The Use of Telehealth and Telemedicine in Public Health

The increasingly widespread implementation of telehealth is due, in large part, to the belief that it will reduce costs and improve access to care, especially for underserved populations and residents of rural areas. Telehealth is a promising public health tool because of its 1) potentially significant impact on medically underserved populations through increased access, 2) increasing prevalence as a recognized standard of care, 3) influence on the provider-patient relationship, and 4) potential to save billions of dollars in healthcare expenditures.1,2

The use of telehealth has expanded exponentially since the late 1990s, and current projections indicate that its use will occupy a $30 billion dollar corner of the healthcare market by 2020,1 an increase of $20.4 billion since 2013.3 Among rural Medicare recipients alone, the number of telemedicine visits increased from just over 7,000 in 2004 to nearly 108,000 in 2013.2

The legal and policy resources below can help public health practitioners, policy makers, and public health lawyers as they explore and shape law and policy around the use of telehealth and telemedicine.

• Telehealth and Telemedicine: A Research Anthology of Law and Policy Resources
  This anthology provides a collection of resources discussing a variety of telehealth and telemedicine topics: 1) barriers to telehealth, 2) evidence of cost and health outcomes, 3) statutes and regulations, 4) policy recommendations, and 5) telehealth in rural areas.
• How Are Telehealth Laws Intersecting with Laws Addressing the Opioid Overdose Epidemic?
  Opioid-involved drug overdose deaths have been a growing concern in the US for several decades. The Centers for Disease Control and Prevention identified several strategies to address the opioid overdose epidemic, including increased availability of and access to medication-assisted treatment and guidance on safer opioid prescribing practices. Telehealth offers the potential for increasing access and availability to these strategies, and laws governing telehealth have implications for their utilization. To understand how state telehealth laws intersect with the opioid overdose epidemic, we conducted a legal mapping study, a type of legal epidemiological assessment, of statutes and regulations that intersect at telehealth and opioids. This search yielded 28 laws from 17 states. These laws intersect both telehealth and the opioid overdose epidemic in different ways, including prescribing limitations, opioid treatment through medication and counseling, patient plan review, and professional collaboration. Continued legal and policy surveillance is needed to be able to evaluate the impact of law in addressing opioid overdose outcomes.
• Broadband Access as a Public Health Issue: The Role of Law in Expanding Broadband Access and Connecting Underserved Communities for Better Health Outcomes
  47(2_suppl) J. Law, Med. & Ethics 39-42 (2019), https://doi.org/10.1177/1073110519857314From a panel presentation at the 2018 Public Health Law Conference, this paper explores the access issue inherent in the deployment of telehealth and telemedicine interventions.  Broadband internet is a super determinant of health that plays an important role in healthcare and public health outcomes. State laws shape implementation and use of broadband for healthcare and public health by encouraging, prohibiting, or limiting the adoption of broadband. Connecting broadband and telehealth laws with their health impacts, through legal epidemiological research, enables states to make evidence-based decisions to improve health outcomes for underserved populations.

Resource

• Using Telehealth to Expand Access to Essential Health Services During the COVID-19 Pandemic

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References

1. Rita M. Marcoux & F. Randy Vogenberg, Telehealth: Applications from a Legal and Regulatory Perspective, 41 Pharm. Therapeutics 567 (2016).
2. Ateev Mehrotra et al., Utilization of Telemedicine among Rural Medicare Beneficiaries, 315 J. Am. Med. Ass’n 2015 (2016), doi: 10.1001/jama.2016.2186
3. Margo Edmunds et al., An Emergent Research and Policy Framework for Telehealth, 5 EGEMS (2017), doi: http://doi.org/10.13063/2327-9214.1303.