Telehealth
Loren Bonner
Health experts can agree that one of the silver linings of the COVID-19 pandemic is the way it has propelled telehealth forward.
An analysis from Frost and Sullivan found that telehealth visits increased 50% in March, and a recent poll from a large market research firm found that more than one in eight Americans engaged in a video consult with a health professional in a recent month.
“Telehealth has been absolutely essential for the response to COVID in managing it both at home and in hospitals, but it has also been absolutely essential to provide continued access to health care for non-COVID patients,” said Dana Lichtenberg, assistant director of congressional affairs at the American Medical Association (AMA), during a May webinar on telehealth from the Brookings Institute. She added that the aggressive rollout of telehealth over the past few months normally would have taken 3 to 5 years to complete.
Like other health professionals, some pharmacists have had to make a quick transition to telehealth.
While the landscape for telehealth is still evolving, this article, the first in a series, will cover the basics of what pharmacists need to know about telehealth.
What is telehealth?
Telehealth is a broad term that refers to an array of remote health care services, which can include clinical as well as nonclinical services, monitoring of vitals, health education, and more.
Telemedicine comes under telehealth, but it refers to remote clinical services. Typically, telemedicine services are administered by physicians, while telehealth can be provided by a wide range of health professionals, “such as nurses, pharmacists, and others,” according to the World Health Organization.
What is telepharmacy?
By definition, telepharmacy is the delivery of pharmacy care via telecommunication to patients in locations where they may not have direct contact with a pharmacist. Just like telemedicine has been essential during the COVID-19 crisis, the same can be said for telepharmacy.
“Pharmacists are a great resource for patients who have questions about drug interactions, vaccines, and testing. Telepharmacy allows those conversations to happen in a safer way, with patients located in the comfort of their home, keeping the public and pharmacists safe,” said Sandra Leal, PharmD, MPH, FAPhA, CDE, who is Tabula Rasa HealthCare executive vice president of SinfoniaRx and APhA president-elect.
Making the transition to telehealth
Telehealth has allowed some ambulatory care pharmacists, like Courtney Doyle-Campbell, PharmD, to continue working with patients during the pandemic. Along with her primary care colleagues in the Springfield, MA, hypertension clinic where she works, Doyle-Campbell has had to transition recently to telehealth. She speaks to her patients on the phone while her practice readies its technology for video consults.
“What I offer to patients, I can mostly do,” Doyle-Campbell said.
The phone, however, can present challenges with certain types of education she provides, such as inhaler technique. The same goes for educating patients on proper monitoring, as more patients are now being encouraged to do that at home.
“Vitals are a big component of what I do,” said Doyle-Campbell. When educating patients about how to check their blood pressure, she can walk them through the steps and some of the common errors. “I just can’t watch them do it to verify their technique,” she said.
Overall, she added, the experience with telehealth has mostly been positive. “Patients are glad they still have the connection.”
Ensuring HIPAA privacy protections is paramount as her practice transitions to telehealth. Any device, software, or app used in telehealth needs to be designed for privacy.
Doyle-Campbell and other providers on her team must make sure their personal phone numbers are protected since they are working from home. They use a HIPAA-compliant phone app for health care providers called Doximity, which shows the recipient a phone number different from the caller’s actual number.
In Doyle-Campbell’s case, she can put in her clinic’s phone number, and this way the patient knows it’s her calling.
Telehealth policy changes
Telehealth has experienced a slow adoption in the United States, with coverage, reimbursement, and federal and state licensing laws for providers some of the barriers that have prevented it from taking off.
“The policy changes that just happened allowing for telehealth and paying for telehealth, specifically the two-way interactive video, has been a linchpin, sea-change moment,” said AMA’s Lichtenberg during the Brookings Institute webinar on telehealth.
In response to COVID-19, the Trump administration and the U.S. Department of Health and Human Services approved the use of telehealth services as part of the Coronavirus Preparedness and Response Supplemental Appropriations Act. According to a Brookings Institute report on telehealth before and after COVID-19, many of these telehealth barriers were removed.
“As part of this newly granted permission, most Medicare payment requirements were waived, and recipients were able to access remote care, regardless of where they live. During the pandemic, telehealth services were also charged at the same rate of in-person medical services, or at parity,” the report authors wrote.
The Trump administration is also allowing states to take steps (the COVID-19 Telehealth Toolkit) to accelerate adoption of broader telehealth coverage policies in the Medicaid and Children’s Health Insurance Programs.
Telepharmacy regulation is state based, and around two-thirds of states have regulation or legislation in place.
“A good first step is to find out if your current state has such legislation in place, and what the requirements are,” said Leal. “State pharmacy associations can be another useful resource to determine the feasibility in your location.”
Reaching rural Americans
The success of telehealth also hinges on being able to reach a key demographic: patients in rural communities who lack high-speed internet. For them, successful communication via telehealth requires the expansion of broadband internet access.
Amber Briggs, PharmD, a clinical pharmacy specialist for the Alaska Veterans Affairs (VA) Healthcare System, has been prepared for this moment. The Alaska VA and the Indian Health Services in Alaska have had telehealth capabilities for some time, and Briggs has been part of the effort to manage patients remotely, some in the far corners of Alaska.
“In the COVID world, the clinics are reduced to a minimum, and I am maintaining a busy load,” said Briggs. She is now doing half of her appointments electronically.
“This has been an opportunity for pharmacists to step into the role we’ve been intended to play,” Briggs said. “From my perspective, we’ve done it.”
One pharmacist’s telehealth story
Sandra Leal, PharmD, MPH, FAPhA, CDE, is Tabula Rasa HealthCare executive vice president of SinfoniaRx, a national provider of medication therapy management services. She shared a story with Pharmacy Today about how a SinfoniaRx pharmacist provided care to a patient during the pandemic.
“The patient’s asthma was acting up, and her doctor was not available because the office was closed due to coronavirus. She said she believed her anxiety was causing her to have asthma symptoms. She had no medicine for her nebulizer, but she did have the machine.
I inquired about fever and shortness of breath, which she denied, but she described coughing. I encouraged her to continue taking her allergy medication, and I counseled her on additional beneficial actions. Together we called her pharmacy to request an emergency fill of her nebulizer medication. They agreed to pursue authorization for the fill, as her last prescription for this medication was 2 years prior.
I also provided the patient with the closest urgent care clinic location, hours, and phone number; I advised her to contact them if her breathing worsened. The patient was very grateful for the conversation and for the information I provided.”