Telehealth Knowledge in A Post-Pandemic Environment

As we transition into a post-pandemic era, clinicians wonder if telehealth skills is still relevant.

The COVID-19 pandemic thrust many novice and experienced physical and occupational therapy practitioners into becoming overnight teletherapists. Although the provision of telehealth services existed before the pandemic, basic knowledge about telehealth was and is a mystery to many clinicians. As we transition into a post-pandemic era, clinicians may wonder if acquiring telehealth skills is still relevant for their professional journey.  

Recommended course: Telehealth for Physical and Occupational Therapy, 2nd Edition 

A national survey found that compared to the pandemic's beginning, telehealth utilization was lower during the study’s period of April 14, 2021, through August 8, 2022. However, the study also found that telehealth utilization remained above pre-pandemic levels.  

Advanced degree clinical programs are adding telehealth curriculums to prepare future clinicians for virtual service provision. Research regarding patients’ positive experiences, satisfaction with virtual services and telehealth studies detailing positive patient outcomes are becoming increasingly available. Healthcare regulations and third-party payors are making it easier to receive compensation for telehealth services.  

These actions and trends all support telehealth’s continuance as a viable, post-pandemic service delivery model. Physical and occupational therapy practitioners would benefit from at least a foundational knowledge of telehealth to keep abreast of current options for service delivery. 

What is telehealth? 

The American Occupational Therapy Association (AOTA) defines telehealth as “the application of an evaluative, consultative, preventative and therapeutic service delivered through information and communication technology (ICT).”  

Both the American Physical Therapy Association (APTA) and the AOTA have position papers supporting the use of telehealth services independent of the COVID-19 pandemic. 

How are telehealth services provided?  

There are two ways to provide telehealth services: synchronously and asynchronously.  

• Synchronous means live, interactive, “face-to-face” communications, often referred to as video conferencing.  
• Asynchronous communication refers to storing and forwarding information such as images, videos, chat, instant messaging, and/or email.  

Whether services are provided asynchronously or synchronously, they must use a telehealth platform compliant with the Health Insurance Portability and Accountability Act (HIPPA). Third-party payors may also have their criteria for which type of service administration is eligible for payment. 

What are some benefits of telehealth? 

The option for telehealth services provides many benefits for both clients and clinicians. A few of these benefits include: 

• Increased access to quality physical and occupational therapy services for clients living in remote areas with a clinician shortage. Telehealth services can decrease or prevent unnecessary delays in receiving services.   
• Reduced financial burden of accessing services for the client (i.e., transportation costs, cost of missing work, cost of securing childcare, etc.). Although a streaming device and the internet are required for telehealth services, the other costs of attending therapy sessions can be barriers to service. 
• Services can be provided without concern of passing illnesses between the clinician and the client. This is especially important for the medically fragile and immunocompromised. 
• Transitioning to telehealth may be a professional alternative for clinicians with a lifestyle warranting frequent relocation or living in areas with limited employment opportunities. 
• Telehealth knowledge offers clinicians an alternative to the physical demands of onsite client care. Even as skilled practitioners, knowledgeable in body mechanics, age-related changes and unforeseen circumstances can make it challenging to meet the physical demands of being a physical or occupational therapy practitioner. 
• Telehealth services can enhance interprofessional practice (IPP) and interprofessional education (IPE). Telehealth provides the ability to coordinate care among team members in different locations.  
• Caregiver coaching via virtual services is supported by research and increases the effectiveness of patient outcomes. 

How does telehealth compare to onsite services? 

Telehealth services can look different from traditional onsite services but are comparable in several ways. Clinicians: 

• A therapeutic use of self to build rapport and support intervention implementations. 
• Use therapeutic use of the environment to increase client engagement, utilize environmental resources, and support intervention implementations. 
• Can use virtual services to address client needs in various settings, including but not limited to mental health services, school-based services, and home health services. 
• Can administer some standardized assessments to gather data on a client’s skill set. Several published assessments have the option for virtual administration while maintaining the validity of the assessment results. 
• Use evidence-based interventions when implementing treatment plans. 
• Provide client and caregiver education and training. 
• Implement function-based treatments. 
• Use IPP and IPE to increase patient outcomes and increase team collaboration and knowledge. 

Recommended course: Troubleshooting Telehealth Issues: Overcome Challenges in Pediatric Telehealth Sessions 

How can clinicians hone their telehealth skills? 

Since the pandemic, resources have increased for clinicians interested in telehealth. Each clinician’s learning journey will differ based on time, resources, and interests. However, several options exist to increase a physical and occupational therapist practitioner’s skillset based on individualized learning styles and unique learning needs. These options include: 

• Seeking a mentor experienced in telehealth knowledge who can support knowledge acquisition. Since telehealth practices have been around for over a decade, many clinicians have years of experience to share. 
• Reading articles about telehealth to gain information about virtual services. Blog articles and research articles are an excellent way to access information about telehealth. 
• Attending high-quality continuing education courses to learn more about providing virtual services. Like telehealth services, continuing education courses can be synchronous or asynchronous to accommodate the schedule of busy clinicians. 
• Reviewing best practices for virtually administering assessments from assessment publishers. This information can be beneficial when preparing to administer an assessment for the first time virtually. 
• Utilizing case studies to facilitate thinking about IPP and IPE and practice tailoring IPP and IPE to virtual settings. Looking at resources from other disciplines' websites is an effective way to get a broader scope of telehealth practices. 
• Accessing telehealth resources and telehealth practice information from the AOTA and the APTA websites. The information on these sites can assist with making ethical decisions about telehealth sessions and gaining additional information. 
• Practicing mock therapy sessions with co-workers, friends, or family members. Mock sessions provide opportunities to get comfortable in front of the camera and to see how assessments and interventions work best in a virtual setting.  

What should a clinician remember when providing telehealth services? 

• Be organized and prepared. Pre-session planning will increase the success of your sessions. Connect with clients before the first session to give them a general overview of what to expect from the session, request the materials needed for the session, and answer questions about the upcoming session. 
• Be flexible. Just like onsite sessions, things will not always go as planned; having a backup plan is essential. 
• Be confident. As already skilled clinicians, OT and PT practitioners will use their professional expertise and creativity to execute services using this service modality. 
• Be clear and concise with explanations and requests. Clinicians must rely heavily on verbal and demonstration skills to convey information. 
• Be compliant. Clinicians still have to adhere to state laws and regulations when providing virtual services, as well as complying with the criteria for third-party payment. 
• Have fun! Teletherapy is exciting. It allows clinicians to pair their expertise with technology for improved client outcomes. 

As telehealth services continue to become increasingly available, physical therapy and occupational therapy practitioners will encounter this service model as a service provider, a client, a caregiver, or as an educator. The continued relevance of telehealth knowledge warrants education in this healthcare niche for all service providers and clinical educators.