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Chen A, Ayub MH, Mishuris RG, Rodriguez JA, Gwynn K, Lo MC, Noronha C, Henry TL, Jones D, Lee WW, Varma M, Cuevas E, Onumah C, Gupta R, Goodson J, Lu AD, Syed Q, Suen LW, Heiman E, Salhi BA, Khoong EC, Schmidt S. Telehealth Policy, Practice, and Education: a Position Statement of the Society of General Internal Medicine. J Gen Intern Med 2023; 38:2613-2620. [PMID: 37095331 PMCID: PMC10124932 DOI: 10.1007/s11606-023-08190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023]
Abstract
Telehealth services, specifically telemedicine audio-video and audio-only patient encounters, expanded dramatically during the COVID-19 pandemic through temporary waivers and flexibilities tied to the public health emergency. Early studies demonstrate significant potential to advance the quintuple aim (patient experience, health outcomes, cost, clinician well-being, and equity). Supported well, telemedicine can particularly improve patient satisfaction, health outcomes, and equity. Implemented poorly, telemedicine can facilitate unsafe care, worsen disparities, and waste resources. Without further action from lawmakers and agencies, payment will end for many telemedicine services currently used by millions of Americans at the end of 2024. Policymakers, health systems, clinicians, and educators must decide how to support, implement, and sustain telemedicine, and long-term studies and clinical practice guidelines are emerging to provide direction. In this position statement, we use clinical vignettes to review relevant literature and highlight where key actions are needed. These include areas where telemedicine must be expanded (e.g., to support chronic disease management) and where guidelines are needed (e.g., to prevent inequitable offering of telemedicine services and prevent unsafe or low-value care). We provide policy, clinical practice, and education recommendations for telemedicine on behalf of the Society of General Internal Medicine. Policy recommendations include ending geographic and site restrictions, expanding the definition of telemedicine to include audio-only services, establishing appropriate telemedicine service codes, and expanding broadband access to all Americans. Clinical practice recommendations include ensuring appropriate telemedicine use (for limited acute care situations or in conjunction with in-person services to extend longitudinal care relationships), that the choice of modality be done through patient-clinician shared decision-making, and that health systems design telemedicine services through community partnerships to ensure equitable implementation. Education recommendations include developing telemedicine-specific educational strategies for trainees that align with accreditation body competencies and providing educators with protected time and faculty development resources.
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Affiliation(s)
- Anders Chen
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Box 356421, Seattle, WA, 98195, USA.
| | - Mariam H Ayub
- Division of General Internal Medicine, MedStar Georgetown University Hospital, Georgetown University Medical Center, Washington, DC, USA
| | - Rebecca G Mishuris
- Digital, Mass General Brigham, Somerville, MA, USA
- Division of General Internal Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Jorge A Rodriguez
- Division of General Internal Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Kendrick Gwynn
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Community Physicians, Baltimore, MD, USA
| | - Margaret C Lo
- Division of General Internal Medicine, Department of Medicine, University of Florida College of Medicine, Malcom Randall VAMC, Gainesville, FL, USA
| | - Craig Noronha
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Tracey L Henry
- Division of General Internal Medicine, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Danielle Jones
- Division of General Internal Medicine, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Wei Wei Lee
- Section of General Internal Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Malvika Varma
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- New England VA GRECC, Boston VA Medical Center, Boston, MA, USA
| | - Elizabeth Cuevas
- Division of Academic Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Chavon Onumah
- Division or General Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Reena Gupta
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - John Goodson
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy D Lu
- Division of General Internal Medicine, Denver Health and Hospital Authority, Denver, CO, USA
- Department of Medicine, University of Colorado, Aurora, CO, USA
| | - Quratulain Syed
- Birmingham-Atlanta VA GRECC, Atlanta VA Medical Center, Atlanta, GA, USA
| | - Leslie W Suen
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Erica Heiman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bisan A Salhi
- Department of Emergency Medicine, Drexel University College of Medicine, Reading, PA, USA
| | - Elaine C Khoong
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Stacie Schmidt
- Division of General Internal Medicine, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
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