The Infectious Disease Society of America (IDSA) issued an updated statement supporting the appropriate use of telemedicine and telehealth technologies in clinical care, research, and education. Details of the position statement were published in Clinical Infectious Diseases.
To use telemedicine and telehealth technologies, IDSA listed various factors that should be taken into consideration, such as liability, licensure, reimbursement, and patient satisfaction. IDSA supported efforts to lower physicians’ burden to obtain licenses in multiple states. Assuming state licensure requirements and criteria such as HIPAA compliance and proper use of technology are met, IDSA supported coverage and payment parity for telehealth services when provided by subspecialty-trained, board-certified infectious disease physicians.
IDSA urged providers to be aware of the policies within their states, as programs are funded in several ways. For example, Medicare covers telehealth services only when certain conditions are met, such as the beneficiary needing to be from a rural area. In addition, while 48 state Medicaid programs provide some telemedicine coverage, the extent of coverage, rules, and regulations vary widely.
While a key benefit of telemedicine and telehealth technologies is being able to provide up-to-date, timely, and cost-effective subspecialty care to resource-limited populations, IDSA advises clinicians to also recognize when it may not be appropriate to use. For example, telehealth may be appropriate for evaluating a patient with an upper respiratory tract infection but not for discussing end-of-life issues. Further, clinicians should discuss issues of depersonalization with their patients to manage expectations and improve patient satisfaction.
IDSA highlighted 6 key areas with established use of telemedicine and telehealth technologies for infectious diseases.
- HIV management: The IDSA supported the use of telemedicine for HIV care, as it can improve adherence to antiretroviral therapy with use of mobile health interventions such as text messages.
- Tuberculosis management: To reduce the burden of time and travel, an electronic directly observed treatment strategy can be implemented. IDSA noted that the Centers for Disease Control and Prevention has developed a toolkit for tuberculosis programs that are looking for electronic directly observed treatment guidance.
- Outpatient parenteral antimicrobial therapy (OPAT): To reduce drug toxicities, new infections, and treatment failures that require hospital readmission, a virtual home OPAT visit can be implemented using an interactive audiovisual communication system. This can “eliminate travel costs for patients, improve outcomes, reduce clinic no-show rates, reduce costs, and improve patient satisfaction,” especially in low-income regions.
- Antimicrobial stewardship programs (ASP): IDSA supported the use of technology in ASP. “Telehealth platforms can be used to provide educational opportunities regarding stewardship, share tools and best practices, provide case consultation, and allow the review of antimicrobial use, with feedback.”
- Infection prevention and control (IPC): Since IPC is a national priority, healthcare facilities lacking expertise in IPC practices can use telehealth platforms to connect with infectious disease physicians and “other experts with local providers, allowing them to provide education and assistance in policy development, healthcare-associated infection surveillance, infection recognition, the investigation of outbreaks, and antibiotic use monitoring.”
- Consultative care across diverse settings: “As an educational and practical consultative model, [telehealth] has great potential to increase access to subspecialist care in rural areas, nursing homes, correctional facilities, and other underserved areas.”
IDSA stressed that if technology is used, “the clinical and ethical standards in medicine must apply.” In addition, “We must advocate for patient safety, the protection of [protected health information], funding of [infectious disease] telehealth research, and payment parity,” concluded the authors.
Young JD, Abdel-Massih R, Herchline T, et al. Infectious Diseases Society of America position statement on telehealth and telemedicine as applied to the practice of infectious diseases. Clin Infect Dis. 2019;68(9):1437-1443.