Telemedicine and emerging technologies for health care in allergy/immunology

Abstract

Telemedicine (TM) has become a popular method of accessing medical services between providers and patients and is viewed as a cost-effective alternative to more traditional episodic faceto-face encounters. TM overcomes 2 barriers that patients face when seeking health care: distance and time. It is as effective as in-person visits for outpatient treatment of asthma, and it is a convenient way to provide inpatient consultations for patients when the allergist practices outside of the hospital. TM also has been used to manage patients with asthma in schools. Patients tend to be as satisfied with TM or they prefer TM over in-person visits, but infrequently they do prefer in-person visits. In addition to virtual visits using TM, there are several emerging technologies that are relevant to the practice of allergy/ immunology including electronic diaries (eg, symptoms and medication use), wearable technology (eg, to monitor activity and vital signs), remote patient monitoring (eg, environmental exposures and medication adherence) as well as electronic medical records augmented with clinical decision support. We believe that the use of TM, particularly when combined with information technologies such as electronic health records, has the potential to cause a transformational change in the way care is delivered by altering the process of interaction between patient and provider. TM addresses the shortage of allergy specialists in rural and underserved urban communities and facilitates patient access to allergy services. As patients take more control of their health care, use of TM is likely to increase because a large part of the move to adopt TM is driven by patient preference. (J Allergy Clin Immunol 2020;145:445-54.)

COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic

“…Please see this article's Online Repository at www.jaci-inpractice.org for additional information on telehealth. [15][16][17][18][19][20][21][22][23] The American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology telemedicine/telehealth toolkits can be valuable resources. 17,24 Although telehealth may be a valuable and critical resource, challenges will include triaging patient diagnoses and severity to provide immediate access to services to patients with more acute need.…”

What do asthmatic patients think about telemedicine visits?

“…Worldwide coronavirus disease 2019 (COVID-19) brought a lot of challenges to healthcare organizations, including safety measures, with the need to restrict the number of face-to-face visits (1). Telemedicine is capable to overcome the distance and safety barriers in this context and might be as effective as in-person visits for outpatient management of asthma (2), enabling mild to moderate-severe patients to get the supportive care they need. Several authors documented that virtual visits (VV), that could be either video or phone calls, for asthma patients allow positive outcomes, such as more symptom-free days and fewer emergency department visits or hospitalizations, improving asthma control (3,4).…”

Specialty-level Factors Historically Influencing Telehealth Use Can Provide Implications for Sustainability in a Post-Pandemic Era: A Systematic Review and Narrative Synthesis

“…Also, telemedicine services covered by Medicare were required to have both interactive audio and video with real-time communication, with restricted payment options for store-and-forward and RPM telemedicine modalities. [16,36,37] Among other payers, there is considerable variation in coverage and payment for telemedicine across states and private insurers. [89] There are some variations to be noted in Radiology and Psychiatry.…”

“…The society has also articulated the need for hospitalorganizational support for patient education, indicating that it has historically not taken the lead in promoting telehealth use among patients within the specialty. [36,39] In Family Medicine, the American Academy of Family Physicians (AAFP) has historically played an active role in advocating for technology use in primary care. However, the emphasis was largely on in uencing policies related to meaningful use of EHRs, including interoperability of EHR and need for integration of data sources (e.g., social determinants of health into primary care, to enable holistic population healthcare) to ful ll the premise of PCMHs.…”

“…[82,83,85] MESO: Specialty-level treatment factors Among "lower-using" specialties, telehealth could be used to provide a variety of treatments in Allergy-Immunology, including telehealth for asthma and antibiotic allergy & stewardship, home-based videos for triage, to isolate and protect providers, as well as telehealth for chronic disease management. [36,37,42] As such, the eld is uniquely positioned to bene t from telehealth. Historically however, these unique opportunities for remote asthma management through telemedicine have been under-leveraged, and the eld has been characterized by traditional in-clinic encounter-based care for asthma.…”