UB researchers advocate for continuing fewer rules for telemedicine

During the COVID-19 pandemic, the federal government loosened regulations that govern the use of telemedicine for patients, which are set to expire on Dec 31. With a few months to go, an extension is possible. Some UB researchers and clinicians believe that returning to pre-pandemic restrictions would have a profoundly negative impact on health care.

“It is an important time to be raising issues about telemedicine,” says Andrew Talal, professor of medicine in the Jacobs School of Medicine and Biomedical Sciences and associate director for the Clinical and Translational Science Institute’s (CTSI) Hub Liaison Team. “Health care is changing. We have the technology; people should be seen wherever they are, when they want to be seen.”

“[Telemedicine] has allowed for increased access to treatment for many people and has certainly saved tens of thousands of lives — if not more — across the country,” adds Joshua J. Lynch, clinical associate professor in the Department of Emergency Medicine in the Jacobs School. “Letting these rules expire or requiring in-person visits to continue virtual care would be going backward.”

Both Talal and Lynch began exploring the effectiveness of telemedicine in their research before the pandemic. In a pilot study, Talal found that telemedicine was effective in treating and curing individuals with opioid use disorder and hepatitis C virus (HCV). “The pilot study enabled us to test the concept that telemedicine encounters facilitated by a case manager could be embedded in an opioid treatment program,” Talal explains.

And in a different study, Lynch and Brian Clemency, professor in the Department of Emergency Medicine, found that telemedicine referrals for emergency department patients with opioid use disorder can be a more effective than referrals to an outpatient clinic.

In April 2024, Talal published the results of a large randomized controlled trial in JAMA that directly compared the effectiveness of integrating telemedicine into opioid treatment programs for HCV management compared to usual care, off-site referral. (Preliminary data came from the pilot study published in 2019.)

“We achieved 90% cure in the facilitated telemedicine arm compared to 39% in referral,” Talal says. The study resulted from the identification of what Talal describes as limited access to direct-acting antivirals (DAAs) for HCV and difficulties acquiring and operating digital equipment and infrastructure among hepatitis patients.

“In 2012, I saw that DAAs for HCV were going to be developed, and they were going to revolutionize treatment, as they cure almost everyone within two to three months,” Talal explains. “Since HCV is spread through contaminated needles, people with opioid use disorder have the highest rates of infection. Those who are on methadone therapy for treatment of their substance use may go every day or multiple times each week to pick up methadone, and many of them have this infection. So, we wondered, ‘Why can’t we use telemedicine to overcome the temporal and geographic barriers? Would somebody seeing me distantly [be able to] trust me?’ What we discovered through our research is the answer is a definite yes.”

The advent of the smartphone helped many patients overcome digital barriers to the use of telehealth — i.e., lack of a home computer or internet connection. And once COVID-19 began to impact the world, telemedicine moved from occasional use to heavy use.

“What COVID did was move telemedicine to the forefront of public discourse,” Talal says. “And it led to some fundamental reforms within how opioid use disorder is treated.”

In a paper co-authored by Talal and published in 2023, opioid treatment program staff commented that “[o]n-site facilitated telemedicine in opioid treatment programs expands treatment access for an underserved population with high levels of health inequities” and even “provided an innovative patient care experience for the staff as well as opportunities to enrich competencies, which enhanced staff’s acceptance of telemedicine.”

In another publication, opioid treatment program staff described that facilitated telemedicine for HCV achieved high levels of collaboration and integration largely leveraging pre-existing workflows.

Lynch and Clemency co-authored a paper published in 2024 in the Journal of Substance Use and Addiction Treatment that evaluated whether telemedicine evaluations are feasible for people with opioid use disorder. Data came from patients who were part of the MATTERS Network, an opioid treatment network affiliated with UBMD Emergency Medicine and the UB Department of Emergency Medicine, and available across New York State.

While the study looked at referrals made between Oct. 1, 2020, through Sept. 30, 2022, Lynch says UBMD telemedicine services were in place prior to COVID. During the pandemic, however, an interesting trend was observed.

“We realized that the vast majority of patients that were taking advantage of the telemedicine service were patients with addiction and mental health issues,” Lynch explains. “So, UBMD pivoted the telemedicine program that we built for the hospitals, and MATTERS pivoted also, so that we could provide emergency telemedicine evaluations and then add in the MATTERS resources.”

Study results showed that patients who were evaluated on telemedicine and then linked to treatment followed up at a much higher rate than those who were seen in the emergency room in person and were referred to treatment.

“If you start to think about challenging diagnoses like opioid use disorder, mental health, HIV, hepatitis — those are marginalized patient populations that are stigmatized, and the fact that they must go to an office is contributing to why a lot of people never get treatment.”

Telemedicine provided a way to be seen by a physician in the privacy of their own homes and without having to worry about issues like transportation and child care.

“Consider all the convenience issues and logistical steps that someone has to go  through to get care,” Lynch says. “Telehealth breaks down barriers across the entire spectrum.”

In addition, Lynch says telemedicine adds flexibility and cost savings for providers and health care professionals.

“When we have our emergency telemedicine assessments, a lot of times our providers are at their own homes instead of sitting in an office overnight for 12 hours,” he says. “It is much more cost effective to have them at home. And then they can be called if there is a consult during the night.”

Both Talal and Lynch believe that artificial intelligence will lead to changes in telemedicine — in fact, AI is already making an impact. For the MATTERS program, Lynch says there have been discussions about AI-driven, automated follow-ups with patients after they are linked to treatment.

“Then, if it sounds like they are about to fall through the cracks, we can relink them to the treatment or offer them a telemedicine visit,” he says. “We have also started to explore AI-powered virtual assistants to provide 24-hour support. It could provide basic guidance on certain clinical scenarios, with the ability to kick it up to a person who can help.”

Talal says human interaction is still paramount, especially when it comes to establishing trust between patient and doctor: “They saw the telemedicine provider — be it me or someone working with me — as the face of the opioid treatment program. That matters.”

Several legislative pathways are currently being considered that would result in an extension of post-COVID telemedicine regulations. With just three months between now and Dec. 31, researchers and telehealth advocates are watching closely to see what the future holds.