko, marketing manager for Wilmington Health. “At the start of the pandemic, it prompted us to go ahead and launch telehealth in under two days.”
 

Learning Curve

 
The process of adopting telehealth had some learning hurdles, with both patients and physicians having to navigate technical issues.
 
“(Telehealth) was complicated by the lack of internet access, technical difficulties with computers – including those at Wilmington Health – and helping patients to ‘get on’ the platforms,” Jones said. “However, we learned that for many health care needs, telehealth was a safe and efficient way to provide care to patients who were elderly and could not travel or leave homes safely, busy working and not able to leave to come into an office or unable to find child care to come to a visit.”
 
Despite the accessibility advantage of telemedicine, physicians agree that technology literacy is one of the major drawbacks.
 
In the AMA study, 64% of surveyed physicians said they foresee technology challenges for patients as barriers related to maintaining telehealth after COVID-19.
 
Robes said one of the cons to telehealth is that it may not be accessible for people who lack the technology tools or who are not tech savvy.
 
“It also has to do with the quality of the tech you have from the phone to the internet service,” Robes added. “Additionally, having the ability or support to correct digital issues in the middle of a telehealth visit can be daunting.”
 
Technology accessibility is the biggest disadvantage that Jones outlined for telehealth. “Not all patients have good internet or computers, phones with connectivity to the modern telehealth platforms,” she said.
 

‘Telehealth is Here to Stay’

 
Among those working on developing technologies for the health care industry is Wilmington-based Greenlight Ventures.
 
In 2020, the incubator announced that it had temporarily shifted all its focus to create Presence, a telemedicine solution that was developed in partnership with the N.C. Medical Society. Some of the actions that Presence can provide include patient self-scheduling, text and email-based communications, and audio/video visits between providers and patients.
 
With regard to technology literacy being one of the biggest obstacles of telehealth, Reynold Yordy, Greenlight co-founder and chief technology officer, said that adapting to new technologies is a hurdle in any industry and that the company has been addressing it with product development and resources.
 
“At Greenlight, we accompany all technology releases with training specialists and account managers upfront, visually clear and easy to follow, to ensure success in the process of user adaptation,” Yordy said. “With visibly clear means of accessibility, we also provide a resource section containing numerous manuals, videos and other assets to which users have easy access for answering questions and resolving problems.”
 
Greenlight officials believe that telehealth will continue to grow thanks to the common use of mobile devices and wide internet connectivity.
 
“With its ease of use and its universal accessibility, telehealth provides access to health care for patients without transportation or patients who live in rural areas,” Yordy said. “Telehealth is here to stay.”
 

Opening Barriers

 
Besides providing accessibility for patients, telemedicine has also opened traditional barriers of entry for certain providers who no longer require a physical office space to see patients.
 
In July 2020, registered dietitian Callan Wall opened Foods For Thought Nutrition Counseling with a virtual office, motivated by the increased use of telemedicine during the pandemic.
 
“Since this was amidst the pandemic and telehealth was becoming more widely accepted, I figured virtual would be a great option for my business model since many providers were already offering that,” Wall said. “Also, with overhead costs of renting an office space, this was a great option for me to work from home and save startup cost.”
 
One advantage Wall has noticed with a virtual office is her ability to see patients at varied hours and expand her services beyond the Wilmington region.
 
“I can work with clients who are located in any city in North Carolina, which ultimately allows me to support more people in their health journey,” she said. “There is also the possibility of offering group classes and group coaching, allowing access to more individuals across the state.”
 
As someone providing nutrition counseling with a focus on holistic health, telemedicine allows clients to be more comfortable during sessions because they are home, she said.
 
“I believe being in a familiar environment allows clients to more clearly envision themselves making changes in their lifestyles and health behaviors,” Wall said.
 

‘Silver Lining’

 
Overall, patients appear to have positive experiences with telehealth, according to the AMA study. The majority of patients surveyed said they were very satisfied with the care they received and that they would continue to use it in the future.
 
Additionally, they felt that the quality of patient-provider communication was good.
 
“Given this favorable, early experience with telehealth, we anticipate that telehealth will continue to be an integral component of healthcare in the months and years to come,” the study stated.
 
Despite all the outlined advantages of telehealth, some local providers are finding that an element that cannot be replaced is in-person human interaction.
 
“The biggest (limitation) is ‘touching your patient,’ in other words, the human element of holding someone’s hand when they are experiencing grief or an overwhelming medical problem and you can convey so much empathy with touch than you can with 100 words,” Robes said.
 
While the pandemic was the genesis for the growth in telemedicine that the country experienced over the past year, it seems that both patient and physician satisfaction with its use could make sure that the service is here to stay.
 
“For the right patient population and augmented at intervals by patient visits, I feel telehealth is the way medicine will be performed in the future,” Robes said.
 
“This has been a silver lining in a year of isolation,” Jones said. “Let’s continue to make health care accessible for all people.”