The Case for Expanding Emergency Telehealth Services

by Aditi U. Joshi, MD, MSC, FACEP

Telehealth and tel-emergency care isn’t new, not in its purest definition of using technology to connect two people for a medical encounter. While it already existed in aerospace, military, and rural areas, it has become more widespread due to the COVID-19 pandemic.

Almost everyone has now had experience with this modality, including its use in emergency care. However, not all are convinced that this is something that we should be doing. In a decade working in this space, there is little I haven’t heard about the cons of using telehealth. I will not claim that telehealth is good for everything: there will always be a need for in-person emergency care. However, technology has been part of almost all other parts of our lives. Recognizing and planning for its utility in emergency medicine is a more efficient use of time. Telehealth does have some broad advantage—namely access, efficiency, and potential costs.

In terms of access, it removes the geography requirements to see patients where they are, whether at home, on an ambulance, at another hospital, or in rural areas. It allows for specialist consultations for our colleagues in rural areas where there are fewer specialists available. Research in tele-stroke has demonstrated that there is less time to tissue plasminogen activator (tPA) and decreased morbidity with clinician-to-clinician telehealth use.¹ This access to specialists also brings a type of continuing medical education (CME), as one must be there during the virtual consultation and witness the specialist working, which improves outcomes and efficiency.

It also increases access for patient populations that may have a hard time leaving home, whether it is due to caregiving, disability, or having childcare responsibilities. Emergency physicians appreciate that these limitations lead to a delay in seeking care from the traditional brick and mortar of health care facilities. With telehealth, patients can at least get a visit to determine if they need to see a physician in-person or if they can safely follow up later. The utility is huge—we can educate, see, train, and be part of a collaborative team from a distance.

Telehealth also has the potential to improve efficiency and decrease costs as a triage measure to ensure all patients are at the right level of care. Tele-triage programs have been used to triage and begin a workup within EDs already; this can potentially be extended to triaging at home, with EMS, home care facilities, and other places that funnel into the ED.² Tele-triage can help alleviate some of the burden on EDs, especially when patients could be seen in an outpatient setting. For patients who have already had an ED workup, newer programs are using telehealth for virtual observation units, keeping ED and hospital beds open and allowing patients to recover in their home. As we see better personal health and monitoring devices, this care model has the potential to grow. The burden on EDs has only grown, and one solution is to use tele-emergency care more efficiently to decrease this only growing issue.