The Benefits and Limitations of Telehealth

The Benefits and Limitations of
Telehealth
US Pharm. 2021;46(8):5-8.
Telemedicine, a subset of telehealth, is defined as the distribution of health-related

information between a provider and patient via telecommunication technologies.
While telehealth refers to remote nonclinical services, telemedicine refers to remote
clinical services. The major goal of telemedicine is to improve a patient’s clinical
health status. Telemedicine requires audio and visual components and can be provided
either in real time as live, two-way audiovisual interactions between patients and
providers (synchronous telemedicine) or by storing and forwarding data and images
for use at a different time (asynchronous telemedicine).1
Recently, telemedicine has gained popularity with patients due to ease of use,
decreased cost, and decreased travel time. However, it also has several limitations,
which will be discussed later.1
Before a telemedicine visit, providers should anticipate and manage patient

expectations, and ensure that the technology required for a successful telemedicine
visit is working and accessible. Key points include confirming technological
requirements, obtaining consent, discussing reimbursement and copay responsibilities,
and discussing privacy expectations.2
Since its first appearance in the late 1950s, telemedicine has contributed to seniors
having the choice to age at home. In addition, patients residing in rural areas who
previously had difficulties accessing a physician can reach physicians virtually.2
Modern technology has enabled physicians to consult patients through HIPAA-
compliant videoconferencing tools, providing care, advice, reminders, education,
intervention, monitoring, and remote admissions to their patients.2
It is worth mentioning that the concept of telemedicine and telehealth is still new to
some providers. However, continuing advances in technology and healthcare
innovation have greatly expanded its usability. Moreover, the demand from younger
and more tech-savvy generations has pushed for rapid adoption.2
Benefits of Telemedicine
There are three common types of telemedicine, shown in SIDEBAR 1. The early use
of telemedicine focused primarily on urgent-care issues, particularly acute respiratory
or urinary tract infections. However, telemedicine is now being more broadly used for
a variety of applications, from specialty care to chronic disease management.4
Patients in rural areas can benefit from expanding telemedicine services in both
primary care and specialty consultative care. In primary care, telemedicine encounters
can be utilized for a variety of visits. The video component may provide important
clinical information beyond what can be ascertained through a telephone call or
through electronic messaging. Telemedicine visits may also be used for medicine
reconciliation appointments, substance-use disorder treatment, and form completion
(e.g., return to work or school paperwork).4
In addition, information from remote patient monitoring equipment (e.g., glucometers,

blood pressure monitors, scales, oximeters, noninvasive ventilation equipment for
sleep apnea) can be uploaded and transmitted to a provider, or in some cases, providers
can communicate with the patient’s electronic medical record automatically. The
provider can use this information to monitor and adjust therapy, including medication
changes and behavioral-modification advice.4
Just as telemedicine can be used in primary care, it is also beneficial for specialty-care
management. Telemedicine is being used in cardiology, endocrinology, hepatology,
nephrology, neurology, pediatrics, and surgical perioperative care management.4
Traditionally, the principle of telemedicine in specialty care has centered around
patient self-empowerment to improve health and prevent disease exacerbations.
The use of telemedicine in chronic diabetes mellitus management is well established.

Several studies highlight the benefits of telemedicine interventions for diabetes care,
and many incorporate several care modalities, ranging from teleconsultation to
remote-patient monitoring.5,6
In patients with chronic heart failure, telemonitoring is used to predict and prevent
acute decompensation episodes by tracking symptoms that require optimization of
therapy.7
In heart failure patients with implantable cardioverter-defibrillators, telemonitoring

combined with scheduled in-person visits can reduce healthcare utilization as well as
acute-care visits.7
Telemental health services have been a rapidly growing area, particularly in areas with
shortages of in-person mental healthcare. Individuals with mental health disorders are
generally able to participate effectively in telemedicine encounters, and telemedicine
visits may be used for capacity evaluations and management of mood disorders and
psychoses.7
Importantly, when in-person visits need to be minimized, telemedicine encounters can

substitute for a range of in-person appointments, increasing the range of applications
of virtual care.7 As an example, telemedicine is being used to evaluate patients with
known or suspected COVID-19. Remote management of these patients can prevent
unnecessary in-person medical visits, including visits to primary care providers, urgent
care facilities, and emergency departments, avoiding additional, unnecessary strain on
an already overburdened and overwhelmed healthcare system (including utilization of
limited resources, especially personal protective equipment).8 This can be helpful in
the management of some infectious diseases to minimize the risk of infection
transmission and other potential high-risk exposures.8
During the COVID-19 pandemic, telemedicine has been particularly helpful for
chronic disease management by allowing continuity of care for high-risk populations
while allowing for social distancing and reducing the risk for exposure to infection.8
Limitations of Telemedicine
Telemedicine visits are not a complete substitute for in-person visits; nor they are
feasible for all patients or clinical situations. For example, technology does not always
work smoothly, and technical difficulties may interfere with delivery of care. A
significant limitation is the inability to conduct an in-person physical examination.
Inaccurate dosing of weight-based drugs (e.g., chemotherapy treatments, pediatric
medications) may occur due to the inability to weigh patients.5-7,9
In addition, patient and provider perceptions and experiences may differ from those
experienced during an in-person visit; it is essential to be aware of these potential
differences. Many traditional office elements, such as touch, physical presence, and
emotional connection, can be restricted by digital technologies. Some patients may
have no prior experience with video visits and prefer in-person visits over video visits.
Similar preferences for in-person interactions have been noted in specialty care
services.5-7,9
Telemedicine visits may not be appropriate or feasible for all patients or all clinical
situations; therefore, the clinician must use telemedicine services appropriately for
care to be delivered effectively and accurately. The “digital divide” can create
potential disparities in access to participation to telemedicine, including for those
living in rural areas with limited Internet access, older adults, and those with diverse
cultural settings and socioeconomics.5-7,9
Even among individuals with adequate Internet access, it is important to clarify their
comfort level with conducting a telemedicine visit; their Internet access may be
limited to a public location or may incur significant monetary costs due to data
charges. Older adults may have difficulty accessing telemedicine services due to
inexperience with technology or physical disabilities.5-7,9
Data from Europe suggest that home Internet use and Web access among older
individuals vary widely among nations, with older individuals being more inclined to
use computers rather than mobile phones for telehealth access; mobile phones were
preferred among younger individuals and were more accessible to lower-income
populations.5-7,9
Despite these limitations, many patients continue to favor telemedicine modalities for
their ease of use, cost-savings, and decrease in travel time.
Appropriateness of the Telemedicine Visit

Not all patients or clinical situations are appropriate for telemedicine evaluation.
Examples include situations where patients are unable to have a private conversation,
patients lack decision-making capacity, or an in-person physical examination is
anticipated to yield information essential for clinical decision-making (e.g., chest pain
or digital test for male’s prostate).7,10
The provider must consider whether a patient lacks decision-making capacity (e.g.,
children, older adults with dementia, or individuals with severe cognitive or mental
health disorders), as consent for the telemedicine visit is required. As with any other
visit for such patients, having the person with decision-making authority available to
conduct a telemedicine encounter and for treatment decisions is required.7,10
In addition, some patients, particularly some older adults, may not know enough
technology, and telemedicine visits may be difficult to arrange for such patients. Older
patients may have hearing or visual impairment that can make telemedicine visits
challenging.7,10
Some individuals with disabilities may require adaptive equipment to allow a

successful telemedicine encounter. An example might be the inclusion of a sign-
language interpreter to assist individuals who are hard of hearing.7,10
As with in-person visits, interpreter services should be provided for patients in whom
there is a language incongruence with the provider. Increasingly, video software
platforms can accommodate multiple participants, which can enable participation of an
interpreter to assist with the encounter.7,10
The content contained in this article is for informational purposes only. The content is
not intended to be a substitute for professional advice. Reliance on any information
provided in this article is solely at your own risk.
REFERENCES
1. Mermelstein H, Guzman E, Robinowitz T, et al. The application of technology to

health: the evolution of telephone to telemedicine and telepsychiatry: a historical
review and look at human factors. J Technol Behav Sci. 2017;2:5-20.
2. Weinstein RS, Lopez AM, Joseph BA, et al. Telemedicine, telehealth, and mobile
health applications that work: opportunities and barriers. Am J Med. 2014;127:183-
187.
3. Office of the National Coordinator for Health Information Technology. What is
telehealth? How is telehealth different from telemedicine? www.healthit.gov/faq/what-
telehealth-how-telehealth-different-telemedicine. Accessed May 26, 2021.
4. Liaw WR, Jetty A, Coffman M, et al. Disconnected: a survey of users and nonusers
of telehealth and their use of primary care. J Am Med Inform Assoc. 2019;26:420-428.
5. Lee JY, Lee SWH. Telemedicine cost-effective for diabetes management: a
systematic review. Diabetes Technol Ther. 2018;20;492.
6. Dorsey ER, Topol EJ. State of telehealth. N Engl J Med. 2016;375:154-161.
7. Ong MK, Pfeffer M, Mullur SR. Telemedicine for adults. www.UptoDate.com
2020. Accessed May 2021.
8. Ramirez AV, Ojeaga M, Espinoza V, et al. Telemedicine in minority and
scocioecnomically disadvantaged communities amidst COVID-19 pandemic.
Otolaryngol Head Neck Surg. 2021;164:91-92.
9. Nieman CL, Oh ES. Connecting with older adults via telemedicine. Ann Intern
Med. 2020;173:831-832.
10. Croymans D, Hurst I, Han M. Telehealth: the right care, at the right time, via the
right medium. NEJM Catalyst. 2020. Accessed July 23, 2021.
To comment on this article, contact rdavidson@uspharmacist.com.
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What are the three common types of telemedicine?

What are some benefits of using telemedicine for specialty care?

The Benefits and Limitations of

Telemedicine, a subset of telehealth, is defined as the distribution of health-related

Before a telemedicine visit, providers should anticipate and manage patient

In addition, information from remote patient monitoring equipment (e.g., glucometers,

The use of telemedicine in chronic diabetes mellitus management is well established.

In heart failure patients with implantable cardioverter-defibrillators, telemonitoring

Importantly, when in-person visits need to be minimized, telemedicine encounters can

Appropriateness of the Telemedicine Visit

Some individuals with disabilities may require adaptive equipment to allow a

1. Mermelstein H, Guzman E, Robinowitz T, et al. The application of technology to

To comment on this article, contact rdavidson@uspharmacist.com.

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