What is telehealth, how does it work, and which laws regulate it?

Telehealth, also called telemedicine, has gained wide popularity over the past year.

As the coronavirus made it more difficult and even risky to visit medical professionals in-person, telemedicine offered an effective way for patients to visit with their doctors while maintaining social distancing. Millions of Americans used this innovative and convenient technology in 2020. Maybe you’re one of them. But what exactly is telehealth, how does it work, and which laws regulate it?

What is telehealth?

Telehealth is a process where doctors provide healthcare to patients virtually—through the phone or through video.

However, the term “telehealth” covers so much more—any time a specialist from another state is called for a consultation, that’s telehealth. Sending X-rays, remote patient monitoring (like what many now do with their smart watches), and even the transmission of medical records from one doctor to another are all part of the umbrella term of “telehealth.”

When did telehealth start?

From its sudden popularity, it may seem like telehealth is a new technology. It’s not! In fact, the first widely reported use of interactive video communications for healthcare was in 1959—when doctors at the University of Nebraska sent neurological scans to medical students across campus. In the late 1960s, the National Aeronautics and Space Administration (NASA) started to use telemedicine to monitor astronauts’ health while they were in space.

What are the benefits of telehealth?

Telehealth limits exposure to diseases. Because telehealth allows for remote interactions, it limits both the patient’s and the medical professional’s exposure to diseases and infections, including the coronavirus.
Telehealth reduces the time, effort, and cost of seeing a doctor. Telehealth allows patients to “visit” their doctor from home—eliminating the cost and effort required to get to a physical office. Telehealth can help low-income families who may have difficulty finding transportation to visit the doctor. It can also help families who may struggle to find or afford childcare while they’re at a doctor’s appointment. Additionally, telehealth helps individuals with physical limitations who may find it difficult to make the trip to see their doctor in-person.
Telehealth reduces wait times. Because patients can consult with doctors and specialists regardless of where those providers’ offices are located, many more medical professionals are available to patients, reducing wait times.
Telehealth increases access to specialists. Many areas of the country, particularly rural communities, have limited medical facilities and often little-to-no healthcare specialization. Telehealth gives rural residents access to highly-skilled medical professionals—even if those professionals may be hundreds of miles away.
Telehealth allows in-person medical providers to prioritize the patients who need them most. During crises like the pandemic, telehealth allowed patients with easily treatable conditions to receive care remotely, freeing up hospital staff and other medical professionals so they can work with patients that had serious health issues.

What laws regulate telehealth?

States are primarily responsible for crafting laws that regulate telehealth, and each state has different rules and regulations.

Common telehealth regulations include:

Limiting the conditions that can be treated through telehealth.
Requiring patients to visit a doctor in-person before they can take advantage of virtual options.
Limiting telehealth visits only to medical professionals licensed within the state—excluding medical professionals licensed in other states.

Reasons for excessive telehealth regulations range from well-intentioned concern about patient health and quality of care to the desire of private interests to maintain monopolies and prevent competition.

What matters most is what can be done to remove unnecessary regulations to ensure all Americans have access to quality healthcare through telemedicine.

What have states done to expand telehealth during the coronavirus?

Since the pandemic began, 36 states have enacted legislation to permanently or temporarily suspend telehealth laws. As millions of Americans experienced the benefits of this innovative technology during the coronavirus, many states are working to make temporary deregulations permanent.

Here are just a few of the many examples of state policy organizations working to make telehealth reforms permanent:

Libertas Institute championed a bill to expand telehealth access for mental health services in Utah, which passed with nearly unanimous bipartisan support.
The Buckeye Institute helped Ohio permanently expand access to telehealth and cut needless government regulations that limit the ability of medical professionals to provide care to patients.
Thanks to the efforts of the Idaho Freedom Foundation, the Idaho Governor signed an executive order to make many of his temporary coronavirus deregulations permanent, including restrictions on telehealth.
The Massachusetts Governor issued two executive orders removing barriers to telehealth during the height of the pandemic, and pending legislation promises to make telehealth permanent—a change that the Pioneer Institute has pursued through research and media appearances for years.
The Maine Governor took emergency action to loosen occupational licensing and telehealth rules—in line with recommendations from the Maine Policy Institute.
The Mississippi Center for Public Policy helped the Magnolia State pass policies that expanded access to telemedicine and allowed medical professionals licensed in other states to work in Mississippi.

How can states continue to expand access to telehealth?

States should first review existing telehealth regulations and consider making reforms that improve patients’ access to this beneficial technology.

Telehealth reforms include the following:

Allow more licensed medical professionals to perform their services virtually, including nurses and pharmacists.
Allow out-of-state doctors to visit virtually with patients in other states.
Revise standards so more illnesses can be treated through telehealth.
Remove requirements that patients visit with a doctor in-person before virtual visits.
Allow Medicare patients to use telehealth services.
Allow medical professionals to write prescriptions based on telehealth visits.
Expand Food and Drug Administration (FDA) approval of virtual vital-sign monitoring tools, such as blood pressure measurement.

Other steps states can take:

Increase quality broadband access, especially in rural communities.
Review certificate-of-need (CON) laws, or regulations that require healthcare providers to get special permission from the government before adding or expanding healthcare services or facilities. These laws can keep innovators and new medical providers from offering healthcare services.
Review job licensing laws and reciprocity arrangements with other states to ensure their citizens have access to quality care regardless of state borders.

April’s Story: How telehealth saved lives during the pandemic

For many patients with life-threatening conditions, their chance of survival is only as good as the doctor who is treating them. For the millions of Americans who do not live in a major city, access to specialists can be limited. April Hynes’s incredible story shows how telehealth is saving lives by making it possible for patients to work with specialists outside their immediate geographic area.

April is a mother of three from southeastern Pennsylvania who was already suffering from stage-four cancer when the pandemic struck. She had been traveling to see a physician in a nearby state, who had expertise treating her illness. But when Pennsylvania’s governor banned cross-state telemedicine, April could no longer work with the doctor she trusted and needed.

Fortunately, state-based think tanks across the country were already aware of these bans on cross-state telehealth and were already working to remove them. While continuing a push for broader healthcare reforms that would benefit all residents of the state, Pennsylvania’s Commonwealth Foundation realized that April needed help now, not when the legislature got around to it. So, while continuing to encourage the state legislature to enact general telehealth reforms, they helped April get in touch with her state representative.

Thanks to their efforts, April was able to obtain a special telehealth exception because of her life-threatening illness