As a result of the COVID-19 pandemic, telehealth has become a staple of US healthcare. Telehealth visits increased significantly as a response to global stay-at-home orders; between June and November 2020, around 30 percent of all weekly American health center visits were done through telehealth services.
The concept behind telehealth is simple: patients schedule a phone or video appointment through an online portal or with a primary care provider, bypassing the need for in-person appointments. Popularized in the 1960s, telemedicine services have been used more recently to help bridge the gap in quality healthcare in rural and impoverished communities where access to healthcare is often limited by the number of doctors who practice in the immediate area. Today, the use of telemedicine has become especially commonplace as a direct result of the overcrowding in hospitals and the national shortage of physicians/doctors facilitated by the COVID-19 pandemic.
Although Tufts Counseling and Mental Health Services has offered telehealth services through external websites such as Betterhelp since 2018, it was not until Fall 2020 that Tufts Health Service established an internal system for telehealth appointments in response to the pandemic. This process requires students to schedule appointments via the online Health and Wellness patient portal or by phone with the front desk. Medical Director of Health Service Marie Caggiano wrote in an email to the Tufts Observer that telehealth appointments are meant to be “convenient” for students and “[offer] an option to receive the health advice they are looking for.”
As in-person services begin to open back up, considering the future of telehealth—both its benefits and its limitations—could illuminate how best to see it implemented, even beyond the pandemic.
Within Health Service, telehealth appointments are created and accessed through the Health and Wellness portal. Caggiano explained that providers at Health Service set up meeting rooms on “a HIPAA compliant Zoom platform.” If Zoom is not an option for the student, providers may offer a phone call visit. During appointments, providers “interview the student to learn more about their concern and will collect objective data based on what they can see or hear,” then provide recommendations for further care. If the provider deems an in-person follow-up or testing necessary, the provider will then schedule an appointment.
In many ways, telehealth has been convenient for both patients and providers throughout the past year and a half. While working around the need for social distancing during the first stages of the pandemic, the widespread adoption of online healthcare meant that people were not spreading diseases in crowded doctor’s offices.
Brandy Rasche, a junior treated for pneumonia at Health Service in 2019, spoke on the state of Health Service before the pandemic: “It was super crowded when I went… I was concerned about getting sick or getting others sick, and [Health Service] just didn’t really seem like they knew how to handle it. There were just way too many students coming in at once.”
Caggiano stated that the switch to telehealth helped Health Service mitigate the spread of disease. She wrote, “[It’s] allowed Health Service to avoid having large numbers of students in the waiting room and exposing students to others who may be sick with a contagious illness.”
The switch to virtual care has not only reduced the spread of disease, but also increased accessibility for many students by reducing the mental and physical toll of travel. Al Bolton, a junior and co-head of Access Betters the Lives of Everyone, Tufts’ disability advocacy group, explained that people with disabilities have a different relationship with the time and energy that is required to access most healthcare.
“[For] somebody with a chronic illness or chronic pain… every day is going to be different in terms of what their pain level is, what kind of energy they have, [and] what they have the capacity to do,” they said, “but having doctor’s offices be online and being able to just open it up from your bed and access a really essential health care service from the safety of your own home… has been… a really great option.”
Despite the accessibility benefits, telehealth would have limited effectiveness if used as someone’s primary source for care. In an email, community health professor Amy Lischko described telehealth as useful for “triaging, to see who really needs an in-person visit.” Rasche echoed this sentiment, saying, “There are some things you can really only check in person… You’re expecting people to keep track of their symptoms more than if they were to just go in person. What if someone… can’t interpret their symptoms in the way a doctor can, can’t figure out what’s important and what isn’t?”
Caggiano recognized that telehealth is not always the best way to assess someone’s needs “when a more detailed physical exam is required.” She noted that “students who prefer an in-person visit for other reasons… may request that when scheduling their appointment.” Additionally, if physicians cannot accurately assess an issue through telehealth, the student will be directed to schedule an in-person appointment. “Every telehealth visit is an individualized encounter between the student and the healthcare provider,” she wrote.
The necessity to supplement telehealth with in-person visits goes beyond the unreliability of a telehealth setting. Junior Shariqa Rahman had a prescription delayed for several days this semester, leading her to question the connection between providers and their virtual patients. She said, “I think in hindsight now I would have preferred [to go in person] so maybe they would have remembered me or could have taken me more seriously. I think part of that telehealth distance is you have a certain barrier that keeps [providers] less accountable, [and] that’s frustrating.”
Bolton attributes this disconnect to an overworked staff. As a result, “[doctors] are having to cut down the amount of time that they spend with patients… which makes it harder for them to do their job well. It makes patients become these faceless, disembodied things that they are just kind of there to fix but not spend any time with.”
Caggiano acknowledged that “Health Service is well utilized by students,” meaning it requires “a careful coordination and deployment of our staff to cover all these different areas [of care].”
Due to these limitations, both students and staff are examining how an accessible telehealth service could be implemented post-pandemic.
As businesses begin to open and in-person events are starting up again, some are concerned that health care appointments may also return to a solely in-person service. Bolton explained the worry she has about such valuable access to care being stripped from disabled people. They said, “The trend seems to be pushing people back into an office setting, face-to-face healthcare provision. So [telehealth] was given to [disabled people], and now it’s being taken away because it’s still not benefiting the mainstream population of able-bodied people… The medical system has seen the benefits, but I don’t know if that’s necessarily enough to make it continue.”
Caggiano assures that at Tufts, “[Health Service] will continue to offer telehealth for students who wish to receive care this way.” She explained how Health Service has been listening to feedback from students and continually trying to adapt the telehealth service to the shifting needs of the campus.
“Based on feedback from providers and students, we have implemented online scheduling which allows students to use the Health and Wellness portal to schedule their visits online. We have also… implemented remote work options for many of our clinical staff, since providers can conduct telehealth visits from home,” she wrote.
The biggest concern for many is the universal application of telehealth in all parts of the country. Lischko talked about barriers to general quality of care in how different telehealth technologies are used in other states. “Providers use different systems in different areas, so patients seeking care from multiple providers may have these barriers each time they use a new system,” she wrote. “Providers also did not want to purchase or learn to use the technology… I think this is one of the biggest problems even if the patient prefers telehealth.”
Bolton also expressed concern about universal access in different areas, wherein doctors can only practice in states where they are licensed, blocking access to care for people in different states. “That doesn’t make sense to me,” she said. “Why can’t we have access via telehealth? We have all of this technological advancement [so] why can’t somebody in Massachusetts see somebody in California that is a specialist on what they think they might have?”
When considering the future of telehealth, students stress the importance of drastic changes to accessibility within the medical industry. “[The future of telehealth] is difficult, but it also conveys what a larger issue this brings up in the medical system… The system that we have in the U.S. needs an overhaul,” Bolton said. In response to questions about how to make telehealth more accessible, they responded, “we should be making healthcare in general… more accessible.”