AI-powered diagnostic tools have revolutionized healthcare across multiple domains. In medical imaging analysis, AI algorithms enhance radiologists’ ability to detect abnormalities in X-rays, CT scans, MRI scans, and mammograms, leading to more accurate diagnoses and treatment plans. Pathology and histopathology benefit from AI’s capacity to analyze tissue samples, aiding pathologists in identifying cancerous cells and other abnormalities with greater precision. Dermatology has seen advancements with AI analyzing skin images to detect conditions such as melanoma, improving early detection rates. Ophthalmology utilizes AI to analyze retinal images for diseases like diabetic retinopathy and macular degeneration, enhancing early intervention strategies. AI also plays a crucial role in cardiology by analyzing ECG signals and cardiac imaging to diagnose heart conditions like arrhythmias and coronary artery disease more effectively. In genomics, AI analyzes genetic data to identify disease patterns and personalize treatment plans. Clinical decision support systems (CDSS) integrate AI to synthesize patient data and medical knowledge, assisting healthcare providers in making informed decisions.

By harnessing AI algorithms to analyze patient data remotely, telemedicine platforms can enhance diagnostic accuracy, expand access to specialized medical expertise, and improve patient outcomes.

Additionally, AI-powered remote monitoring systems analyze real-time patient data from wearable devices, enabling proactive health management and early intervention. These AI applications continue to evolve, promising to improve diagnostic accuracy, patient outcomes, and healthcare delivery efficiency. Equitable telemedicine continues to be a challenge, specifically in the underserved communities and geriatric populations. In some cases, it is believed to close the disparity gap by enhancing access in rural areas by utilizing eConsults, which can allow for specialized care, in areas where it was difficult to reach in the past.

AI diagnostics and telemedicine represent a powerful convergence that is reshaping healthcare delivery. AI enables telemedicine platforms to analyze patient data, including symptoms, vital signs, and medical history, to assist healthcare providers in making accurate diagnoses remotely. This integration facilitates more efficient and timely healthcare access, especially in remote or underserved areas where access to specialists may be limited. AI algorithms can interpret medical images, such as X-rays and CT scans, improving diagnostic accuracy in telemedicine consultations. Moreover, AI-driven chatbots and virtual assistants in telemedicine platforms can triage patients, provide preliminary assessments, and offer personalized health recommendations, thereby enhancing patient care and operational efficiency. As AI continues to evolve, its role in telemedicine is expected to further streamline healthcare delivery, improve patient outcomes, and expand access to quality care worldwide.

The uncertainty of reimbursement model in this new era of Telehealth/AI Diagnostics and the impacts of disruptive innovation have led to some uncertainties. Although data is still fuzzy around this, utilizing these platforms to deter long-term health cost consequences (preventing hospitalizations) in the risk-based value model as well as incremental cost savings in the fee-for-service model, seem promising. A fee that incentivizes the clinicians may be needed so that this type of virtual care is substitutive vs. additive in the grand scheme of things. They would also need to ease up on the regulations to improve continuum of care and transparency on a national level as the state-to-state restrictions have been challenging to overcome. In addition, a qualitative outcome worth assessing is the effect on clinician burnout. This will potentially play a role in either contributing to this or improving clinician satisfaction.

If the technology is accurate and reimbursements become more transparent, the next question will come down to equity. AI diagnostics have the potential to address healthcare equity by improving access to accurate and timely medical diagnoses across diverse populations. AI algorithms can analyze vast amounts of data efficiently, which is particularly beneficial in regions with limited access to healthcare professionals or specialized diagnostic services. By automating and standardizing diagnostic processes, AI can reduce disparities in healthcare outcomes caused by variations in access to resources or healthcare provider expertise.

However, there are challenges to ensuring equity in AI diagnostics. Biases in AI algorithms can perpetuate disparities if not addressed, as algorithms trained on biased datasets may produce inaccurate or inequitable results, particularly for underrepresented or marginalized groups. Ensuring diverse and representative datasets, along with rigorous testing and validation of AI models across different demographics, is crucial to mitigate biases and promote equity in AI diagnostics. Furthermore, the implementation of AI diagnostics must consider the digital divide, ensuring that all populations have access to the technology and infrastructure needed to benefit from AI-driven healthcare solutions. This includes considerations of internet access, digital literacy, and affordability of technology. Overall, while AI diagnostics hold promise in advancing healthcare equity by improving access to diagnostic capabilities, addressing biases and ensuring equitable access to AI technologies are essential steps towards realizing these benefits for all populations.

In summary, the integration of AI diagnostics into telemedicine represents a transformative advancement in healthcare delivery. By harnessing AI algorithms to analyze patient data remotely, telemedicine platforms can enhance diagnostic accuracy, expand access to specialized medical expertise, and improve patient outcomes. This synergy not only facilitates more efficient healthcare delivery but also addresses geographic and socioeconomic barriers to healthcare access. However, ensuring the ethical use of AI, addressing biases in algorithms, and bridging the digital divide are critical considerations to maximize the benefits of AI diagnostics in telemedicine while promoting equitable healthcare delivery for all populations. As AI technology continues to evolve, its role in telemedicine holds promise for shaping a more accessible, efficient, and patient-centered healthcare system globally.

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Utilizing AI and Wearable Technology to Democratize Access to Physical Therapy in Underserved Populations through Tele-Rehabilitation

When it comes to rehabilitation services, distance and cost should not be barriers to care. Tele-rehabilitation uses technology to bridge these gaps, delivering vital rehab to those who need it most. With over 2 billion people worldwide living with disabilities, innovative solutions are essential. The research shows tele-rehab works, improving key outcomes like mobility and strength when compared to in-clinic care. And it does this at a lower cost to patients and healthcare systems. By combining tech tools like wearable sensors and artificial intelligence (AI), tele-rehab has huge potential to transform rehab delivery across the globe. It can bring specialized, effective care right to people’s homes, no matter where they live. This approach promotes health equity and can help meet the massive unmet need for rehabilitation.

Wearable technology and artificial intelligence are key catalysts that can help telerehabilitation live up to its potential for transforming rehabilitative care.

Wearable sensors like activity trackers and motion sensors provide real-time monitoring of patient movement and progress when integrated into tele-rehab programs. A recent study on telerehabilitation for elbow fractures used motion trackers and biofeedback devices to monitor joint mobility and provide visual feedback during remote therapy sessions, resulting in an improved range of motion.

The continuous stream of patient data from wearables enables the use of artificial intelligence and data analytics to personalize telerehabilitation in real-time. AI algorithms can analyze wearable data to track patient progress, adapt exercise difficulty, and provide feedback based on each patient’s capability and needs. For instance, a study on AI-assisted telerehabilitation systems for stroke survivors employed machine learning (ML) to analyze patient movement and automatically adjust the exercise difficulty to match their motor capabilities, thus enabling a more personalized rehabilitation experience.

Tele-rehabilitation, powered by wearables and AI, breaks down barriers to care, delivering personalized, cost-effective rehab and advancing public health goals.

By combining wearable technology and AI, telerehabilitation can deliver individualized therapy remotely while giving therapists crucial insights. This was highlighted as part of the AFTER (App-Facilitated Tele-Rehabilitation) program for COVID-19 survivors. Paolo Bonato, Ph.D., an Associate Faculty member at the Wyss Institute, underscored the significance of wearable technology in rehabilitation, stating that it is “suitable to accurately track motor recovery of individuals with brain injuries and thus allow clinicians to choose more effective interventions and to improve outcomes”. This assertion emphasizes the pivotal role of wearable technology, coupled with AI, plays in refining telerehabilitation strategies, making it a more precise and impactful approach to patient care.

Together, wearables and AI make telerehabilitation scalable and responsive to each patient’s progress. With further research, they can enable tele-rehab to fulfill its potential in transforming rehabilitation delivery.

How can telerehabilitation help us achieve public health goals?

Tele-rehabilitation helps to advance public health goals in rural and medically underserved areas by improving access to rehabilitation services. Research has shown that telerehabilitation interventions can successfully overcome geographical barriers to provide rural patients with essential rehabilitation care. One such study is published in the Journal of Telemedicine and Telecare emphasizes that reducing healthcare inequities is a major public health goal that is directly aided by this increased accessibility.

Telerehabilitation has also been demonstrated to improve patient participation and adherence to treatment. Another comprehensive analysis suggests that telerehabilitation interventions consistently result in higher adherence rates than traditional in-person rehabilitation. In medically underserved areas, this is essential to obtaining improved health outcomes.

The average daily rehabilitation expenses per individual amounted to approximately $1,600, resulting in a total cost of around $46,000 per person. Another significant benefit of telerehabilitation is its low cost. There have been research studies which identified substantial per-person cost differences, ranging from $565.66 to $2,352 in savings. Tele-rehabilitation helps patients and optimizes resource allocation in healthcare systems by eliminating the need for lengthy travel and simplifying the delivery of care. Platforms for telerehabilitation frequently include data gathering and analysis, allowing for the creation of individualized care plans and evaluation of results. A recent study in the Journal of Telemedicine and e-Health, tele-rehabilitation highlighted the need for data-driven decision-making, which helps rural healthcare providers tailor their offerings to the unique requirements of their patient communities.

Furthermore, wearables and remote patient monitoring (RPM) tools are examples of cutting-edge technology solutions that support telerehabilitation. These developments give rehabilitation specialists additional ways to track patients’ progress and deliver timely treatments.

To summarize, telerehabilitation has a substantial impact on meeting public health objectives in underserved areas. Research continuously demonstrates how well it works to increase patient involvement, ensure cost-effectiveness, and improve access to care. In addition, it makes data-driven decision-making easier and makes use of cutting-edge technologies to offer complete rehabilitation services. To fully utilize telerehabilitation in addressing public health inequities in underprivileged communities, further research and policy assistance are required.

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In March 2020, the world was about to experience an unprecedented surge in the need for critical care.   While COVID-19 strained the healthcare capacity of communities across the nation, it impacted the 55% of US counties that lack an Intensive Care Unit (ICU) especially hard. 

Tele-critical care (TCC) expands both the capability and capacity of nurses and physicians, who lack experience in critical care, to provide this care. As described by Barbash, “Locations without ICU beds do not have clinicians who know how to use ventilators – even if they become available. Necessary is a simple, consistent means to reliably and effectively support people who deliver critical care. As long as network resources are available, Tele-Critical Care is a solution.” 

Formulating the National Emergency Tele-Critical Care Network (NETCCN)

With resources from the CARES Act, the Telemedicine & Advanced Technology Research Center (TATRC), a lab within the US Army Medical Research and Development Command (USAMRDC), established a plan to address this gap in the availability and capacity of critical care expertise and to inform how to deliver “resource-limited” care in future disasters and warfare.

The National Emergency Tele-Critical Care Network (NETCCN – rhymes with “Jetson”) allowed clinicians in need to access an on-demand, interoperable network of clinicians using secure, smartphone-based “anywhere to anywhere” telehealth. NETCCN clinicians would use digital health tools to communicate with and support local clinicians – often people with very limited critical care expertise – in the care of their sickest patients.

Traditional TCC is based on a hub and spoke model working under an established relationship with associated contracts, IT integration and other prior collaborations. During the pandemic – and other disasters – the hub and spoke model for TCC breaks down: If a hub is overwhelmed with a surge, it lacks the capacity to serve its (usual) spoke partners. Further, non-traditional sites of care – like convention centers, field hospitals  – simply could not have been part of TCC networks prior to the pandemic. Thus, the need for NETCCN to establish basic, secure communication means to support frontline clinicians in the delivery of care from where resources are available to wherever they are needed, without hardware beyond a smartphone or tablet and without basic cell connectivity..

NETCCN will become a component of global response as part of our nation’s emergency support functions for public health and medical services.

Launching and Scaling NETCCN

TATRC kicked off NETCCN with an initial cohort of nine clinical-technical teams (i.e., composed of civilian critical care clinicians and a prototype smartphone-based “anywhere to anywhere” telemedicine platform) in June 2022, less than 90 days after the declaration of the pandemic. In early September 2020, NETCCN began support of its first mission: a COVID-19 surge at a civilian hospital in Guam. On its second day of operations, NETCCN assisted a local nurse in diagnosing and treating a tension pneumothorax, which saved the patient’s life.

Through the pandemic and in collaboration with the Department of Health and Human Services (HHS) Administration for Preparedness and Response (ASPR), NETCCN supported over 60 hospitals in 19 states and territories in assisting over 1,000 unique patients. NETCCN assisted as many as 26 hospitals at the same time and enabled the President’s Test to Treat program at community testing centers across Michigan.

NETCCN was the first experience with telehealth for some supported hospitals and a supplement to other telehealth services for others. While NETCCN was available for no cost, the main barriers to deployment were related to licensure, credentialing and conceptualization of an “anywhere to anywhere” TCC service. While there were relaxed licensure restrictions during the pandemic, confusion, uncertainty, and risk aversion slowed the availability of NETCCN on multiple occasions. Similarly, unwillingness to adapt and expedite credentialing using the Federation of State Medical Boards (FSMB) ProviderBridge caused unnecessary delays. 

The Future of NETCCN

The COVID-19 pandemic – and system strains from surges and longstanding disparities – pressed TATRC and those across the healthcare continuum to reconsider traditional models and definitions of TCC.  From disasters like pandemics, hurricanes and floods to modern warfare, we must adapt telehealth and associated care models, policies, workflows and reimbursement to best serve our frontline caregivers and their patients. 

Global Response

The 2023 Omnibus directed ASPR “to continue clinical deployments for… NETCCN, which has helped health systems respond to the COVID-19 public health emergency by accessing skilled telehealth providers, and directs ASPR to make NETCCN partners available to respond to other public health emergencies and disaster response efforts on an as-needed basis.” NETCCN will become a component of global response as part of our nation’s emergency support functions for public health and medical services.

Support for Care in Modern Warfare

Modern warfare against near-peer adversaries – called Multi-Domain Operations (MDO) – will likely be characterized by large numbers of casualties, severe injuries and delayed ability to evacuate injured Soldiers. NETCCN can help address the dual challenges of mass casualties and prolonged care. TATRC is incorporating NETCCN into military exercises and “experimentation” activities to adapt NETCCN from something that made a difference during COVID-19, into something that can also make a difference during MDO.

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The healthcare industry has undergone a profound transformation, driven by technological advancements and changing patient needs. One of the most significant shifts has been the widespread adoption of telehealth services fueled by the COVID-19 Public Health Emergency (PHE). It took just a little over three years since the start of the PHE for most healthcare providers to report that they are comfortable, if not proficient, with telehealth. What does it really mean to be proficient with telehealth? What are the competencies required to claim proficiency? In March 2021, the Association of American Medical Colleges (AAMC) published “Telehealth Competencies Across the Learning Continuum” as part of their New and Emerging Areas in Medicine Series. They intended these competencies to help educators design and deliver curricula and related activities and help learners in their individual professional development in telehealth. They explicitly state that the competencies are not intended to be used for high-stakes assessments or accreditation of schools, programs, or institutions. I would beg to differ.

In this digital age, where technology continues to redefine our daily lives, healthcare professions training programs cannot afford to lag behind. Telehealth competency has emerged as a critical skill set for healthcare professionals, but it is far more than a checkbox on a resume, taking a class, or acquiring a set of technical skills. The AAMC was spot on in saying that telehealth competencies go across the learning continuum. However, these competencies should not be seen as “nice to haves”, but as imperatives. Without high-stakes assessments or impact on accreditation, it could take years or even decades before this happens. These competencies need to be woven into the very fabric of every aspect of health professions education with a sense of urgency….and even that is insufficient.

Telehealth competency necessitates adopting a transformative mindset, transcending the notion of a mere class or sequence of courses.

Historically, health professions education has been built on the foundation of the in-person model of care. Therefore, telehealth has been viewed as a mechanism for extending access to care in situations where in-person care is not feasible and/or as a more convenient alternative to in-person care. Telehealth competence is, therefore, defined as the ability to successfully replicate in-person services in a virtual setting. Admittedly, this is no small feat. It requires technical proficiency, an understanding of legal and ethical considerations, the ability to communicate clearly and compassionately through technology, the capacity to ensure data privacy and security, the skills to assure equity in access for patients from diverse cultures and needs and more. These are critically important competencies that many providers have yet to master. But I want to make the case that these are starting points for telehealth competency, and not end goals. 

There is significantly more that can be done with digital health tools that augment in-person care, and for which there is no in-person equivalent. For example, telehealth also brings the opportunity to monitor patients remotely, gather data with the aid of artificial intelligence (AI) for better decision-making, and provide timely interventions—all of which can lead to better health outcomes—transitioning from the status quo in-person care model to a hybrid model that fully embraces all available telehealth and digital health tools is needed for the future of modern healthcare. 

We all need to take a step back and rethink how we educate, practice, and experience healthcare. What better place to start than with health professions education? Telehealth competency necessitates adopting a transformative mindset, transcending the notion of a mere class or sequence of courses. If we work backward, a transformative mindset in health professions education is one that produces health professionals who enter the workforce:

• Knowing the value of telehealth and how technology can be used to improve access to care, enhance patient experience, and lead to better health outcomes.
• Having a good understanding and proficiency in navigating technology, legal and ethical considerations, telehealth etiquette, and telehealth equity.
• Feeling empowered to make sound clinical decisions about what digital tools to use, when and with whom to use them, and how to assess whether these tools add value. 
• Able to quickly adapt and pivot as new tools emerge; proactively integrating new technologies and methods into practice as appropriate.

How might we change the way we educate providers to achieve these objectives? This process will require a combination of intentional design and imagination, and it must start now. We need to look carefully at the structure of existing curricula, the sequencing of courses, the teaching methods and experiences, the assessment and evaluation tools, as well as the accreditation requirements. We also need to look closely at faculty professional development. Having the next generation of health professionals equipped not only with technical skills; but also, with the ability to provide patient-centered care, navigate legal and ethical complexities, embrace technology and innovation, and adapt to an ever-changing healthcare landscape is imperative for ensuring that these professionals are not just ready for the future; but able to shape it.

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The University of Kansas Health System, along with the University of Kansas, has been a pioneer in telemedicine for more than thirty years. In the months leading up to the pandemic, it was typical for our providers to see around 100 patients per month. We specialized in telestroke, telebehavioral health and telecancer throughout the state of Kansas. The laws at the time limited our providers and patients to being physically in a clinic space in order to give and receive telehealth care. Like most health organizations, the pandemic accelerated the demand for telehealth. At the height of the pandemic, our providers gave care to more than 1,200 patients daily. Today, our telehealth volume has leveled off to 600 patients a day. To meet the initial demand, 2500 plus employees pivoted from their regular duties to help with the implementation of software, hardware, testing and education in order to bring providers, support staff and patients up to speed on the new technologies.

A few months into the pandemic, we expanded our telehealth capabilities by offering virtual urgent care, grew our asynchronous care offerings and created a remote patient monitoring (RPM) department. Our digital care interactions with patients totaled more than 1.7 million last year alone. Within the last three years, we have witnessed a paradigm shift in which more and more of our patients have come to expect a menu of offerings to receive their care beyond in-person and many of them want to do so in the comfort of their home. We calculated last year alone, we collectively saved our patients 2.5 million miles of driving, countless hours of time off from work, extra childcare, hotel expenses etc. Additionally, we noticed a positive impact on missed appointments. A challenge, of course, is balancing patients’ expectations of wanting to do many things digitally. One example is reconciling with physicians accustomed to seeing the first patient encounters in person…not via telehealth. While our numbers speak of great success, it has been challenging helping patients understand why, some care necessitates they come in and encouraging providers to offer virtual care. Initially, to promote telehealth and build confidence among providers, our telehealth department went on a sort of roadshow to all our departments touting the benefits of telehealth, i.e., fewer canceled appointments, ability to deliver care sooner, increased patient satisfaction, etc. We learned; however, this approach did not yield the success we were hoping to achieve by increasing the number of specialties offering telehealth. Word of mouth by champion providers was ultimately the key to showcasing the power of telehealth. As they promoted the benefits of telehealth to their colleagues, our email inboxes filled up and phones started ringing. Today, our team continues to partner alongside more and more specialties to develop workflows designed to free up in-person appointments for higher acuity patient appointments and safely move more patients to our virtual options. Another benefit of telehealth has been building relationships throughout Kansas and Missouri by allowing patients to stay hospitalized in their community while having access to our specialized care as needed.

Telehealth helps close the access gaps to all patients, no matter where they live.

Something worth noting is how the temporary relaxing of several federal and state laws along with private payor policies helped break down barriers to telehealth which limited telehealth to certain providers within a certain geography in order for providers to be reimbursed. While these geographic restrictions were designed to give patients access to hard-to-reach services in rural areas in our country, patients in very urban settings also can experience situations which limit their ability to see a provider. Telehealth helps close the access gaps to all patients, no matter where they live. As we move forward, we are continuing to work with federal and state lawmakers to encourage codifying some of the temporary relaxation of laws into permanency including the important extensions within the Consolidated Appropriations Act of 2023 and CMS’s physician fee schedule. Just as important are the parity laws in which states hold the power to mandate. Hospitals which offer telehealth as a part of their care options do not have the cost savings as standalone telehealth companies. Hospital-based telehealth programs still have the overhead costs in order to provide both in-person and telehealth care. The concerns are providers will eventually become frustrated with the lower reimbursement and change back to more in-person, higher reimbursable encounters. From a policy standpoint, there is a need for caution to consider this when changing and applying reimbursement policies unilaterally to all telehealth care. It has been encouraging to see how our involvement in writing several bills and policies has been presented for debate at the federal and state levels, as well as policy changes with our private payors. As the Public Health Emergency (PHE) for COVID-19 continues to be further behind us and other issues work their way to the top of our policymakers list, the temporary gains accomplished in expanding telehealth are meeting some headwinds.

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Telemedicine emerged as a tool to provide basic primary care services to rural/remote locations by conducting virtual visits via videoconference or a phone call. Before the onset of a global pandemic, the utilization of remote patient monitoring (RPM) was minimal. In recent times, telemedicine has become the limelight in healthcare practices. Its impact on the industry has been substantial and continues to grow. Barring all geographical restrictions, patients are now able to receive the care they need from their comfort zone, reducing the risk and overcrowding.

Telehealth enhanced chronic disease management (CDM) through frequent monitoring and communication between healthcare providers and patients with chronic conditions. This proactive approach leads to better disease management and improved patient outcomes. Telemedicine is immensely valuable for specialized services like psychiatry, dermatology, etc. With telemedicine, patients often experience shorter wait times for appointments as they can access care more quickly than traditional in-person visits. This is particularly important for non-emergency care. Virtual appointments are less likely to be missed by patients, leading to improved continuity of care and better patient adherence to treatment plans.

Telemedicine platforms include patient portal and educational resources, enabling patients to access information about their conditions and treatment options, fostering better health literacy.

Investments in AI are expected to grow as the health industry recognizes the value of AI in enhancing patient care, addressing some of the challenges faced in healthcare delivery.

Wearable medical devices and sensors play a vital role in telemedicine, providing continuous, real-time monitoring of vital signs, health metrics and activity levels. This continuous data stream allows for more comprehensive insights into patient’s health. These devices can detect subtle changes in the parameters, allowing early detection of potential health issues. Some wearables remind patients of their medications or dosage instructions. This improves medication adherence, and is of help for individuals, particularly with complex medication regimes.

With the introduction of artificial intelligence (AI), telemedicine revolutionized the way healthcare services are delivered, monitored and managed remotely. AI technologies are integrated into EMR to enhance accessibility, efficiency, accuracy and outcomes. AI can analyze data and trends for anomalies, allowing healthcare providers to intervene proactively in chronic disease management. Natural Language Processing (NLP) algorithms can transcribe and analyze during telehealth visits, reducing the provider documentation time and yielding appointment slots for more visits. AI is deemed to be promising in provider satisfaction by reducing administrative workload. Better financial outcomes can be fostered from more accurate documentation and coding.

Although the COVID-19 pandemic heightened the adaption of telemedicine as an initial encounter for patient screening, throughout the country, many health systems struggled with enabling their legacy EMR systems to provide telemedicine features. Practices experienced challenges procuring technology and changing their workflows designed for in-person encounters.

Some healthcare programs that swiftly enabled their practices with telemedicine, grappled with clinical staff adoption. A diminutive percentage of physicians remain conservative of the telemedicine practice compared with in-person care. Preeminent reasons are identifying patients for in-person versus televisit, low reimbursement rates for virtual visits, technological barriers etc. Telemedicine limits physician’s ability to perform physical examinations, which are crucial for diagnosing certain conditions. Physicians may need to rely on patients’ descriptions and observations, potentially leading to incomplete assessments.

The limitations of adaption of telemedicine are not only with practices, but also with patients. The barriers may not be the same as they were a few years ago, but they are still persistent among the patient demographics, technology literacy and financial circumstances. Especially in underserved and rural areas, patients may not have access to smartphones, computers or internet connections to utilize telemedicine. Older adults may lack the digital literacy skills needed to schedule appointments and utilize video conferencing.  Patients with disabilities may encounter accessibility issues with telemedicine platforms, such as screen readers, captions, or other assistive technologies. In addition, the providers and patients experience privacy and security concerns. Ensuring the security and privacy of patient information during virtual consultations is a significant affair. Physicians must adhere to the regulations and utilize secure communication tools.

To address these adaptation issues, healthcare organizations should offer training and support to the clinical staff as well as patients. Implement user-friendly telemedicine platforms, and ensure clear policies and procedures are in place. One strategy is to leverage super users along with providers for an effortless experience of virtual care encounters. The provider should be supported by technology platform experts readily available to troubleshoot any issues that emerge during the encounter. Another way is to engage patients via technology bar (Tech-Bar) during in-person visit and empower them with the tools they need to utilize telehealth services for better disease management.

Over time, as AI in telemedicine becomes more integrated into healthcare systems, it brings about a wide range of benefits and transformations. And as physicians gain experience, many of these challenges can be overcome, leading to more widespread acceptance and effective use of telemedicine in medical practice. However, it also brings challenges related to data privacy, ethics, and ensuring AI technologies are adopted responsibly and equitably across diverse patient populations. Investments in AI are expected to grow as the health industry recognizes the value of AI in enhancing patient care, addressing some of the challenges faced in healthcare delivery. These investments encourage innovations, driving research and development, and creating solutions that potentially benefit patients and providers.

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The past few years have been a constant roller coaster for those in Telehealth. There have been significant changes in the regulatory environment, the corporate makeup of the industry, provider interest, and consumer preferences. We are finally settling to a new normal, bringing stability and predictability to supply and demand. Many organizations in response are evaluating strategies around digital access and telehealth. Developing project plans to meet consumer demand through improving access and convenience with telehealth.

Telehealth saw a significant increase in adoption due to the COVID-19 pandemic. Patients and healthcare providers turned to virtual visits to maintain access to care while minimizing in-person interactions. This has since been followed by a slow cooling-off phase. Most programs have settled into their new normal for telehealth. We are now in the baseline period for most organizational telehealth strategy work.

Most states relaxed regulations around telemedicine to make it more accessible during the pandemic. The federal government has yet to solidify telehealth coverage to the home for medicare patients. The coverage is extended until December 31, 2024. Not having it be a permanent benefit without expiration is a significant risk for organizations seeking to invest further in telehealth. If you are following the recent DEA comment period on the registration allowance for the Ryan Haight Act, it appears the regulation makers are not congruent with common expectations in the healthcare market. Despite such great progress in our regulatory landscape, much more work is needed.

Telehealth has seen plenty of vendor mergers and acquisition activity, coalescing a few giants.  There are numerous VC-funded startups, all seeking to become unicorns. New entrants to the telehealth provider space by international corporations with household names has caused quite a stir in the industry. We have seen a lot of failed and discontinued services, along with very successful and proven models of care adopted nationally. I have no prediction around the corporate makeup of our industry except to state it will continually evolve and change. New entrants and existing provider groups rethinking strategy and product offerings is the largest opportunity for vendors in telehealth. Expanding the focus beyond telehealth to digital strategy is ideal. Addressing digital front door, patient engagement tools, and whether to develop apps are large projects that need to have a cohesive strategy.

Organizations should focus their strategy on including digital access, future possibilities with AI, and continued focus on physician and patient buy-in.

With the new normal, organizations and telehealth departments are focusing back on provider satisfaction and patient experience. Before COVID-19, I considered my job as leading a grassroots movement to virtual care. We are back to that mindset. Convincing providers of the utility and benefits of telehealth. Supporting well with intuitive tools that work without error. Designing systems to support clinical workflows matching in-person care.

Those developing strategies in telehealth are well advised to in tandem develop strategies around Artificial Intelligence (AI). When I began working in telehealth eight years ago, the hot feature I would hear during sales calls was how they were market disrupters. Though the term is still around, it is not as valued in purchasing decisions now. AI is now the favorite term in telehealth marketing and is on the agenda of every major conference. Some front runners and innovative workflows are making waves in the industry. Most organizations are either investigating or outright developing AI strategies. There are very loud voices sharing concerns around AI in healthcare. I have heard issues around data security, diversity and equity, and even ethical dilemmas in decision-making processes. A notable concern raised is AI models with repeated input of information produces some variation in their output. Inconsistency is not how healthcare decision-making should happen. Regardless of the concerns, AI has a lot of promise and opportunity. In my opinion, the most significant opportunity lies in leveraging methods to decrease provider time documenting in the electronic medical record (EMR). The great resignation of COVID-19 resulted in shortage of resources to manage the demand. Provider burnout is a crucial problem in our industry and AI can significantly help.

The next phase of Telehealth healthcare will be the Telehealth strategy in the new normal.  Organizations should focus their strategy on including digital access, future possibilities with AI, and continued focus on physician and patient buy-in. The federal government must solidify reimbursement coverage to the home and also the provider type expansion that is currently extended to the end of 2024. It will be critical for some organizations to determine where to make future capital investments.

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The company’s services for hospitals, imaging centers, mobile imaging companies, and radiology medical groups are created with an exclusive vision of empowering healthcare structures to not sacrifice the quality of patient care.

Earl Maes, the CEO and Medical Director of Emergence Teleradiology, has over two decades of experience involving clinical medicine, radiology, and business leadership. His knowledge and awareness about the gaps between the patients and their radiologists gave him the opportunity to build solution offerings that better the radiology experience by making it more personal, reliable, and detailed.

Patient-friendly Diagnostics

From a patient’s standpoint, there are always questions about their health conditions, diagnostics reports, and treatment plans. Giving radiology departments the hands-on tools to answer patient queries with accuracy is a game changer in the healthcare field. “The primary objective of Emergence Teleradiology is to always advocate for the patient and provide them with the most insightful report,” says Earl. “Sometimes this means we recommend a patient not have contrast due to poor kidney function or perhaps we recommend a different type of exam altogether to better evaluate the symptoms the patient is experiencing.”

The primary objective of Emergence Teleradiology is to always advocate for the patient and provide them with the most insightful report.

Emergence Teleradiology leverages superior technology to improve efficiency within the hospital teleradiology service. That includes state-of-the-art security, redundant offsite storage of all images, reports in secure data centers, voice recognition and battle-proven templates, as well as customer service coordinators to directly link radiologists and all the company’s imaging customers.

Typically, most radiology programs need to be quite large in order to support radiologists sub-specializing in the many different areas of radiology. Emergence Teleradiology’s nighthawk radiology services can be tailored as per the customers’ needs. They can be scaled as desired due to the automated and expandable layered features. The nighthawk radiology services include final or preliminary radiology interpretations, specialty interpretation and more. Additionally, Emergence Teleradiology also provides patient billing and image storage.

Boosting Hospitals’ Radiology Efficiencies

Hospitals that do not have enough bandwidth to conduct health exams often hire an additional radiologist which ends up impacting them financially or would have to rely on their existing radiology staff. The latter situation leads to overworked staff in the radiology departments. When hospitals collaborate with Emergence Teleradiology, they help combine ‘the volumes of three hospitals’ and use one radiologist to cover those three hospitals. This makes a significant difference to the hospitals that end up with better cost savings. In addition, Emergence Teleradiology has specialists in areas such as pediatric radiology, neuroradiology, or orthopedic radiology, which a hospital-based may not be able to provide themselves.

“I enjoy the opportunity to work with hospital radiology departments to fine-tune their existing imaging protocols,” adds Earl. “Often, something as simple as changing the imaging plane on a reconstruction can greatly increase the sensitivity for making a particular diagnosis.”

Well-Rounded Team Equals Superior Offering

Behind Emergence Teleradiology’s customer success stories is its leadership team, which ultimately oversees the quality assurance program and provides recommendations for additional continuing medical education when deficiencies are identified. The team regularly meets with the radiology directors and ER directors at the hospitals to ensure the core objectives are fulfilled. The goals can range from turnaround times for stat exams, ensuring that critical results are called to the facility and documented in the reports. Additionally, they monitor Emergence Teleradiology’s stroke protocols that have been established to help patients as quickly as possible.

Since the company’s inception, Emergence Teleradiology has spread its operations from one state to 26 states across the nation. Emergence Teleradiology proudly offers HL7 interfaces to all our customers so that the radiology reports will seamlessly be directed into the hospital’s medical records.

“Because we provide this service ourselves and do not outsource it to a third-party technology company, we are able to establish these interfaces much quicker,” explains Earl. Emergence Teleradiology also is known for providing more customizations around this to their healthcare customers.

Channeling the AI Momentum  

For the road ahead, Emergence Teleradiology plans to provide more teleradiology coverage in the western states of the United States which is a relatively new market. When asked about their plans to integrate emerging technologies such as AI in radiology, Emergence Teleradiology, as a company, believes it as an efficiency driver. AI independently is not advanced enough to replace the indispensable role of a radiologist. But as a technology, it does help in adding the confidence, increasing the sensitivity, and drawing attention to findings that are often very subtle to the naked eye.

There have already been several industry-backed research and use cases involving AI deployed across medical imaging. The overarching goal has always been enabling radiologists to do more with less and speed up diagnostics exam throughput. With the demand for improved image quality, hospitals and healthcare companies look at taking a step further with better capability to organize and pull data for compliance and reporting. AI combined with the technological superiority of Emergence Teleradiology, the company has the potential to put an end to physician burnout and help offset issues with radiologist staff shortages in hospitals.

One of the significant areas where Emergence Teleradiology presently leverages AI is in detecting strokes with CT perfusion. This not only helps radiologists see the stroke, but also identify which parts of the stroke that are potentially salvageable when treated promptly.

Emergence Teleradiology plans to continue the adoption of AI-driven capabilities in its service offerings and roll out AI programs to improve radiologists’ interpretations and make the ever-challenging diagnosis more comprehensive.

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Continued demand for telemedicine and remote learning.

When medical historians look back on this time, the easy connection between the COVID-19 pandemic and the rise of telemedicine and remote learning will surely be made. While it is true that the pandemic necessitated an increased role for remote operations, the establishment of telemedicine and specifically teleradiology began in the years prior to 2020 with the ubiquitous rise of hospital networks and cloud storage. Successful telemedicine/teleradiology companies arose and found a niche in the market following the turn of the century, however, a stigma existed within some large health systems and especially academia that teleradiology provided suboptimal care and found the nontraditional fact that some physicians worked from home to be unacceptable. As a result, most teleradiology job openings were for less desirable overnight shifts. It wasn’t until the pandemic, however, many health systems were pushed to discover that telemedicine/teleradiology is not only acceptable, but in some instances, becoming the standard.

The ability to provide adequate care to patients at different and oftentimes remote locations all within the comfort of their home office affords radiologists the ability to spread their expertise around while streamlining their workday. The stigma of teleradiology providing suboptimal care is now gone and many accomplished imaging specialists are choosing to transition to remote positions. The elimination of the work commute and common hospital tasks has resulted in improved work-life balance for these individuals.

Radiologists are leading the charge in welcoming and establishing the role of AI in improving healthcare.

Prominent healthcare systems can now see the undeniable benefits of remote coverage which includes faster turnaround time and greater access to subspecialized care. This culture shift has led to most radiology practices employing teleradiologists in some capacity or, at a minimum, providing home reading stations for current employees so that some degree of work can be performed remotely. Employing teleradiologists allows these systems to recruit more broadly and in fact, healthcare systems that serve more undesirable locations can recruit fantastic radiologists who otherwise would have no interest to cover their facilities remotely which ultimately results in better patient care.

Medical trainees have taken note of this change in practice, as the competitiveness of matching into radiology has increased greatly. Additionally, training programs have evolved and adapted in their methods. High quality recorded lectures are now commonplace and afford residents the flexibility to learn and relearn material at their own acceptable pace. Residency programs are also able to more easily invite remote guest lecturers or subscribe to a dedicated teaching curriculum to improve their own educational or training weaknesses. Remote read-out sessions, once frowned upon, are now enhanced with videoconferencing. Even the ABR board exams are now given remotely, eliminating unnecessary spending on travel and lodging.

My specific field of breast imaging has been slow to accept remote imaging services due to the known benefits of real-time physician scanning and physical examinations. Additionally, there are stricter quality assurance checks for remote workstations that are used to read mammography. However, remote breast imaging (telemammography) services are starting to become more common due to the benefits mentioned above. The stricter QA checks have been solved with specialized software and updated self-evaluating screens. It will be essential that performance data of remote breast imagers and patient outcome data is compared to the more traditional established metrics. If early results are indicative of future performance, telemammography is here to stay.

Enhanced role of Artificial Intelligence

Artificial Intelligence has been a hot topic in medical imaging for several years now. The two main areas where the AI is establishing a role are assisting in the interpretation and optimization of efficiency. There is seemingly endless research being performed and published on the utilization of medical imaging AI.

There are some people outside the medical imaging community who erroneously believe that “radiologists will be replaced by robots” due to continued improvements with AI. While it is true that AI’s role will continue to grow and evolve, the need for human physician imagers to perform quality and accuracy checks will never approach zero. Rather, human physicians and AI will grow synergistically together and the role each plays in the care of patients must be embraced.

In breast imaging, we’ve been using a form of AI for some time called “Computer Aided Detection,” aka CAD. CAD affords breast imagers to take a second look at mammograms aiming to help limit errors in cancer detection. CAD is far from perfect, however, it has become an established useful tool that breast imagers use on nearly every mammogram that is read. As we continue to improve our mammogram machine and technique, CAD should theoretically improve as well.

Radiologists are leading the charge in welcoming and establishing the role of AI in improving healthcare. Physicians and healthcare systems should be wise to embrace the advancements and provide the necessary funding to adopt and adapt when appropriate so that they do not fall behind.

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The concept of cognitive Telehealth has been around for many years. It’s convenient, fast and when accomplished without technical snags, is quite efficient. If we broaden our definition to include all non-in-person visits such as simple, voice-only telephone encounters, the number climbs even further. However, despite this apparent utility, the numbers of total U.S. cognitive telehealth visits up to and including 2019 remained relatively low. We had the technology. In fact, we had the technology in place, ready to use—primarily through a module within the EHR as well as stand-alone platforms. But many doctors were reluctant to move forward. Some cited a sense of depersonalization; some felt the telehealth framework did not allow for an adequate physical exam and some were, at the time, averse to technology.

Then, in March 2020, COVID-19 hit. ERs across the country were busting at the seams while ambulatory medical clinics were shutting down as non-emergent, in-person visits posed too high a risk. If this were to keep up, the impact to the long-term physical and emotional health of patients and the financial impact to providers would be catastrophic. A collective and simultaneous realization occurred across the medical community—Telehealth would allow for continued interactions between doctors and patients without the risk of spreading COVID. This physical separation would serve to both decrease the risk of aerosolized transmission of the virus as well as simultaneously preserve, what was at the time, scarce Personal Protective Equipment (PPE). Suddenly, the country pivoted on a dime. Many utilized their EHR Telehealth platforms, while some leveraged other platforms. To aid in this rapid utilization, CMS announced that it would temporarily suspend the previous tight restriction on using non-medical grade platforms such as Apple’s FaceTime, Google’s Duo and Microsoft’s Skype. This restriction had been put in place to protect patient privacy in line with HIPAA federal law. At this stage, the public health risk of not having patients seen for their care was deemed to be greater than patient privacy risks if a breach occurred. And, in lockstep, payers began to reimburse Telehealth visits on par with in-person visits. That lit the powder keg and physicians use of Telehealth platforms to investigate, diagnose and treat patients exploded. The weekly number of telehealth visits rose from 16,540 to 397,977 per week — a 23-fold increase — from the pre-COVID-19 period to the COVID-19 period(Healio). Between June 26 and November 26 of 2020, Telehealth visits accounted for a whopping 30.2% of weekly Telehealth visits (CDC data).

Physicians’ initial reluctance has given way to the practical reality that technology can bring a host of benefits not previously recognized.

On a separate yet equally exciting track, procedural Telehealth has been evolving at a rapid clip. That is, video technology specifically orchestrated to maximize the result of a surgical procedure. Consider the example of a patient in Peru who requires cleft-lip corrective surgery, but facial reconstructive surgeons are not locally available. Years ago, this required a surgeon and his/her team to travel to the destination country and physically perform every procedure.  Now, surgeons can work in teams—a local general surgeon who performs the procedure and a specialty trained surgeon connected via a video fed computer platform who can guide, advise and assure the quality of the procedure. And the outcomes are impressive. 30-40% improvements in cosmetic results were suddenly possible.

In lockstep, video capability has been expanding dramatically with heightened bandwidth and advanced computer and data storage power. Together, the clinical use case combined with advancing technology has effectively made this dream a reality. A London-based company is pioneering procedural Telehealth. Their technology provides a digital user interface, on both sides of the equation. Their platform applies basic and advanced tools to allow surgeons to highlight key aspects of the procedure as well as more advanced capability such as augmented reality. Local video storage is frequently accompanied by cloud-based storage in AWS which will allow for a centralized repository of searchable procedures. How cool is that? Imagine a doctor searching the database to see the specific procedure he/she is studying.

The implication of having these databases of video procedures for medical training are huge: medical students, interns, residents and ongoing continuous training for established surgeons. Imagine the doctor preparing to assist on an appendectomy. He/she can now watch the surgery –from initial incision to last closing suture. He/she can pause and rewind on particularly complex aspects until it is clear. In short, the physician can now really see and understand what is supposed to happen before actually doing so on a live human.

Further, surgical credentialing of established physicians, is being impacted as the old process to credential a doctor is being supplanted by this new technology. Previously, for the hospital to allow a surgeon to perform a procedure that is new to him/her, it required the physician to watch 10 of these specific surgeries and then perform 10 of these surgeries with supervision. Now, both the observing and proctored surgeries can be accomplished via a technology platform. Zero travel. And a full recording for reference. 

Where Cognitive and Procedural Telehealth goes in the near to medium-term future, will depend largely on several key factors including payer reimbursement, levels of federal and state support and, I believe, ease of technology use. If physicians and patients can continue to derive and prove massive value from this expanded use of both cognitive and procedural Telehealth, then it is likely to continue to expand as a fundamental healthcare delivery vehicle for the foreseeable future. Physicians’ initial reluctance has given way to the practical reality that technology can bring a host of benefits not previously recognized. And the technology can be delivered in such a way as to make the experience beneficial for both the patient and the doctor. And, ultimately, patients are benefitting from technology which finally unburdens both the physician and the patient while connecting all of us in meaningful and objectively measurable ways.

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