Implementation of Telehealth in Radiation Oncology: Rapid Integration During COVID-19 and Its Future Role in Our Practice

Abstract

Introduction The widespread coronavirus disease 2019 (COVID-19) has resulted in significant changes in care delivery among radiation oncology practices and demanded the rapid incorporation of telehealth. However, the impact of a large-scale transition to telehealth in radiation oncology on patient access to care and the viability of care delivery are largely unknown. In this manuscript, we review our implementation and report data on patient access to care and billing implications. As telehealth is likely to continue after COVID-19, we propose a radiation oncology-specific algorithm for telehealth. Material and Methods In March 2020, our department began to use telehealth for all new consults, post-treatment encounters, and follow-up appointments. Billable encounters from January to April 2020 were reviewed and categorized into one of the following visit types: in-person, telephonic, or two-way audio-video. Logistic regression models tested whether visit type differed by patient age, income, or provider. Results There was a 35% decrease in billable activity from January to April. In-person visits decreased from 100% to 21%. Sixty percent of telehealth appointments in April were performed with two-way audio-video, and 40% by telephonic only. In-person consultation visits were associated with higher billing codes compared to two-way audio-video telehealth visits (p<0.01). No difference was seen for follow-up visits. Univariate and multivariable analysis identified that older patient age was associated with reduced likelihood of two-way audio-video encounters (p<0.01). The physician conducting the telehealth appointment was also associated with the type of visit performed (p<0.01). Patient income was not associated with the type of telehealth visit. Conclusions Since the onset of COVID-19 pandemic, we were able to move the majority of patient visits to telehealth but observed inconsistent utilization of the audio-video telehealth platform. We present guidelines and quality metrics for incorporating telehealth in radiation oncology practice, based on type of encounter and disease subsite.

Telehealth utilization during the Covid-19 pandemic: A systematic review

“…Providing practical guidelines for implementing and using telehealth effectively has motivated different researchers during the COVID-19 pandemic [ 35 , 66 , 80 ]. Different clinicians were motivated to share their best practices in using telehealth to provide guidelines to others who will assist them in continuing to provide care services during the pandemic, such as gynaecology care [ 33 ], otolaryngology care [ 37 ], ophthalmology care [ 81 ], prostate cancer care [ 20 ], radiation oncology care [ 41 ], children with respiratory illnesses care [ 89 ] and physician care [ 27 ]. Furthermore, providing guidelines to perform neurological exams remotely was the main motivation of [ 47 ].…”

“…In the literature, numerous studies recommended the implementation and expansion of telehealth because of its essential role in the continuation of patient care during the current pandemic and beyond [ 13 , 14 , 39 , 41 ]. Telehealth expansion was recommended to improve access to care of underserved populations [ 43 ].…”

“…This study found that women in obstetric units received foetal medicine consultations in a reliable and feasible option by telemedicine. Furthermore, a telehealth service in radiation oncology was implemented during the COVID-19 pandemic to allow patients access to care [ 41 ]. A framework and usage guidelines were developed for incorporating telehealth into on-treatment and follow-up care.…”

Telemedicine Use and Satisfaction Among Radiation Oncologists During the COVID-19 Pandemic: Evaluation of Current Trends and Future Opportunities

“…Given the costs associated with the technology required for telemedicine visits it is possible that widespread adoption could increase healthcare disparities amongst low income populations [16] or the elderly [17]. This may be particularly true for telemedicine visits requiring a video platform [18] as a prior study found that certain demographic characteristics such as age, race and income were associated with telemedicine use and ability to interface by video [19]. Efforts to overcome these barriers include the distribution of tablets by the VA to high need veterans [20].…”

Diagnosis of COVID-19, vitality of emerging technologies and preventive measures

“…Goenka et al . implemented telemedicine consultation for radiation-oncology and effectively lessoned the in person visit from 100% to 21% [195] . The rapid developments in supportive technologies are the future of TM including POC diagnostics and laboratory measurements to care the patients effectively while staying at their home [196] .…”