Telehealth, What It Is, and Its Pros and Cons

Telehealth is a way to receive healthcare services remotely through electronic devices like your computer, tablet, or smartphone. Telehealth services come in different forms, such as live video or audio appointments, secured text messaging with your healthcare provider, or remote monitoring devices that allow your healthcare provider to track things like your blood sugar.

This article describes how telehealth started and the different ways that telehealth can and cannot be used. It also explores the advantages and disadvantages of telehealth and whether it is the best option for you.

Telehealth Overview and History

Telehealth has been around since long before the COVID-19 pandemic, but it was arguably during the lockdowns of 2020 that telehealth came into the public's consciousness.

Telehealth, as we know it today, began over 50 years ago when NASA developed telehealth services for astronauts on long-duration missions.

By the 1990s, telehealth was introduced as a means to deliver remote care to specific occupations, such as a system called Mednet that connected healthcare providers with workers on ships. Remote devices were soon after introduced that allowed healthcare providers to monitor people with sleep apnea or keep track of people with Alzheimer's disease using GPS technology.

The advent of high-speed internet, webcams, video chats, and specialized smartphone apps spurred the rapid adoption of telehealth in the early-2000s.

Services became sophisticated so that by the early part of the COVID-19 pandemic, the federal government not only aggressively adopted and increased awareness of telehealth but passed legislation that allowed for Medicare coverage of many at-home telehealth services.

A 2020 review published in BMC Public Health concluded that telehealth improved the delivery of healthcare during the pandemic, minimizing COVID-19 transmission and potentially reducing morbidity and deaths.

Telehealth Today

Today, telehealth encompasses a variety of virtual services that you can access through personal electronic devices, secure web portals, or dedicated monitoring devices. Although many people associate telehealth with "virtual health visits," it has come to mean much more than that.

Today, telehealth can serve many different purposes, such as:

• Enabling real-time visits with multiple providers or patients (such as for group therapy)
• Taking and sharing photos or videos of a skin rash, eye infection, or other symptoms
• Allowing you to direct message your provider with questions or requests (such as about medication doses, refills, or side effects)
• Receiving an email, phone, or text reminder about prescription refills or recommended health screenings
• Providing you with video instructions on how to use a medical device, such as a self-injector or at-home dialysis machine
• Remotely monitoring your blood sugar, heart rate, blood oxygen, sleep patterns, and other functions
• Providing you immediate secure access to electronic health records (EHRs)
• Linking you with an urgent care provider to get immediate treatment for uncomplicated conditions (like a cold sore)

Telehealth is even being explored as a way for surgeons to perform remote robotic surgery ("telesurgery") for conditions like kidney tumors.

What Can Telehealth Treat?

Due to advances in video and medical technology and online security, telehealth can be utilized in many fields of practice once thought unimaginable. These include primary care, dermatology, dietetics, mental health, cardiology, endocrinology, and others.

Common conditions treated or managed with telehealth include:

• Headaches or migraines
• Colds, flu, or stomach aches
• Skin conditions such as acne or rashes
• Musculoskeletal conditions such as backaches
• Recurring conditions such as urinary tract infections or herpes
• Mental health problems such as anxiety or depression
• Gastrointestinal symptoms such as constipation
• Chronic medical conditions such as diabetes

Types of visits appropriate for telehealth include:

• Wellness visits
• Nutrition counseling
• Psychotherapy
• Physical or occupational therapy
• Some urgent or emergent care
• Obtaining referrals or prescriptions
• Fertility counseling
• Prescription management
• Lab test or X-ray results
• Post-surgical follow-up
• Follow-up appointments

Advantages of Telehealth

There are many benefits to telehealth as evidenced by its impact during the COVID-19 pandemic. Even after the pandemic officially ended, many of the benefits remain.

Increased Accessibility

Telehealth is particularly beneficial for people in rural or isolated locations who might otherwise skip checkups or have limited access to urgent care. Telehealth is also more accessible for people who have mobility issues or are restricted to bed because of illness or infection.

Telehealth can also help people with conditions like agoraphobia or social anxiety who find it difficult to leave the house or those with long or inconvenient work hours who can benefit from a telehealth appointment after normal office hours. People with chronic illnesses that are often stigmatized like major depression or HIV/AIDS may also be more likely to seek care through telemedicine.

Telehealth may also be a faster way to access services. In many cases, a telehealth provider can see you right away, sometimes within minutes or hours of making an appointment.

Reduced Hospitalizations

Telehealth may lead to reduced hospitalizations, in part because people can access care earlier before severe symptoms develop.

A 2015 study in the American Journal of Managed Care reported that among people with a prior cardiovascular event, those who used telehealth for follow-ups had 31% fewer hospital admissions than those who didn't.

A 2020 review in the Journal of Medical Internet Research similarly concluded that high-quality telehealth reduces the risk of all-cause or condition-related hospitalization by 4.8% and 15.6% respectively.

Cost-Effectiveness

Generally, telehealth appointments are less costly than in-person because more patients can be seen in the same timeframe with fewer support staff.

Beyond the actual out-of-pocket costs, telehealth can also be more cost-effective. Research indicates telehealth can offer additional cost-savings such as:

• Less work absenteeism and/or loss of income
• Reduced childcare costs
• Reduced travel expenses

Telehealth is also linked to increased independent living and better quality of life for those who are older or frail.

Avoiding Waiting Rooms

During the COVID-19 pandemic, access to healthcare services through telemedicine was implemented to help limit the spread of the virus. This is still an important reason why you may want to choose telemedicine services over in-person visits.

By using telemedicine during flu season or at times when these viruses are known to be spreading in your community, you may be able to avoid exposure to COVID-19 and other illnesses such as influenza and respiratory syncytial virus (RSV). This is particularly important for older people, people who are unvaccinated, or those who are immunocompromised.

Disadvantages of Telehealth

While telehealth may be more accessible for many people, it has its limitations and drawbacks that may make it less appropriate for certain groups.

Technical Barriers

Telehealth requires a certain level of technical literacy. Older populations and those with cognitive problems may not be able to utilize the services without a caregiver's help.

Older age is also associated with lower technology use. A 2022 study in Clinical Liver Disease reported that only 53% of adults 65 and over in the United States own a smartphone and only 59% have broadband access.

Other technical barriers include slow broadband speeds and unreliable internet service (particularly in remote regions) that can cause video calls to drop or interfere with streaming.

Cost

Telehealth requires a personal electronic device such as a computer or smartphone as well as internet access. Socioeconomic disparities alone may stand in the way of this.

A 2023 study from the University of Central Florida found that ethnic minorities and people with lower incomes are far less likely to access telehealth for economic reasons.

In Black communities especially, where poverty rates run high, people were less likely to engage in telehealth services than other ethnic groups. (In the same way, Black people are less likely to access healthcare in clinics due to cost and other social or economic reasons.)

Similarly, unemployed people are 15% less likely to access telehealth than those with a job.

Limitations in Care

There are also limitations as to what can and cannot be done via telehealth. In the end, some health services can’t be replicated virtually and require in-person visits.

These include appointments for:

• Blood and urine tests
• X-rays
• Physical diagnostic tests
• Physical examinations
• Shots or vaccinations
• Contraception placements
• Surgery
• Physical therapy

Because telehealth providers can't conduct a physical examination, there is also a greater risk of misdiagnosis associated with telemedicine services.

Regulations and Insurance Restrictions

Different states and insurance providers have different regulations and restrictions when it comes to telemedicine. For example:

• State regulations may create barriers to accessing telehealth, such as in-person visit requirements for people who need prescribed medication
• Health insurance companies may not cover telehealth services from providers located out of state
• There may be confusion about what types of telehealth services are covered by your provider
  

Privacy Concerns

Telehealth also comes with a broad range of privacy concerns, which may affect some groups more than others. For example:

• Data security can't always be guaranteed when using personal or public Wi-Fi networks, which means sensitive health information could be accessed by third parties.
• Some people do not have access to private spaces where they can use telehealth services.

There are steps you can take to ensure your privacy when using telehealth services:

• Make sure you are in a private location, such as a room with a locked door or a parked car.
• Turn off any devices that could record your conversation, such as security cameras, web cameras, smart speakers, etc.
• Avoid using a public computer, a work computer, or a public Wi-Fi network. Whenever possible, use your own device such as a phone, tablet, or laptop.
• Make sure your device has the latest operating system, including all recommended security updates.
• Choose a strong password when setting up your telehealth account. Your password should contain a mix of numbers, lowercase letters, capital letters, and symbols and should not be used on any other websites.
• Use encrypted email services when sending sensitive health information to your provider.

The Future of Telehealth

Telehealth was popular during the COVID-19 pandemic when lockdowns kept people confined to their homes and the healthcare system was overburdened. By 2022, however, telehealth use was significantly down, with an overall usage of around 31% compared to around 39% the previous year.

Other studies have found that there is still a preference for in-person telehealth services, with around 80% of providers saying they would rather provide limited or no telehealth services in the future, and only 36% of patients saying they prefer telehealth over an in-person visit.

Some analysts believe this indicates a trend towards limited telehealth services in the near future, though changes in access and improvements in home-based diagnostic tools could change this.

How to Use Telehealth

Before scheduling a telehealth appointment, speak with your provider and ask what platform or service they are using. It may be FaceTime on your iPhone, a Zoom call on your computer, or a secure portal on the internet.

If possible, do a test run to see if you can use the platform without freezing, dropped lines, sound problems, or pixelation (when the image breaks up).

How to Find a Telehealth Provider

If you have insurance, check directly with your insurance carrier when looking for a provider to see if they've partnered with any organizations that provide telehealth.

Some health insurance companies also provide searchable directories of healthcare providers with telehealth options. The providers in your health insurer's directory should also accept your insurance, though it's always a good idea to confirm this with the provider.

If you have Medicare or Medicaid, make sure that the service you plan to use is covered. While most telehealth services were covered by Medicare and Medicaid during the COVID-19 pandemic, some of those emergency concessions have since been withdrawn.

How to Prepare for a Telehealth Appointment

Once you are comfortable with the technology and out-of-pocket expense, you can prepare for the appointment by:

• Finding a private space where you can speak openly and confidentially
• Locating a well-lit spot so that your healthcare provider can see your face clearly
• Turning down any background noise
• Closing all other applications on your smartphone or laptop before the appointment begins

As with all other appointments, you can better prepare by writing down any symptoms or concerns you'd like to discuss. It is also important to be patient if your provider is running late as the same can happen with an in-office visit.

Summary

Telehealth involves the use of technology to deliver medical care remotely. This not only includes virtual visits on your smartphone, laptop, or tablet but also the sharing of electronic records, management of prescriptions and lab results, and the remote monitoring of conditions like diabetes.

The advantages of telehealth include convenience, generally lower costs, and more consistent management of medical conditions. Disadvantages include a lack of access to technology, a lack of technical literacy, the cost of telehealth for low-income people, and privacy concerns.

There are also limitations to the types of conditions that telehealth can and cannot treat.