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Thursday, November 24, 2022

Researchers Bust Common Telemedicine Myths

Not What You Think 


Telemedicine, often known as telehealth or e-medicine, is the remote delivery of healthcare services via electronic information and telecommunication technologies.  This allows healthcare providers to examine, diagnose, and treat patients without having to see them in person.

A new study shows that telemedicine is effective and doesn’t reduce access to care. 

A first-of-its-kind study demonstrating telemedicine’s exceptional effectiveness comes to the conclusion that common telemedicine concerns don’t hold up to scrutiny.

The study is one of two telemedicine studies recently published in NEJM Catalyst by researchers from the University of Rochester Medical Center (URMC). The second study demonstrates the success of URMC’s effort to provide mental health services to nursing homes via a hybrid model that includes telemedicine.

“For patients, the message is clear and reassuring: Telemedicine is an effective and efficient way of receiving many kinds of health care,” said Kathleen Fear, Ph.D., lead author of the first paper, “Busting Myths about the Impact of Telemedicine Parity,” and director of data & analytics at the UR Health Lab. “Especially for those with transportation challenges, it is a service that really fills a gap – and, vitally, it does not compromise the quality of the care that patients receive.”

Fear and her co-authors examined three particular telemedicine-related concerns using data that was partly generated by the COVID pandemic, which caused healthcare providers all around the country to rapidly expand their telemedicine services:

  • That it will reduce access to care for the most vulnerable patients who may be unable to access digital services.
  • That reimbursing providers for telemedicine services at the same rate as traditional services will encourage telemedicine overuse.
  • Telemedicine is not an effective way to provide care.

“We really dug into the data, and it disproved all three concerns, which is really quite exciting,” Fear said. “Not only did our most vulnerable patients not get left behind—they were among those engaging the most with, and benefit the most from, telemedicine services. We did not see worse outcomes or increased costs, or patients needing an increased amount of in-person follow-up. Nor did we find evidence of overuse. This is good care, and it is equitable care for vulnerable populations.”

The paper, according to senior author and chief digital health officer of URMC Michael Hasselberg, Ph.D., RN, is the first to provide comprehensive data dispelling the three myths that have hindered the widespread use of telemedicine. URMC researchers were in a unique position to conduct the study due to the work of more than 3,000 telemedicine providers throughout the health system and the UR Health Lab’s ability to analyze the data generated by their work.

The researchers compared data from July to December 2020, a period of relative normalcy after the pandemic’s first surge, to pre-pandemic data from July to December of 2019, using data from January to June 2021 as a follow-up period. Their analysis encompassed a review of patient demographics, outcomes, provider use, visits completed, and more.

“For our providers, a major concern about telemedicine has always been, ‘What might I miss if I can’t sit in the room with the patient?’” Fear said. “But we simply didn’t find any increase in negative outcomes. This doesn’t mean telemedicine will replace in-person care, but it’s clear that it can help people access care more consistently and comfortably and that it provides a highly effective complement to traditional care.”

The second NEJM Catalyst study looked at a program URMC physicians developed to bring psychiatric and psychotherapeutic resources to nursing home patients through a combination of telehealth, on-site visits, and staff education. The researchers concluded that the program improved access to care and reduced the number of residents requiring anti-psychotic medication.

“With a small team that we assembled here at URMC, we’ve been able to have a huge reach, extending care to patients in parts of the state where high-quality mental health services are scarce at best,” said Adam Simning, M.D., Ph.D., assistant professor of Psychiatry and the study’s lead author. “At a time when nursing homes nationwide are severely understaffed, and the need for mental health services among their residents is increasing, we’ve efficiently redesigned the way mental health services are provided to the more than 50 nursing homes we work with.”

Hasselberg, who was also a senior author on the nursing home study, believes both papers will resonate in the medical community, encouraging payors and policymakers to continue and expand pandemic-era policies that make the growth of telemedicine services possible.

“Hopefully, what we’ve learned here will help the rest of the country and help shape the future of health care as telemedicine becomes increasingly prominent,” said Hasselberg.

References: “Busting Three Myths About the Impact of Telemedicine Parity” by
Kathleen Fear, Ph.D., Carly Hochreiter and Michael J. Hasselberg, Ph.D., RN, PMHNP-BC, 21 September 2022, NEJM Catalyst.
DOI: 10.1056/CAT.22.0086

“Scaling Supply to Meet Behavioral Health Demand in New York State Nursing Homes” by Adam C. Simning, MD, Ph.D., Zhi-Yang Tsun, MD, Ph.D., Nirav R. Shah, MD, MPH, Elizabeth J. Santos, MD, MPH, Lara Press-Ellingham, MPA, OT and Michael J. Hasselberg, Ph.D., RN, PMHNP-BC, 21 September 2022, NEJM Catalyst.
DOI: 10.1056/CAT.22.0196