COVID-19 has made telehealth an important tool. New technologies may help clinical laboratories collect blood samples ordered by physicians treating patients remotely

Even before COVID-19, telehealth services were gaining in popularity. But the SARS-CoV-2 pandemic fully opened the door to widespread use of mobile healthcare (mHealth) technologies. This has had an on-going impact on clinical laboratories.

Pre-pandemic, if a patient visited a healthcare provider and that provider ordered medical laboratory tests, the patient could simply walk down the hall to the lab’s patient service center and provide a blood sample. But when patients and providers meet through telehealth services, it is not so easy for lab personnel to collect samples for testing.

Several questions face healthcare providers and clinical laboratories as the pandemic subsides:

  • Will telehealth remain popular?
  • Does it benefit patient care?
  • Can physicians fit it into their workflows?
  • Will it continue to be reimbursed fairly?

COVID-19 Gives Telehealth Adoption a Big Boost

Telemedicine became important very quickly as SARS-CoV-2 coronavirus infections spread in early 2020. And not just in the United States. Clinicians worldwide began to embrace mHealth technology as a method of delivering care in a way that reduced the transmission of the virus.

The number of telemedicine consultations has declined since April 2020 but continues to be significantly higher than before the pandemic. It is also interesting to note that 90% of telemedicine visits were by phone in Australia and Canada, according to an article published in JAMA Network, titled, “Paying for Telemedicine After the Pandemic.”

Ateev Mehrotra, MD, MPH (above), Associate Professor of Health Care Policy, Harvard Medical School, and Associate Professor of Medicine and Hospitalist, Beth Israel Deaconess Medical Center (BIDMC) headshot image
“At its peak in April 2020, telemedicine was responsible for 38% of all ambulatory visits among Australia’s Medicare program, 42% of all ambulatory visits for individuals insured by a US commercial insurer, and 77% of all ambulatory visits among people in Ontario, Canada,” wrote Ateev Mehrotra, MD, MPH (above), Associate Professor of Health Care Policy, Harvard Medical School, and Associate Professor of Medicine and Hospitalist, Beth Israel Deaconess Medical Center (BIDMC), et al, in the Jama Network article. Clinical laboratory testing was part of all of that and continues to find its way in this new world of mobile healthcare. (Photo copyright: Managed Healthcare Executive.)

Telehealth Popular with Community Health Centers but Disparities Remain

In “Community Health Centers Lead in Telehealth Adoption During Pandemic,” the National Association of Community Health Centers, (NACHC) reported that, in the US, 98% of community health centers used telehealth services.

One of the big issues with telehealth, according to the NACHC, is that not all patients have access to the technology necessary for telehealth to be a viable alternative to traditional office visits. And that patients who use NACHC clinics tend to be “low income, minority, and uninsured or publicly insured.”

Thus, the NACHC lists “inadequate broadband” as one of the biggest issues regarding the continued use of telehealth. “Patients without reliable internet or the necessary technology still face difficulties accessing services, which has resulted in forgone or delayed care,” the NACHC noted.

A study, titled, “Who Is (and Is Not) Receiving Telemedicine Care During the COVID-19 Pandemic,” published in the American Journal of Preventative Medicine (AJPM), confirms the findings of the NACHC. “The COVID-19 pandemic has affected telehealth utilization disproportionately based on patient age, and both county-level poverty rate and urbanicity.”

Although in-person visits declined by 50%, the AJPM study’s authors noted that telehealth did not completely bridge the gap, particularly in areas where there were higher levels of poverty.

Physician Practices Are Businesses Too

The pandemic hurt businesses of all types, including independent physician’s offices. Approximately 8% of practices closed due to the pandemic, and 4% expect they will shut down within the next year. Along with the financial burden of shutdowns, physicians are burning out, Fast Company reported.

Organizations now have the technology in place and some patients have learned to utilize the service. However, the situation does raise important questions:

  • Will telehealth remain a critical component of healthcare in the future?
  • As physician’s offices close, will telehealth fill the gap?

Telehealth and Payment

Becker’s Hospital Review asked nine hospital CIOs if telehealth would “have staying power.” Every executive mentioned either reimbursement or payers in their response. Therefore, whether telehealth remains a viable method of care delivery may depend more on who will pay for it and less on popularity or patient access.

During the COVID-19 pandemic, CMS revised the rules surrounding telehealth. This allowed practitioners to charge the same for telehealth visits as they would for in-person visits. Many private payers followed suit as well. However, those rules were temporary and it is not certain that they will be extended.

“Payers must continue to reimburse for telehealth visits,” Mark Amey, CIO, Alameda Health System, told Becker’s Hospital Review. “This has been approved with emergency orders, but there are questions on whether this will become permanent. The sooner this is addressed and resolved, the sooner organizations can make sure they are investing in permanent—not temporary—solutions.”

How Does This Affect Clinical Laboratories?

In “COVID-19 Is a Catalyst for Remote Sampling and Telemedicine,” the American Association for Clinical Chemistry (AACC) examined the trend toward at-home testing.

Tests that use nasal swabs and saliva have seen an enormous boom thanks to demand for COVID-19 testing that can be done at home, and COVID-19 antibody tests also are in high demand. Additionally, direct-to-consumer (DTC) tests that use blood samples also are seeing advancements. However, none of those factors—not even reimbursement—help medical laboratory managers who are trying to identify new methods of collecting specimens for testing that support telehealth doctors.

“Innovations in blood sample collection are proving their utility and validity just in time for the home-based medicine push,” noted the AACC. The article goes on to describe Mitra microsampling devices, produced by Neoteryx. These devices collect 20 uL of blood via a finger prick and are already used by organ transplant recipients.

Another method involves the use of dried blood spots.

Though COVID-19 is a factor, it is not the only one driving development of new healthcare technologies that may expand options for medical laboratories looking for ways to collect samples remotely.

In “‘There’s an App for That’ is Becoming the Norm in Healthcare as Smartphones Provide Access to Patient Medical Records and Clinical Laboratory Test Results,” Dark Daily looked at smartphone apps in mobile health (mHealth) that monitor patients’ conditions and report results to doctors. And in “McKinsey and Company Says the COVID-19 Pandemic is Accelerating Six Critical Trends in Healthcare, at Least One Which Would Benefit Anatomic Pathologists,” we noted that Telehealth was among several critical trends in healthcare accelerated by the COVID-19 pandemic, and how the pandemic is reshaping healthcare, especially in the realm of mobile healthcare technology.

As the COVID-19 pandemic progresses, we will continue to bring you news about healthcare technology that can enhance clinical laboratories’ ability to collect patient samples, include advancements in remote sampling techniques and technologies.

—Dava Stewart

Related Information:

Paying for Telemedicine After the Pandemic

Community Health Centers Lead in Telehealth Adoption During Pandemic

Who Is (and Isn’t) Receiving Telemedicine Care During the COVID-19 Pandemic

As Thousands of Doctors’ Offices Shutter, Telehealth Becomes a Way of Life

Will Telehealth Have Staying Power After the Pandemic? 9 CIOs Weigh In

COVID-19 Is a Catalyst for Remote Sampling and Telemedicine

“There’s an App for That” Is Becoming the Norm in Healthcare as Smartphones Provide Access to Patient Medical Records and Clinical Laboratory Test Results

McKinsey and Company Says the COVID-19 Pandemic Is Accelerating Six Critical Trends in Healthcare, at Least One Which Would Benefit Anatomic Pathologists

Guidehouse Healthcare Experts Outline Six Ways COVID-19 Pandemic Is Accelerating Healthcare Transformation