The COVID-19 pandemic resulted in an abrupt change to reimbursement of telehealth services, allowing healthcare providers to more broadly expand patient access to virtual care.

For faculty members in the University of Maryland School of Medicine's psychiatry and family medicine departments, based in Baltimore, telemedicine services encompass a vast array of tools that help engage patients, monitor symptoms and provide direct care beyond the confines of a physical location.

Over the course of the pandemic, virtual care was implemented out of necessity to mitigate the risk of COVID-19 infection. However, prior to the pandemic, there were many barriers to in-person care.

Barriers to in-person care

These barriers included practical considerations (for example, transportation costs), physical health challenges (for example, fatigue and illness symptoms making it difficult to leave home) and emotional issues (for example, depression and anxiety impacting motivation and comfort with coming into a medical office).

Further, patient monitoring between sessions typically required patients to proactively report symptoms (for example, call an office, wait on hold, and give symptom updates and any vital sign measurements like blood pressure by phone). 

Psychiatry and family medicine staff did not have tools to improve the systematic collection of objective data (for example, pulse and temperature) and direct transmission of data to the treatment team.

"The opportunities available in telemedicine, however, were initially challenging for many health systems because of the increased demand for equipment and internet connectivity, which impacted both patients and providers," said Dr. Gloria Reeves, associate professor of psychiatry at the University of Maryland School of Medicine and a practicing child and adolescent psychiatrist at the University of Maryland Medical Center.

"Providers who had to quarantine over the pandemic had issues with internet connectivity as they tried to work from home, and their clinical teams were initially not equipped with adequate equipment to conduct large volumes of telemedicine visits," she continued.

Health disparities from the digital divide

Of serious concern, patients from underserved communities experienced health disparities from the "digital divide," where those who were already experiencing more difficulty accessing in-person care also had greater difficulty with accessing technology and internet connectivity to participate in virtual care services.

"In our COVID-19 experience, we learned about the great importance of timely and comprehensive symptom monitoring to support treatment decision-making over different phases of illness, but symptom monitoring and engagement in care is also critical for very common chronic physical and mental health conditions, including depression and hypertension," Reeves explained.

"We have witnessed a large increase in vendors for telehealth-related equipment and services, so we encourage health systems to explore emerging options and we do not endorse a specific vendor," she added.

Recipient of an FCC grant

The University of Maryland School of Medicine was awarded $977,066 from the FCC telehealth grant program for the purchase of laptops, internet services, mobile telehealth carts, equipment for vaccine outreach, and vaccine hotline and remote patient monitoring equipment to provide telehealth.

"Our FCC telehealth equipment grant supported virtual care of patients through the University of Maryland School of Medicine Family Medicine and Psychiatry departments," Reeves said. "We have utilized the funds to purchase equipment and internet hotspots to support connectivity.

"A substantial purchase from our grant was for laptops that can be used securely by clinicians in family medicine and psychiatry for off-site, community-based initiatives, including school-based health programs and vaccine outreach activities, as well as office- and home-based telehealth work," she continued.

The organization also purchased remote monitoring equipment that allows the collection of vital signs from the patient's home, and the data is transmitted directly to the care team. This remote monitoring equipment has internet connectivity and simple instructions to eliminate barriers for use by patients who may have challenges managing technology or accessing the internet.

Uses for RPM

"Remote patient monitoring is being used in patients at high risk for severe COVID – to manage chronic disease and to manage COVID-19 quarantine," she said.

"We also purchased mobile telehealth carts, which are being used in a variety of settings, including the University of Maryland Medical Center, outpatient practices and community-based programs," she said. "This equipment is used for many purposes, including patient monitoring at vaccine clinics, conducting hospital-based consultations and improving options for patient-family communication during hospital care."

The organization used internet hotspots for clinicians who provide care in community-based settings, so they can securely access information needed in electronic health records to provide and document care. It also offered internet hotspots for patients to help them stay connected to care.

"This support has added collateral benefits since the hotspots can be used by multiple household members for appointments," Reeves noted. "Finally, we purchased TV monitors and telecommunication headsets that allowed us to offer patient education information in different clinical settings and support timely response to health questions."

Collecting data on the programs

The psychiatry and family medicine departments still are in the process of implementing new protocols and technologies, so Reeves said it is premature to share any outcomes data.

"The information we are collecting includes data on both provider and consumer experience of virtual care services, telemedicine service volume, and new applications of technology-based care, for example, mobile telehealth carts to improve family communication with patients during hospitalizations," she said.