Telemedicine during COVID-19 Pandemic - Trend Analysis

This article provides an analysis of the trend of telemedicine during the COVID-19 pandemic. It discusses the support for telemedicine, the background of its use during the pandemic, the data sources and analysis methods used, and the results of the analysis. The article highlights the increased demand for telehealth services and the need for scaling up telehealth infrastructure and capability.

Telemedicine during covid- 19
pandemic – trend Analysis .
Rana Ali Shafai
2o2003473
Corse Code : 321
Information technology
HUMAN – COMPUTER interaction
D/Siva Malar

CONTENTS:-
• Introduction
• Support for telemedicine
• BACKGROUND
• Data Sources
• Data Analysis
• Methods
• Results
• Discussion
• Strengths and Limitations
• Conclusion

Introduction
COVID-19 was formally declared a pandemic by the World Health Organization
(WHO) on March 11, 2020. As of September 7, the WHO has reported over 27
million cases, with a cumulative mortality rate of 3.26% [1]. In the context of
infectious disease outbreaks such as the current COVID-19 pandemic, concerns
regarding the overloading of health care facilties, coupled with the need to
minimize patient and health care provider exposure in hospital care settings have
led to calls for a shift from the traditional patient-physician face-to-face physical
consultations to telehealth-based remote clinical services [2-6]. However, the
magnitude of this major shift in health care management has yet to be evaluated.
Public interest in and potential demand for telehealth services are relatively
unknown [7,8]. This information gap poses challenges for health care providers to
redesign strategies, institute new policies, and restructure manpower and
infrastructure to address a potential “new wave” of clinical needs.

Support for telemedicine
Telemedicine, as an alternative health care delivery option, provides quicker access to
some health care services to ensure patient needs are met during this public health
emergency. Among the many approaches to continue providing needed care in the
wake of physical distancing, telemedicine is an effective, yet underutilized method.
Proponents for telemedicine have argued for years about its potential for reaching
hard-to-reach patients.
Current research has demonstrated that telemedicine services create additional
capacity, greater convenience, and also yield greater use of services when offered via
telemedicine. Some of the striking disparities in access to healthcare have been reduced
when implementing a telemedicine model. There is limited research available which
addresses racial inequities in telemedicine services.

BACKGROUND
The use of telehealth services surged during the COVID-19 pandemic. A
2020 study found that telehealth use during the initial COVID-19 peak
(March to April 2020) increased from less than 1 percent of visits1 to as
much as 80 percent in places where the pandemic prevalence was high,2 and
a recent ASPE report found that Medicare telehealth utilization increased
63-fold between 2019 and 2020.3
The Health Resources and Services Administration (HRSA) defines telehealth as the
use of electronic information and telecommunications technologies to support and
promote long-distance clinical health care, patient and professional health-related
education, and public health and health administration.

Data Sources
The HPS was fielded approximately every 1 to 2 weeks beginning April 23, 2020.16 It
is a 20-minute online survey conducted on a weekly or bi-weekly basis with a new
cohort each round.17 The goal of the survey is to provide timely evidence on the
impact of COVID-19 pandemic on U.S. households. In 2021, the National Center for
Health Statistics (NCHS) and the HRSA’s Maternal and Child Health Bureau
(MCHB) partnered with the Census Bureau to include several questions for
monitoring changes in telemedicine use.18
We used data from April 14, 2021 through October 11, 2021, which is the time period in which
the HPS included questions on telehealth use among adults and in households with children.
Beginning in July 21, 2021, the survey added new questions on telehealth services,
distinguishing between those rendered via video-enabled telehealth vs. those with audio-only
services.*

Data Analysis
All analyses used survey weights to mitigate non-response bias and Taylor Series
Expansion/Linearization for variance estimation.
We first conducted descriptive analyses to assess differences in telehealth use across
population subgroups. We then developed two logistic regression models to identify
factors associated with: 1) rates of overall telehealth use in the previous four weeks,
and 2) the share of telehealth visits conducted with video (vs. audio-only) among
telehealth users. Both models accounted for respondents’ age, race, education,
income, health insurance type in five mutually exclusive categories,† and Census
region. We adjusted for gender identity (including transgender) in the telehealth
modality analysis, but not in the overall telehealth analysis due to a change in the
survey instrument during the study period.

Methods
Retrieving COVID-19 Key Dates and Confirmed Case Numbers
Real-world data on daily confirmed COVID-19 cases and deaths were
retrieved on July 9, 2020, from the WHO’s COVID-19 dashboard from
January 1, 2020, until July 7, 2020 [1]. Worldwide data, as well as individual
country-level data for the 50 countries with the highest cumulative confirmed
COVID-19 case numbers (as of July 7, 2020), were also retrieved. Key dates of
the COVID-19 pandemic were retrieved from the WHO’s COVID-19 timeline
and news reports of regional COVID-19–related events [20,21].
Retrieving Data From GT and Other Country-Specific Search Query
Databases
GT provides data on volumes and patterns in online search behaviors of
internet users [15]. It tracks keyword search queries that users enter into the
Google search engine and presents information on the search query according
to the specified time period and geographical location [22]. The search volume
results are normalized and presented as an RSV index, wherein each data
point is divided by the total searches performed in a specified geography
within a given time range to provide relative comparisons [22].

Results
Characteristics of the 50 countries, including the number of COVID-19 cases and deaths,
telehealthrelated RSVs, and ICT index values, are presented in Table 1. Across the 50 countries, the
mean total- RSV was 18.5 (SD 23.2; median 9.20, IQR 5.75–18.68), and the mean ICT index score was
62.1 (SD 15.0; median 64.5, IQR 51.2–72.5). Figure 1 (top) shows a geographic choropleth map of the
telehealth- related GT RSVs. North American countries had the highest total-RSVs (RSV=100 in
Canada and RSV=96.6 in the United States). Within Europe, Switzerland (RSV=19.5) and Portugal
(RSV=16.1) had the highest total-RSVs. For Latin America and the Carribean region, Chile
(RSV=74.7) and Ecuador (RSV=69.0) had the highest total-RSVs. Likewise, the United Arab Emirates
(RSV=40.2) scored the highest for the Middle East, South Africa (RSV=12.6) for sub-Saharan Africa,
Bangladesh (RSV=41.4) for South Asia, and Singapore (RSV=41.4) for East Asia. Similarly, Figure 1
(bottom row) demonstrates geographic choropleth maps by the number of COVID-19 confirmed cases
and deaths, respectively.

Discussion
Principal Findings
In this study, we used data from GT, the Baidu Index, and Yandex Keyword Statistics
to evaluate trends in telehealth demand during the first 6 months of the COVID-19
pandemic. To our knowledge, this is the first study to apply an infodemiological
approach to investigate the potential public demand for telehealth in the 50 countries
most affected by COVID-19. Our study further unraveled trends of demands
alongside key COVID-19 events and varying levels of ICT infrastructure. Our
findings suggest a general trend of increased demand for telehealth services across the
evaluated countries during the COVID-19 pandemic. This trend was largely sustained
beyond the initial wave, country lockdown periods, and subsequent reopenings. Our
results suggest an ongoing and possible increased interest in telehealth services in the
future as we enter a post–COVID-19 new normal phase. We also observed that
current ICT infrastructure in several developing countries may lag behind this
surging demand for telehealth. Our findings collectively indicate a pressing need to
scale up telehealth capabalities in response to this growth in telehealth demand

Strengths and Limitations
The key strengths of our study include our unique infoveillance approach to evaluate
the public demand for telehealth services, capturing real-time responses to key COVID-
19 pandemic events [11,16,43]. Second, our study provided extensive coverage of the 50
most affected countries worldwide, and evaluated these countries over a long duration
(6 months), thus providing more concrete insights on trends. Third, we also included
the additional use of the Baidu Index and Yandex Keyword Statistics to further
investigate RSVs in China and Russia. The high degree of correlation between GT and
Yandex Keyword Statistics for RSVs in Russia (r=0.875, P<.001) further confers a
degree of reliability to our results.

Conclusion
Telehealth is a major health technology solution that has gained further traction
during the COVID-19 pandemic. We identified increased demand for telehealth
services across the 50 countries most affected by COVID-19. We also found
indications that several developing countries may still have suboptimal ICT
infrastructure to cope with this surge in telehealth demand. These findings
underscore a pressing need for policy makers and health care providers to scale
up telehealth infrastructure and capability, during and beyond COVID-19.

END