Telehealth Definitions Scoping Review
Creators: name: Dawson, Leah
name: Hayes, Corey
name: Hernandez, Michelle
name: Bogulski, Cari
name: Allison, Katy
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Medicine and Health Sciences
subject: Social and Behavioral Sciences
subject: Scoping Review
subject: Telehealth Definitions

description: Digital health including telehealth 1 ensures that patients receive optimal, timely healthcare, connecting them to needed services through telecommunication, remote patient monitoring, store and forward technologies, and mobile health. In doing so, it promotes healthcare access, improves care, and offers convenience to patients at their home.2 A 2018 rapid review by Shigekawa et al. shows that telehealth interventions for certain conditions are equally effective as in-person care.3 To date, especially considering the COVID-19 pandemic, the majority of U.S. hospitals now utilize telehealth to connect with patients and consulting practitioners who are not onsite.4 However, despite recent policy changes making telehealth more accessible, many barriers remain that hinder wide and successful adoption of telehealth.5 Barriers to telehealth range from socioeconomic to legislative. This proposal deals with the latter and will review literature and government, state, and private entities’ policies and practices in order to examine and summarize inconsistencies in telehealth definitions across these entities. The many definitions for telehealth create confusion for state legislators and healthcare professionals when providing telehealth and writing the laws that govern it. Differences in definitions potentially cause variations of telehealth reimbursement policies across states and among private payers. As just one example, the term “telehealth” is often used interchangeably with “telemedicine” in the literature and state laws.6 However, these two terms are distinctively different. For example, the Centers for Medicare &amp; Medicaid Services (CMS) states that telemedicine is specifically “two-way, real-time interactive communication between a patient and physician.”7 Telehealth, on the other hand, is often used to encompass a broader definition of remote healthcare that does not always involve live clinical services. This includes patient and professional healthcare education and distance healthcare services such as store-and-forward imaging, which involves transmission of saved—not live—images. Most state Medicaid programs and private payers reimburse telehealth services to some degree,6 and many changes have been made to telehealth reimbursement policies nationwide due to the COVID-19 pandemic. Since the US government declared Public Health Emergency due to COVID-19 on February 3, 2020, telehealth services have expanded expediently.8 CMS made efforts to expand telehealth prior to the pandemic and now they have permanently expanded the scope of Medicare telehealth services to allow Medicare beneficiaries across the country, not just in rural areas, to receive telehealth services from any location.9 Medicare beneficiaries can now receive telehealth services from anywhere, including their homes. Nearly 9 million Medicare beneficiaries have received telehealth services from mid-March through mid-June 2020.10 This unprecedented increase in telehealth service among Medicare beneficiaries is due in part to the expansion telehealth reimbursement and to the changes in what technologies are required for telehealth visits. For example, interactive audio-video technology was typically required for telehealth visits prior to the COVID-19 pandemic but is no longer required. While this flexibility may be a temporary change for telehealth practices, telehealth itself has proven to be a lifeline for healthcare providers and patients. The rapid adoption of telehealth has shown that it provides a unique opportunity to reach patients where they are and address a major healthcare access barrier. For this reason, telehealth services will continue to be a viable solution to access for rural and other underserved populations post pandemic, and further legislative action will be necessary to ensure needed changes to telehealth requirements and reimbursement. Variations in telehealth definitions across states, however, will continue to create problems since they regulate services and reimbursement. Moving forward into this new territory, it is urgent for us to resolve inconsistent telehealth definitions in order to successfully determine best practices and expand telehealth adoption.