With decreased emergency department visits due to the pandemic, the potential for increased complications due to the neglected complications is very high. This deficit can be characterized as "care debt" to the healthcare systems.
Developing a telehealth infrastructure can allow healthcare systems to manage and track complications with patients while maintaining data security and confidentiality.

Postpandemic recovery

- Emergency Telemedicine Consultation System
- Federal Communications Commission COVID-19 Telehealth Program
- Federal Communications Commission Rural Health Care Program

COVID-19 Related Telehealth Programs

- patient-centered
- protects patients, clinicians, and community from exposure
- allows 24/7 communication between patients and clinicians
- reduces staffing issue
- preserves personal protective equipment (PPE)
- maintains patient-provider relationships during quarantine 
- protects the elderly as well as those who live in very rural settings, are medically vulnerable, or experience limited mobility 


Benefits to telehealth infrastructure

- limitations to clinician-to-clinician communications
- limitations of remote patient monitoring
- limitations of video visits
- limitations to telephone visits
- limitations to patient initiated communication
- limitations to training clinicians in using telemedicine devices
- geographic region (in the U.S.)
- payment and reimbursement
- Interstate/ intrastate regulatory protocol and telehealth
- social barriers to telehealth implementation

Limitations of telehealth infrastructure 

- synchronous
- asynchronous
- remote patient monitoring

Telehealth modalities

The types of care administered via telehealth include acute, chronic, primary, and specialty care

Areas of care administered via telehealth

- Include options for language interpretation
- Communicate with insurers and payers to determine the availability of covered telehealth and nurse advice line services
- Provide outreach to patients with limited connectivity and technology access, and provide flexibility in platforms to include video and non-video options


Strategies to increase telehealth uptake

In order to safeguard telehealth services, healthcare systems should consider
- Compliance with federal and state regulations, directives, and expiration dates
- Awareness of announcements on HIPAA and COVID-19 by the Office of Civil Rights (OCR)
- Training of staff and healthcare providers in telehealth protocol 

Safeguarding telehealth services

- Opportunities of E-consult: clinician-to-clinician communications
- Opportunities for Remote patient monitoring
- Opportunities for Patient-initiated messaging
- Opportunities for Telephone visit
- Opportunities for Video visit

Opportunities of telehealth infrastructure

This is the first phase of delivering care to patients during the pandemic and transforming the current system to provide care while minimizing infection.
To optimize care, telephone visits and video visits take up a big portion of out-patient care as telephone visits increased 3000% and video visits increasing 1000% between the period of March 16th to April 9th.

Stay-at-home outpatient care

COVID-19 is different from a normal disaster due to the virulence of the virus. Because of this, the demand for telehealth applications increases to manage the standard of care needed to treat patients all while allowing professionals to work remotely during the initial surge of the virus. 

Initial COVID-19 hospital surge

- Patient satisfaction is associated with modality of Telehealth.
- Comparable with in-person visits

Patient satisfaction

- Video conferences or photos can be used for follow-ups after surgery for post-operative complications without patients needing to physically go to the hospitals. 
- Before engaging in a telehealth follow-up program, patients are asked if they prefer to visit clinicals in person. 
- Many elective surgeries have been postponed to the future by the American College of Surgeons. However, preoperative evaluations should still be conducted utilizing imaging, labs, medical history, risks, benefits, and imaging. This information should be discussed with the patient and their family members.
- Videoconferencing can also be used for emergency situations so that patients can potentially avoid entering the ER and being in danger of COVID-19. 


Telehealth in Surgery (COVID-19)

During the COVID-19 era the regular treatment and communication between physicians and patients regarding preexisting comorbidities has been disrupted. New guidelines and safety precautions must be put in place in order for physicians to still treat their patients and treat them through the use of telehealth or other means. While there are a lot of similarities between new communication policies being implemented across different areas of medicine, there are also many differences due to comorbidity specific criteria which facilitates different levels of involvement and communication between physicians and patients.


The comorbidities addressed under this node include:
- Cancer
- Cardiovascular Diseases
- Digestive Diseases
- Elective Surgeries
- Liver Diseases
- Psychological Disorders
- Renal Diseases

Changes to COVID-19 Patient Comorbidity Treatment and Communication

The COVID-19 infection has shown increased death rates among older patients. Relatedly, the majority of healthcare workers, across the world, are over the age of 50 and are at higher risk of getting infected due to interactions with infected patients. In order to safeguard those in the healthcare profession who are at a higher risk of mortality, a restructuring of the healthcare system is necessary, and telehealth is at the forefront of said restructuring. 

Restructuring the Healthcare System using Telemedicine

- Areas of care administered via telehealth
- Postpandemic recovery
- COVID-19 Related Telehealth Programs 
- Limitations of telehealth infrastructure
- Benefits to telehealth infrastructure
- Telehealth modalities
- Strategies to increase telehealth uptake
- Safeguarding telehealth services
- Opportunities of telehealth infrastructure
- Stay-at-home outpatient care
- Initial COVID-19 hospital surge
- Patient satisfaction
- Telehealth in surgery 
- Restructuring the Healthcare System using Telemedicine

University of California, Santa Cruz

Syracuse University

University of Michigan - Ann Arbor

Ohio State University, Columbus

Emory University

Telehealth are health-related services and information through electronic communication technologies to help patients with or people influenced by COVID-19. It allows long-distance patient and clinician care, education, and monitoring. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. 

Telehealth (telemedicine) and COVID-19

Wosik, J., Fudim, M., Cameron, B., Gellad, Z. F., Cho, A., Phinney, D., . . . Tcheng, J. (2020). Telehealth transformation: COVID-19 and the rise of virtual care. Journal of the American Medical Informatics Association, 27(6), 957-962. doi:10.1093/jamia/ocaa067

Telehealth transformation: COVID-19 and the rise of virtual care

Ohannessian, R., Duong, T. A., & Odone, A. (2020). Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action. JMIR Public Health and Surveillance, 6(2). doi:10.2196/18810

Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action

Portnoy, J., Waller, M., & Elliott, T. (2020). Telemedicine in the Era of COVID-19. The Journal of Allergy and Clinical Immunology: In Practice, 8(5), 1489-1491. doi:10.1016/j.jaip.2020.03.008 

Telemedicine in the Era of COVID-19

Incorporating telemedicine as part of COVID-19 outbreak response systems. (2020). The American Journal of Managed Care, 26(4), 147-148. doi:10.37765/ajmc.2020.42784

Incorporating Telemedicine as Part of COVID-19 Outbreak Response Systems

Focuses of telehealth and telemedicine during the COVID-19 pandemic

- BMC
- BMJ Open
- Cancer
- CDC
- Critical Care
- Diabetes & Metabolic Syndrome: Clinical Research & Reviews
- Frontiers in Public Health
- Health Science Reports
- JAMA
- JMIR Publications
- Journal of Allergy and Clinical Immunology
- Journal of the American Academy of Orthopaedic Surgeons
- Journal of the American Medical Informatics Association
- Journal of Clinical Virology
- Journal of Gastrointestinal Surgery
- Journal of Medical Internet Research
- Journal of Telemedicine and Telecare
- New England Journal of Medicine
- Oxford Academic
- Psychiatric Services
- Telemedicine and e-Health 
- The American Journal of Managed Care
- The Journal of American Surgery 
- The Journal of Emergency Medicine



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