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Table of Contents
Year : 2022  |  Volume : 1  |  Issue : 1  |  Page : 35-39

Strategies, Technologies, and Challenges in the Management of COVID-19 Pandemic by Telehealth

1 Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 The Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Computer Engineering, Iran University of Science and Technology, Tehran, Iran
4 Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
5 Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences; Virology Research Center, and Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Date of Submission10-Jan-2022
Date of Decision27-Feb-2022
Date of Acceptance05-Mar-2022
Date of Web Publication23-Mar-2022

Correspondence Address:
Mitra Rezaei
Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpdtsm.jpdtsm_1_22

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Presenting professional health services after the COVID-19 pandemic age may be recognized with numerous critical features that did not exist in preceding pandemics. The widespread world web and cyberspace, social media, and technologies for providing remote intelligent health services are the most prominent differences between the recent pandemic and previous ones. Most health-care providers in the pandemic era focus more on the technologies needed to set up telehealth but do not pay enough attention to the strategies and challenges ahead. They are more focused on the lucrative health market in the days of the pandemic but do not have appropriate and dynamic strategies for it. This article addresses the strategies, technologies, and challenges facing telehealth and emphasizes the importance and priority of the necessary strategies, prioritizing technology.

Keywords: COVID-19, pandemic, telehealth, telemedicine

How to cite this article:
Babamahmoodi A, Arefnasab Z, Marjani M, Poorhosseini SM, Rezaei M, Marjani M. Strategies, Technologies, and Challenges in the Management of COVID-19 Pandemic by Telehealth. J Prev Diagn Treat Strategies Med 2022;1:35-9

How to cite this URL:
Babamahmoodi A, Arefnasab Z, Marjani M, Poorhosseini SM, Rezaei M, Marjani M. Strategies, Technologies, and Challenges in the Management of COVID-19 Pandemic by Telehealth. J Prev Diagn Treat Strategies Med [serial online] 2022 [cited 2022 May 24];1:35-9. Available from: http://www.jpdtsm.com/text.asp?2022/1/1/35/340548

  Introduction Top

Providing professional health services after the COVID-19 pandemic era can be identified with several essential features that did not exist in previous pandemics. The widespread world web and cyberspace, social media, and technologies for providing remote intelligent health services are the most prominent differences between the recent pandemic and previous ones.[1]

Telemedicine is defined as the provision of faraway services consisting of patient care, education, and monitoring to health service seekers using information, artificial intelligence, and communications technology in synchronous and asynchronous modes.[2]

Ever since the Internet was created and applications in cyberspace have been used, the desire of health-care systems to use this tool in providing services to their customers has increased. However, the question is what technologies and strategies should be adopted to provide more accessible, safer, and more effective services for patients?

Via an analytical study on the challenges in the health system, within the days of the COVID-19 pandemic, we can say the key to unlocking this complicated system is telemedicine, however, applying the idea of telemedicine without thinking about the vital strategies, techniques, and technologies that have emerged as a huge challenge for health-care seekers.[3]

In this article, we review the strategies and technologies necessary to create a telemedicine-based health-care system and emphasize the need to pay attention to the right strategies and appropriate technologies in this way.

  Telehealth and Pandemic Top

The term telemedicine textually means “amelioration at a distance” through the Latin “Medicus” and Greek “Tele.”[4]

In 1996, the Institute of Medicine defined telemedicine as “Telemedicine means the use of digital information and communication technologies in a way that connects health services seekers and health-care providers when they get separated by physical distances.”[5]

The phrases telehealth and telemedicine are regularly used interchangeably. However, telemedicine is typically known as services that are provided clinically and directly associated with a medical situation, while telehealth refers to a wide range of health-related services consisting of counseling, affected person care, training, and outpatient monitoring.

The unbridled increase in treatment costs and the emergence of emerging diseases and pandemics have increased the desire of health managers to use telehealth to be able to provide health-care services to patients faster, cheaper, and more effectively.[6]

During pandemics, the increased patients' requests accompanied by rapid depletion of health system resources create new critical conditions. To achieve the goals of the health system in response to this increased demand, it must be possible to design a structure that integrates the traditional hospital-based services strategies in web-based telehealth strategies.

COVID-19 pandemic proved to all health professionals that the capacity of the traditional health system for offering secure, effective, patient-targeted, timely, efficient, and equitable services in critical situations is not sufficient, and these problems should be addressed as quickly as possible due to the fact the Epidemiologists, public-health professionals, policymakers, and researchers name the 21st century the period of extraordinary pandemics.[7]

It is pretty evident that to successfully enter into the management of the next pandemic, which is not clear when and with what biological factor it will arise, we have to confront and accurate the wrong strategies we had for the control of the COVID-19 pandemic.[8]

The world is still almost in the midst of a devastating crisis, and some may ratiocinate that it is too early to talk about being prepared to manage future epidemics. However, we disagree and think that now is a good time to talk about future crises and the changes that need to take place to improve global capacities to respond to future pandemics. Recent experience has shown that human resources, financial reserves, and political capital are declining with the occurrence of an epidemic. However, the real impact of COVID-19, both in terms of health and economics, is more significant than the impact we have seen so far, and this, in turn, allows us to change the strategies and technologies needed to manage the pandemic (The name coronavirus is still in people's minds and this opportunity should not be wasted).[9]

Health service seekers recognize telehealth as a popular, effective, and growing tool. Especially in the COVID-19 era, this tool, although it had significant shortcomings, was able to provide effective services to the people.[10]

  Telehealth and Strategy Top

While the COVID-19 pandemic hit, health systems worldwide rapidly scaled their telehealth systems and the infrastructures to fulfill the urgent demand for remote care. The governments and commercial payers relaxed regulations around telehealth to cover extra services and raise pay rates so health systems could continue to function properly inside the virtual environment.[11]

The strategy performs a vital role in the application of technology. If the right approach does not govern using technology, technology will pass on the contrary direction of our goals or distract us from our desires.

In general, telehealth has some goals such as improved patient care, lower costs, higher patient engagement, supports value-based care, reduced readmissions, improved access, expanded market reach, and attracting younger, more tech-savvy physicians.

  Various Studies have Listed the Strategies Governing Telehealth Top

  • Understanding and approaching expectations of patients and providers from telehealth
  • Understanding the differences in monetization method in telehealth compared to the traditional method
  • Educate health-care seekers to connect with telehealth and get out of hospital-based medical relationships
  • Being open to discovering new methods and technologies to provide better and cheaper services
  • Creating a suitable and safe space in public places such as schools, universities, parks, and residential complexes with sufficient facilities for people to connect with the health system
  • Redefine the concept of health-care under the rules governing telehealth
  • Being bold and visionary in overcoming the problems of the transitional period from hospital-based to network-based medicine[2]
  • Integration of primary and allied health
  • Support the competitive market of telemedicine solutions providers
  • Development of gateways between national networks and private sector networks
  • Establish a remote information center for health-care providers
  • Insurance support for remote health solutions and recipients of these services
  • Creating requirements and modern architectural plans for the services of the National Telemedicine directory and the national infrastructure required for the management of health system crises
  • Establish coordination between remote health strategy and existing health system strategy
  • Allocating IT management resources to the health system. IT infrastructure is the most essential part of an effective telecommunications program
  • Emphasis on not recreating existing technologies in the field of remote health. Technology for setting up and promoting telecommunications is now available. Managers need to focus on finding suitable systems for their needs
  • Keep the telehealth system simple. A successful telemedicine program enhances health-care services, not complicating the work and lives of physicians, staff, or patients[12]
  • Understand that telehealth is not an independent product. Telehealth should be an integral part of the system that currently provides health care
  • Paying attention to efficient human resources and their training and strengthening. Without skilled and powerful workforce, telehealth will not succeed
  • Coordination and compliance of clinical standards with technical standards. Health system services will not achieve their goals properly if they do not comply with technical standards
  • Requiring government structures and the private sector active in the health system to have a telehealth deputy in their field of management.[13]

However, the fact that telehealth is now primarily responsible for providing health services does not mean that telehealth is easy to implement. The health system managers who are looking to add telehealth to their services still need a precise executive strategy. Without such a strategy, a telehealth program may never reach implementation or, if implemented, achieve its predetermined goals. Telehealth service providers must ensure that the elements of the correct strategy are in place.[14]

  Telehealth and Technology Top

Telehealth uses technology as a bridge to connect patients with remote health-care providers. While the medical factors of this method have been considerably studied, its technical and technological factors are not properly understood by clinical experts who are considering adding telemedicine to their practice.

With the appearance of recent advanced technologies, including high-speed Internet, videoconferencing methods, and virtual exam gadgets, digital visits are now possible as an alternative to face-to-face patient examinations. The technical necessities for a successful telemedicine program include a comfy, high-speed Internet connection, a clinical telemedicine shopping cart to function an interaction center, patient and health practitioner get right of entry to software program, and get admission to IT professionals to launch the program and fix its drawbacks.

If the technological and technical components are considered within the planning procedure, it is more likely to be triumphant.[15]

The quarantine restricts face-to-face clinical counseling in the COVID-19 epidemic, and the challenges of health-care systems in providing care to patients and people quarantined at home have led to alternative information technologies such as telemedicine and smartphones, which play an important critical role.[16]

There are four main types of service offered in telehealth, each of which must have its strategy:

  • Real-time videoconferencing: In this method, the doctor communicates directly with the patient, and regardless of the physical distance, the doctor and the patient meet each other via videoconference.
  • Store and forward: On this method of telehealth, X-rays, MRIs, pix, vital symptoms, and other patient records are stored and forwarded at a later time to a provider, generally a consultant, through a comfy and secure connection.
  • Remote patient monitoring: With far-flung patient monitoring (additionally referred to as the acronym RPM), providers can acquire an expansion of essential health information at the point of care, including blood pressure, heart rate, blood oxygen levels, and blood sugar ranges.
  • mHealth: The use of downloadable health-care apps and wearable health-care gadgets has exploded in current years.

  Telehealth and Challenges in the COVID-19 Era Top

Health systems that consider telemedicine strategy as part of pandemic management policies need to be aware of telehealth's challenges in this era. This includes:

  • Reimbursement: Nonuniformity in the reimbursement of physicians and telehealth service providers is one of the main concerns of many health-care providers. In the days of pandemic management, changing reimbursement policies to a value-based health-care model could ultimately solve the reimbursement problem. In the value-based paradigm, providers are not reimbursed for each service, but a certain amount is paid for each patient, so payers and physicians share the financial risk of care. Telehealth helps improve overall health outcomes and minimize financial risk for physicians by increasing the number of physicians' clients, especially those who do not seek services in hospitals and offices.[17]
  • Physician's license: Having the necessary licenses to provide services in the health system and how to prove it to the public and regulatory authorities is one of the most critical challenges of telehealth, especially in times of pandemics when the number of patients is very high and the need for a doctor increases. Telehealth, on the other hand, has no borders and can be offered internationally, complicating the challenge.
  • Security of patient information: The more patient information is stored and shared electronically, the greater the likelihood of this information being disclosed to unqualified persons, thereby creating problems for the patient and the service provider. In pandemics, due to the increasing number of patients, the volume of information increases, and the probability of their disclosure becomes much higher.[18]
  • Prescription through telehealth: Whether or not a qualified doctor prescribes medication at a remote appointment is another matter. Many have been seen either not providing an exact prescription or writing the patient's prescription without the necessary expertise.
  • Trust in the service provider: In the traditional type of providing health services, physical space and seeing the staff of medical centers would cause them to trust them, but in cyberspace, patients do not trust the service provider because they do not see them. It is more difficult for them to accept treatment orders, so they are less executed.[19]

  Conclusion Top

Telehealth is redefining how health care is delivered, especially after the COVID-19 epidemic. Today, the simultaneous presence of a doctor and a patient in a room is neither necessary nor possible, and the concept of “patient visit and examination” has found an entirely new meaning. To successfully implement telehealth in their organization, health system managers need to understand telehealth in all its aspects: What strategies and technologies are needed to implement telehealth? How can telehealth benefit insurance companies, patients, and health-care providers?

What are the challenges they may face during implementation, the financial implications of telehealth, and the policy changes that may affect telehealth in the future?

Most importantly, managers need a precise strategy and an ongoing program, leading to a standard clinical and technical system based on IT management, to implement strategies, technologies, and programs that address the health-care system staff and serve patients equally.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Schwamm LH. Telehealth: Seven strategies to successfully implement disruptive technology and transform health care. Health Aff (Millwood) 2014;33:200-6.  Back to cited text no. 2
Breton M, Sullivan EE, Deville-Stoetzel N, McKinstry D, DePuccio M, Sriharan A, et al. Telehealth challenges during COVID-19 as reported by primary healthcare physicians in Quebec and Massachusetts. BMC Fam Pract 2021;22:192.  Back to cited text no. 3
Strehle EM, Shabde N. One hundred years of telemedicine: Does this new technology have a place in paediatrics? Arch Dis Child 2006;91:956-9.  Back to cited text no. 4
Institute of Medicine Committee on Evaluating Clinical Applications of T. The National Academies Collection: Reports funded by National Institutes of Health. In: Field MJ, editor. Telemedicine: A Guide to Assessing Telecommunications in Health Care. Washington (DC): National Academies Press (US) Copyright ©1996, National Academy of Sciences; 1996.  Back to cited text no. 5
Porter ME. What is value in health care? N Engl J Med 2010;363:2477-81.  Back to cited text no. 6
Carroll D, Morzaria S, Briand S, Johnson CK, Morens D, Sumption K, et al. Preventing the next pandemic: The power of a global viral surveillance network. BMJ 2021;372:n485.  Back to cited text no. 7
Corden E, Rogers AK, Woo WA, Simmonds R, Mitchell CD. A targeted response to the COVID-19 pandemic: Analysing effectiveness of remote consultations for triage and management of routine dermatology referrals. Clin Exp Dermatol 2020;45:1047-50.  Back to cited text no. 8
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Murdoch DR, Crengle S, Frame B, French NP, Priest PC. “We have been warned”-preparing now to prevent the next pandemic. N Z Med J 2021;134:8-11.  Back to cited text no. 10
Rockwell KL, Gilroy AS. Incorporating telemedicine as part of COVID-19 outbreak response systems. Am J Manag Care 2020;26:147-8.  Back to cited text no. 11
Fields BG. Regulatory, legal, and ethical considerations of telemedicine. Sleep Med Clin 2020;15:409-16.  Back to cited text no. 12
Manocchia A. Telehealth: Enhancing care through technology. R I Med J (2013) 2020;103:18-20.  Back to cited text no. 13
Ellimoottil C, An L, Moyer M, Sossong S, Hollander JE. Challenges and opportunities faced by large health systems implementing telehealth. Health Aff (Millwood) 2018;37:1955-9.  Back to cited text no. 14
Baker J, Stanley A. Telemedicine technology: A review of services, equipment, and other aspects. Curr Allergy Asthma Rep 2018;18:60.  Back to cited text no. 15
Iyengar K, Upadhyaya GK, Vaishya R, Jain V. COVID-19 and applications of smartphone technology in the current pandemic. Diabetes Metab Syndr 2020;14:733-7.  Back to cited text no. 16
Ward MM, Ullrich F, MacKinney AC, Bell AL, Shipp S, Mueller KJ. Tele-emergency utilization: In what clinical situations is tele-emergency activated? J Telemed Telecare 2016;22:25-31.  Back to cited text no. 17
Mehrotra A, Huskamp HA, Souza J, Uscher-Pines L, Rose S, Landon BE, et al. Rapid growth in mental health telemedicine use among rural medicare beneficiaries, wide variation across states. Health Aff (Millwood) 2017;36:909-17.  Back to cited text no. 18
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