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Introduction¹

The use of telehealth technology has expanded rapidly in recent years. This expansion has been dramatically accelerated by the COVID-19 pandemic. Telehealth involves a wide variety of modalities and practices and can bring welcome flexibility for patients, clinicians, and health care organizations. It also raises a range of questions with regard to health care equity and access; digital privacy and security; and how telehealth fits into frameworks for health care policy, regulation, and reimbursement.

The Social Security Administration (SSA) is interested in the growing role of telehealth and the ways in which it can be used in consultative examinations (CEs) as part of its process for evaluating applications for disability benefits (also referred to as a disability claim). When an individual applies for SSA disability benefits, they are required to submit supporting medical records as part of the application. In some cases, after reviewing the medical evidence included in the disability application, SSA may find that information inadequate and will request a CE. The purpose of the CE is to collect medical information that SSA found missing or inadequate in the initial application for disability benefits. SSA sponsored a workshop hosted by the National

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¹ The planning committee’s role was limited to planning the workshop. This Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of the individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

Academies of Sciences, Engineering, and Medicine to examine telehealth and evaluate potential challenges or barriers specific to this mode of care delivery, particularly in respect to patient evaluation. The workshop, organized by a planning committee of the National Academies and titled The Use of Telehealth for Disability Evaluations in Medicine and Allied Health, was held virtually March 9–10, 2022.

The workshop was designed to provide SSA with a picture of current telehealth practice and the challenges associated with this mode of service delivery. The event brought together 25 speakers from government, academia, industry, and nonprofit organizations to examine current practice and challenges associated with patient evaluation via telehealth in a series of live-streamed presentations and interactive discussion sessions.

Allen Heinemann, chair of the workshop planning committee, welcomed participants with a brief overview of the event’s impetus and focus. He noted that examples of telehealth modalities can be found stretching back to the mid-20th century, though the concept was initially more narrowly referred to as telemedicine. Despite this long history, telehealth was only widely adopted after the advent of new technological tools such as electronic health records and mobile devices, multiple health care reforms, and supportive state and federal legislation. The COVID-19 pandemic spurred an incredible rise in use and prompted SSA to establish new processes for providers to use telehealth for some CEs.

The workshop was designed to inform SSA on current telehealth practices and challenges, particularly with respect to patient evaluation, by facilitating a wide-ranging discussion on the use of telehealth across disciplines and areas of practice, Heinemann said. Steve Rollins, acting associate commissioner in the SSA Office of Disability Policy and Office of Retirement and Disability Policy, added that SSA is committed to incorporating medical advancements into its collection and consideration of evidence where appropriate. When telehealth was first introduced, regulatory and technological limitations impeded widespread adoption, but health care reforms and legislation, new technologies, and the COVID-19 pandemic have increased its use across many areas of health care. This prompted SSA to explore how telehealth is being used by the medical and allied health communities along with potential challenges claimants may face with regard to issues such as access, privacy, and legal concerns.

Several speakers throughout the workshop used the term digital divide when discussing concerns related to equity in access during their presentations. The term refers to the division between individuals, communities, and geographic areas that have historically faced barriers to accessing information and communication technologies such as broadband Internet and related devices and those that have not faced such barriers (OECD, 2001).

The workshop was divided into six sessions. Sessions 1 and 2 offered an overview of telehealth broadly and in the context of the COVID-19 pandemic. Session 3 explored the use of telehealth in a range of clinical specialties. The remaining sessions examined telehealth access and digital inclusion and equity; the experiences of various U.S. health care systems in deploying telehealth; and licensure, privacy, and security issues. Throughout the event, participants and speakers engaged in a lively exchange of information and ideas via chat and open discussion sessions.

This workshop proceedings was developed by rapporteurs based on recordings, transcripts, and slides from the workshop and provides a high-level summary of the presentations and discussions. The proceedings are divided into chapters consistent with the sessions of the workshop. Those chapters are organized by the speakers’ respective presentations, with the subsection titles reflecting the title of each presentation. The list of references, the statement of task for the project, the workshop agenda, the speakers’ and planning committee members’ biographies, and a list of acronyms and abbreviations used in the proceedings can be found in the appendices.

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