Applications of telehealth post-pandemic

It has been interesting to hear clinicians from various fields discuss the impact of the pandemic on the rehabilitation and treatment of patients at the 99th American Congress of Rehabilitation Medicine (ACRM) conference in Chicago.

It was, to some extent, technologically fortunate that the COVID-19 pandemic did not happen 20 or even 10 years ago. The use of telehealth has grown exponentially in the US in the last decade, supported by the proliferation of internet access, reliable high-speed broadband and access to smart devices. Thankfully, some of the infrastructure was therefore already in place when doctors, therapists and patient were faced with a new reality in 2020.

One provider described an ‘incidental’ silver-lining of the pandemic being the mass-adoption of remote medical and therapeutic provision. In a field such as physiotherapy, for example, the pandemic accelerated digital provision of treatment because it was the only option. The provider identified the following characteristics of early digital physical therapy adopters:

Those disinclined to go to the clinic.
Where there is a high consumer cost burden.
Geographic restrictions.
Schedule barriers (such as working hours restrictions or childcare limitations).

In the last 12 months, there has been something of a shift in attitude towards the remote provision of technology, treatment, and therapies. There appears to be an acceptance that both the traditional model of patient care and the telehealth model work better together and should not be mutually exclusive. Illustrating this point, one physical therapy provider offered what they called the ‘sandwich metaphor’ for treatment packages; in-person consultations at the beginning and end of a patient rehabilitation package, with virtual assessments/check-ins to maintain engagement and outcomes, along with intermittent in-person follow-ups depending on complexity and need.

However, there remain significant barriers to the implementation of telehealth, in particular: lack of acceptance and familiarity from clinicians, lack of familiarity with available technology from both clinicians and patients, access to reliable internet, patient dissatisfaction with use of the digital platform offering the particular service, difficulties with building rapport, an inability to manually assess and, of course, patient safety.

Whilst telehealth provision or even capability is far from prevalent in the US, there is a clear drive to encourage traditional participants in serious injury rehabilitation/multidisciplinary teams to engage, such as those practicing in occupational therapy, physiotherapy and speech and language therapy.

The desire to use telehealth in neurorehabilitation to reduce inpatient stays and reduce outpatient consultations remains more aspirational. One provider, however, described the current physiotherapy telehealth space as the “wild, wild west of players” – the concern being the lack of consistency in both the technology and treatment provided.

Unfortunately, reliable and extensive patient studies are scarce and what data there is focuses on efficacy of treatment, ensuring safety, and equivalency with traditional face-to-face treatment provision. There is also a lack of published guidance, training and support for remote intervention in areas such as neurorehabilitation.

The most obvious clinical benefit of telehealth is that is produces exponentially more data than a simple clinic visit. A smartphone contains and can make use of accelerometers, gyroscopes, GPS, microphones, cameras, timers, device interaction and metadata. Wearable technology and smart home technology allows objective data to be collected over an extended period of assessment, in combination with algorithms designed to analyse the data and provide further recommendations in conjunction with the oversight of an individual’s clinician.

Practical application in claims

The COVID-19 pandemic demonstrated the efficacy of telehealth in a wide range of fields from delivery of case management, to training of family and carers, to remote medical assessment.

Telehealth will continue to grow with opportunities to deploy telehealth options in claims. There are obvious deflationary gains, including significantly reduced travel costs, remote monitoring in place of human care, and reliable data output to measure real functional abilities and changes.

Many of the barriers to adoption of telehealth in a medical context also apply in a legal claims context. It is therefore important for lawyers and case handlers to be aware of the benefits of remote intervention and deployment of telehealth and technology solutions.

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