Ann Chen Wu|Narmeen Rehman|Jay M. Portnoy
The Good, the Bad, and the Unknown of Telemedicine in Asthma and Allergy Practice
Harvard Pilgrim Health Care|Harvard University|Harvard Pilgrim Health Care|Harvard University|Children's Mercy Hospital
telemedicine tm takes advantage new technologies advance methods physicians provide care patients increased ubiquity personal devices tm industry seen exponential expansion expected market valuation 20 billion 20251greiwe j using telemedicine private allergy practicej allergy clin immunol pract 2019 google scholar 2elliott yopes direct consumer telemedicinej allergy clin immunol 2019 google scholar tm shows promise benefits expanded access care decreased wait times innovative opportunities remotely monitor medical conditions including asthma nevertheless increased implementation technologies raised questions potential challenges provide convenient care without compromising quality care engage institutions patients providers amid complicated billing information sharing processes policies place ensure safety regulation tm services focus issue journal allergy clinical immunology practice use tm asthma allergy practice articles provide review benefits challenges future directions tm clinical settings benefits barriers tm programs presented table itable ibenefits challenges telemedicine tm electronic applications interventions allergy asthmalevelbenefitchallengeindividual access specialist second opinions technological limitations convenient appointment times control privacy security patient records data eliminate travel time lack longterm user engagement increased rates followup reduced unplanned ed hospitalizations opportunities patient educationprovider computerassisted algorithms diagnose treat common conditions lack standardized training ability remotely monitor conditions complex billing procedures reimbursement policies reduced burden expanding clinical knowledge online education increased burden documentation longitudinally track patient condition symptoms medication adherence trigger data inability conduct inperson physical examination though examination performed via tm using digital equipment reduction medical prescription errors econsults decrease unneeded referrals improve care coordination among primary care physicians specialists reduce clinic congestioncommunity increase access care hardtoreach patient populations ensuring acceptability telemedicine across raceethnicity language gender education health literacy levels ses groups greater access chronic ar education programsinstitutional decreases burden understaffed institutions lack information sharing clinical telemedicine clinical records institutional coordinationpolicy lack standardized guidelines procedures assigning responsibility regulatory figures eg fda quality controlar allergic rhinitis ed emergency department fda food drug administration ses socioeconomic status open table new tab ar allergic rhinitis ed emergency department fda food drug administration ses socioeconomic status tm offers ability increase care access patient populations given median wait times inperson consults allergy specialists primary care physicians range 3 weeks months rate higher remote areas significant physician shortages3phadke na wolfson ar mancini c fu x goldstein sa ngo j et alelectronic consultations allergyimmunologyj allergy clin immunol pract 2019 google scholar 4perry turner j schoolbased telemedicine asthma managementj allergy clin immunol pract 2019 google scholar increased care access wellknown tm strength one form telehealth services called electronic consultations econsults allows clinicians primary care physicians quickly consult specialists electronic health records specific cases mentioned elliott et al2elliott yopes direct consumer telemedicinej allergy clin immunol 2019 google scholar econsults expedite process receiving specialist second opinions use econsults shown improve care coordination reduce turnaround time specialist clinical input weeks hours reported greiwe et al1greiwe j using telemedicine private allergy practicej allergy clin immunol pract 2019 google scholar phadke et al3phadke na wolfson ar mancini c fu x goldstein sa ngo j et alelectronic consultations allergyimmunologyj allergy clin immunol pract 2019 google scholar issue asynchronous encounters require realtime communication patients providers shown decrease costs incurred preventable referrals subsequent work absenteeism1greiwe j using telemedicine private allergy practicej allergy clin immunol pract 2019 google scholar 3phadke na wolfson ar mancini c fu x goldstein sa ngo j et alelectronic consultations allergyimmunologyj allergy clin immunol pract 2019 google scholar 4perry turner j schoolbased telemedicine asthma managementj allergy clin immunol pract 2019 google scholar forms tm including synchronous encounters live communication highly promising health equity perspective furthermore remote communities rural populations often disproportionately affected high burden illness3phadke na wolfson ar mancini c fu x goldstein sa ngo j et alelectronic consultations allergyimmunologyj allergy clin immunol pract 2019 google scholar tm services populations eliminate long travel times increase access care despite geographic maldistributions clinicians communities reported taylor et al5taylor l waller portnoy j telemedicine allergy services rural communitiesj allergy clin immunol pract 2019 google scholar issue himes et al6himes b leszinsky l walsh r hepner h wu ca mobile health inhalerbased monitoring devices asthma managementj allergy clin immunol pract 2019 google scholar report tm especially useful chronic asthma management including detecting avoiding triggers monitoring use medication prevent exacerbation symptoms asthma management close monitoring often beneficial improving patients daily quality life tm services allow remote data collection patients symptoms triggers medication adherence6himes b leszinsky l walsh r hepner h wu ca mobile health inhalerbased monitoring devices asthma managementj allergy clin immunol pract 2019 google scholar certain programs integrate data allergen air quality reports enhance predictions symptom flareups information patients physicians longitudinally track trends catch substantial deviations severity patients case ability assist detecting preventing asthma exacerbations could lead hospitalizations6himes b leszinsky l walsh r hepner h wu ca mobile health inhalerbased monitoring devices asthma managementj allergy clin immunol pract 2019 google scholar increasing knowledge data asthma management also chronic disease educational platforms physicians use stay informed best practices patients use gain education chronic asthma management proper inhaler usage4perry turner j schoolbased telemedicine asthma managementj allergy clin immunol pract 2019 google scholar 7dowling p kader r portnoy j cola conferences online allergy ten yearsevolution online fellowship curriculumj allergy clin immunol pract 2019 google scholar used properly tm services evident benefits nonetheless many barriers implementation health care settings still exist first individuals may access required technology overall infrastructure use telehealth programs2elliott yopes direct consumer telemedicinej allergy clin immunol 2019 google scholar also high initial low sustained engagement longterm utility programs must analyzed strategies retain users6himes b leszinsky l walsh r hepner h wu ca mobile health inhalerbased monitoring devices asthma managementj allergy clin immunol pract 2019 google scholar provider level overwhelming number options telehealth programs complex billing policies increase documentation burdens difficulties conducting thorough physical examinations brought decreased willingness implementation1greiwe j using telemedicine private allergy practicej allergy clin immunol pract 2019 google scholar 2elliott yopes direct consumer telemedicinej allergy clin immunol 2019 google scholar concerns addressed new technologies improve remote examinations exist time important note role tm programs completely replace inperson doctors visits supplement visits completed comprehensively online addition providers institutions face lack integration certain telehealth programs electronic health records burdening institutions discover ways address lack information flow tm programs specialists primary care physicians2elliott yopes direct consumer telemedicinej allergy clin immunol 2019 google scholar 6himes b leszinsky l walsh r hepner h wu ca mobile health inhalerbased monitoring devices asthma managementj allergy clin immunol pract 2019 google scholar reason administrators also hesitant make large investment technologies2elliott yopes direct consumer telemedicinej allergy clin immunol 2019 google scholar complicated inconsistent policies licensing guidelines training data safety also contribute provider disinclination6himes b leszinsky l walsh r hepner h wu ca mobile health inhalerbased monitoring devices asthma managementj allergy clin immunol pract 2019 google scholar 8bousquet j ansotegui anto j arnavielhe bachert c basagaa x et almobile technology allergic rhinitis evolution management revolution healthj allergy clin immunol pract 2019 google scholar benefits barriers illustrate many factors must considered widespread tm implementation low barrier enter tm market bousquet et al8bousquet j ansotegui anto j arnavielhe bachert c basagaa x et almobile technology allergic rhinitis evolution management revolution healthj allergy clin immunol pract 2019 google scholar suggest developing legislation regulate tm services often takes much longer developing technologies thus important quickly address potential gaps policies identify methods ensure safety quality tm services tm services successfully implemented greater education awareness needed institutions providers patients may benefit services additional challenge reimbursement licensing policies need addressed tm statelevel medicare medicaid private insurance policies studies show greatest reason institutions providers cite adopting tm programs complexity reimbursement9lin ccc dievler robbins c sripipatana quinn nair telehealth health centers key adoption factors barriers opportunitieshealth aff 2018 37 19671974google scholar statelevel policies restrictions regarding facility type geographic location reimbursing services provided health professional shortage area nonmetropolitan statistical area1greiwe j using telemedicine private allergy practicej allergy clin immunol pract 2019 google scholar add fragmentation states often different restrictions change annually types services covered example 50 states provide coverage synchronous live video services 11 adopted coverage storeandforward asynchronous services econsult service explained previously1greiwe j using telemedicine private allergy practicej allergy clin immunol pract 2019 google scholar 9lin ccc dievler robbins c sripipatana quinn nair telehealth health centers key adoption factors barriers opportunitieshealth aff 2018 37 19671974google scholar incentivize providers states advocating parity laws guarantee level care reimbursement rates tm visits equivalent inperson visits however content laws strongly dictates services covered methods reimbursement means coverage provided parity law may vary challenge tm practitioners provide services different states10marcoux rm vogenberg fr telehealth applications legal regulatory perspectivep 2016 41 567570google scholar terms licensing creation interstate medical licensure compact imlc physicians could practice tm within state lines imlc adopted drivers license model physicians meet criteria licensure 29 states implemented imlc practice tm states adhering compact5taylor l waller portnoy j telemedicine allergy services rural communitiesj allergy clin immunol pract 2019 google scholar policy greatly expanded reach physicians ability provide tm care demonstrates advantageous standardized policies across states increasing capacity tm patient privacy another challenge although use specific health insurance portability accountability act hipaacompliant software mitigates issues privacy many companies lack privacy statements outline patient data protections6himes b leszinsky l walsh r hepner h wu ca mobile health inhalerbased monitoring devices asthma managementj allergy clin immunol pract 2019 google scholar adding concern jurisdiction different federal agencies eg federal trade commission food drug administration regulate safety tm programs unclear certain programs subject discretionary regulation6himes b leszinsky l walsh r hepner h wu ca mobile health inhalerbased monitoring devices asthma managementj allergy clin immunol pract 2019 google scholar 8bousquet j ansotegui anto j arnavielhe bachert c basagaa x et almobile technology allergic rhinitis evolution management revolution healthj allergy clin immunol pract 2019 google scholar 10marcoux rm vogenberg fr telehealth applications legal regulatory perspectivep 2016 41 567570google scholar given numerous styles tm delivery greater development baseline measures used determine quality security tm services states continue working expand patient protections using services finally efficacy telehealth varies significantly among specialty areas methods delivery studies focused best practices general tm findings would likely differ across different diseases areas medical practice furthermore important studies also look tm acceptability across demographics raceethnicity gendersex socioeconomic status health literacy levels6himes b leszinsky l walsh r hepner h wu ca mobile health inhalerbased monitoring devices asthma managementj allergy clin immunol pract 2019 google scholar along need variation studies across groups specialties services variation methods measuring effectiveness services one study found guidelines telehealth programs mainly based randomized control trials generalizability studies vary important researchers also explore tm large observational studies see uptake services context everyday care8bousquet j ansotegui anto j arnavielhe bachert c basagaa x et almobile technology allergic rhinitis evolution management revolution healthj allergy clin immunol pract 2019 google scholar studies current state telehealth delivery ease implementation potential improve along quality services provided tm immense potential positively impact wide range populations address major barriers access care tm industry continues expand innovate essential reimbursement policies regulation research continue expand scope efforts ensure greater patient safety satisfaction