Telemedicine and Telehealth: How They Differ and COVID-19's Effects

About a year ago, we published a blog discussing the difference between telemedicine and telehealth. We hoped to help readers better understand and distinguish between the two terms. They are often used interchangeably despite some differences that are important to note, particularly when discussing matters such as program planning, applications, and benefits.

We also anticipated that telemedicine and telehealth would continue to experience gradual increases in usage, so we wanted to help raise additional awareness of the concepts. The results of an American Well survey of 800 physicians published just a few months before we wrote the blog showed that physician adoption of telehealth had increased from 5% to 22% between 2015 and 2018 and physicians' willingness to use the technology grew during that same period from 57% to 69%, reported Healthcare Dive.

What we did not anticipate was COVID-19 and how the pandemic would seemingly transition telemedicine and telehealth from "nice-to-have" services to "must-have" services. With the increased attention on telemedicine and telehealth, we revisit these two concepts in this blog, reviewing how they differ, sharing some data on how the use of telemedicine and telehealth has grown during the health crisis, and examining some of the ways thought leaders believe COVID-19 has likely affected the future of telemedicine and telehealth.

Difference Between Telemedicine and Telehealth

More often than not, you will see healthcare organizations, leaders, and publications use telemedicine and telehealth synonymously. In mid-March, less than a week after the World Health Organization declared the novel coronavirus outbreak a pandemic, the Centers for Medicare & Medicaid Services (CMS) issued a telemedicine healthcare provider fact sheet that highlighted some of the significant policy changes made to allow greater access to Medicare telehealth services. This fact sheet stated, "Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient's health." 

The end of this fact sheet included a summary of Medicare telemedicine services, which listed three types: Medicare telehealth visits, defined as, "A visit with a provider that use telecommunication systems between a provider and a patient;" virtual check-ins, defined as, "A brief check in with your practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed;" and e-visits, defined as, "A communication between a patient and their provider through an online patient portal."

This summary would seem to indicate that Medicare essentially classifies telehealth as a part of telemedicine. That is one way of looking at it. The American Medical Association (AMA) takes a similar approach in its recently updated quick guide to telemedicine. AMA notes that, "Telemedicine spans a continuum of technologies that offer new ways to deliver care" and identifies the following as examples:

• Real-time, audio-video communication tools (telehealth) that connect physicians and patients in different locations.
• Store-and-forward technologies that collect images and data to be transmitted and interpreted later.
• Remote patient-monitoring tools … that can communicate biometric data for review.
• Verbal/audio-only and virtual check-ins.

We think it's helpful to look at these terms another way, which is summarized on the HealthIT.gov website: "Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services."

The Centers for Disease Control and Prevention notes that, "Often, telehealth is used interchangeably with the terms telemedicine or eHealth. Telehealth, however, is broader than these other terms; telemedicine and eHealth are distinct areas within telehealth."

With so much ambiguity concerning the differences between telemedicine and telehealth, our advice is as follows: When discussing telemedicine and telehealth (and we can expect these topics to come up a lot more going forward), ensure those on the receiving end of your information understand what you are referring to — whether you are distinguishing between the terms and how or whether you are using them interchangeably. This will help avoid confusion and better ensure productive discussions.

Statistics on the Use of Telemedicine and Telehealth During COVID-19

Now let's explore the growth of organizations using and planning to use telemedicine and telehealth to help them deliver care and the embracing of these services by patients during the health crisis. Here are several forecasts and statistics about telemedicine and telehealth growth and adoption (remember, the terms are often used interchangeably):

1. Frost & Sullivan forecast a sevenfold growth in telehealth by 2025, with a five-year compound annual growth rate of more than 38%.
2. Arizton estimated that the U.S. telehealth market will reach around $10 billion this year — that's a year-over-year growth of around 80%. The Frost & Sullivan forecast expected a year-over-year increase of more than 64% this year.
3. Merritt Hawkins reported in April that nearly half of all physicians were treating patients through telemedicine — up from 18% in 2018.
4. A survey conducted by Kareo, with results released in April, indicated that 75% of medical practices and clinics reported they either had a telemedicine option implemented or intended to deploy one soon.
5. The results of a survey of nearly 1,300 U.S. adults aged 18-74 by the Alliance of Community Health Plans and AMCP (formerly the Academy of Managed Care Pharmacy) and released in May found that 28% had used telehealth in the last 90 days, with these users reporting a satisfaction rate of 89%.
6. The results of a Better Medical Alliance survey of more than 1,000 seniors published in May found that 52% were comfortable using telehealth services to receive care. Of those who have used telehealth during the pandemic, 91% reported a favorable experience and 78% indicated a likelihood to complete a medical appointment via telehealth again.
7. An Updox survey of more than 2,000 U.S. adults aged 18-plus released in May found that 42% reported using telehealth services since the pandemic began.
8. In the early days of the pandemic, a Sykes survey revealed that 73% of U.S. Americans would consider using a telehealth service for COVID-19 screening.

Future of Telemedicine and Telehealth

As the statistics above indicate, the future of telemedicine and telehealth is bright. While time will tell how bright, it is safe to assume that remote healthcare will become a mainstay of medical practice.

Here is a sampling of what some pundits are predicting for telemedicine and telehealth.

• Tom Jackiewicz of Keck Medicine of USC: "The most promising technology for the delivery of healthcare remains the leveraging of telemedicine and remote monitoring, though implemented at hyper-speed. The COVID-19 pandemic has accelerated our transition to the direct integration of telehealth into the standard delivery of care. It has become the standard delivery platform for care of chronic illnesses. … Every single payer contract will be revised to incorporate the centrality of telemedicine."
• Naseema Shafi of Whitman Walker Health: "I am determined for the telehealth to stick. The policymakers have been asking us to be creative and figure out how to provide care to them [in the community] and the regulators finally caught up. We have an opportunity to help people get well, conveniently and in their environment."
• Steve Lawler of the North Carolina Healthcare Association: "One of the things that will come out on the other side of this pandemic … are a variety of interesting lessons learned that we can apply going forward. I think telehealth is certainly one of those where we're going to realize that part of the access to care solution for rural and underserved areas is taking advantage of technology and this platform in a way that hadn't been thought of until this crisis."
• Mei Kwong of the Center for Connected Health Policy: "Telehealth has been the missing element to how we deliver healthcare. But now people are familiar with it. They now have the experience and will want to see it used more often."
• Eric Topol of Scripps Research: "… the COVID-19 pandemic is accelerating the transition to a new model of remotely delivered healthcare that embraces the benefits of digital and data technologies. It is not a solution to the current crisis, but it will be one of its lasting consequences. … Remote healthcare will be here to stay once the COVID-19 crisis is gone."
• Lisa Mazur of McDermott Will & Emery: "Telehealth was already experiencing significant momentum and growth prior to this public health emergency, and its continued trajectory has been solidified by the vital role it is playing in care delivery today."
• Seema Verma, Administrator, Centers for Medicare and Medicaid Services (CMS): “For us to truly leverage the potential in the power of telehealth, we’re going to have to rethink our laws around licensing…We should allow…practicing across state lines, because it really has the potential to provide better services and reduce some of those shortages, especially in some of the highly specialized fields.”

At Cureatr, we are optimistic and excited about the future of telemedicine and telehealth. In fact, we've been bullish on remote healthcare for a while. Last July, we identified five key forces driving the uptick in adoption. A pandemic wasn't one of them, but COVID-19 has served as an even greater force for accelerating the embracing of these solutions. There are few silver linings associated with this health crisis, but one of them is the growing recognition of the critical role telemedicine and telehealth should and will play in meeting the healthcare needs of patients today and tomorrow.