Telehealth and mHealth

When we accepted this opportunity to serve as coguest editors of this special issue in late 2019, we could not have fathomed how critically important telehealth and mobile health (mHealth) would become and how timely this issue would be. To say that telehealth has exploded is a gross understatement. During the pandemic and stay-at-home orders, the usefulness and the challenges of telehealth technology have never been more evident. The ability to continue care without in-person contact, was made possible through this valuable technology and the nimble response of providers and patients alike. At one health system alone, the number of virtual encounters increased from 200 per month to 5000 a day; a 25-fold increase in just 3 weeks! National estimates range between a 50- and 175-fold increase since the pandemic began (Zarefsky, 2020). This dramatic increase is commonplace across the country and in most health care disciplines. With the arrival of COVID-19 and stay-at-home orders instituted across the country, health care providers representing nearly all disciplines turned to technology to engage with their patients and deliver health care services. Since we accepted this guest editor assignment, the definition of telehealth has been expanded to include any virtual encounter intended to deliver acute and chronic care, interventions, provide consultation, and support caregivers to name a few. Virtual visits have exploded among psych-mental health providers; urgent care centers and clinics now deliver non-life-threatening emergent care via a screen. The real-time, audio-video communication made available has revolutionized health care with implications, workflows, and policies that will stand long after the pandemic ends. This timely special issue on telehealth and mHealth applications brings these valued technologies to life and helps us see the myriad uses, the challenges and enablers of technology use, and provides new knowledge of its effectiveness and future areas of research. In this special issue, four perspectives have emerged in using telehealth and mHealth. The consumer, provider, educator, and the researcher have all experienced unintended consequences, good and bad, from the rapid proliferation of telehealth and mHealth applications. Fortunately, temporary waivers granted by Medicare related to telehealth and virtual encounters have facilitated the expansion of telehealth and the offering of new telehealth services that were not previously covered. The pandemic and waivers also increased the consumer's acceptance of this explosion and allowed healthcare providers to maintain engagement with their patients. However, challenges still exist including restrictions that limit the virtual environment for some such as state boundary and provider licensure restrictions, broad-band availability, and lack of smart-phone and computer access for some disadvantaged groups. Vulnerable patients/consumers with multiple chronic conditions benefitted from telehealth because they could avoid social contact at the providers' offices by receiving care from their homes. Sadly, technology was employed for end of life goodbyes but also consultation for routine, chronic, and acute illness was made possible. Examples of telehealth interventions designed to support patients and caregivers are found in this special issue. Shaw et al. report on their use of telehealth to care for persons with dementia, demonstrating it was cost-effective compared to providing telephone support. Bakas et al. provide a review of apps useful for those struggling with the after-effects of a stroke, highlighting the importance of offering multiple telehealth technology options to stroke family caregivers. Unfortunately, not all can benefit as access to the technology and internet required to benefit from telehealth and mHealth applications is not enjoyed by all, leaving some without remote access to care. This is an ongoing issue that must be addressed. Our special issue highlights several innovative ways providers leverage technology including using mHealth for breastfeeding support (Mena-Tedula et al.), telehealth to assess depression and suicide ideation and provide interventions to chronically ill adolescents and young adults (Smith et al.). Mena-Tedula and the team found that the support accessed by mothers through the mHealth application LactApp changed according to their needs and their infant's developmental stage all while offering ongoing and updated support. Smith and colleagues successfully employed telehealth to support adolescents and young adults being treated with lifelong home parenteral nutrition infusions for short gut bowel diseases who were also suffering from depression. Depression measures were in the normal range and without any suicide ideation. Participants also appreciated being able to connect with other young patients in similar situations via the technology. The sudden onset of the pandemic pushed many providers into using telehealth without training, causing unease and discomfort, but simultaneously this saved critically needed personal protective equipment and reduced risk to health care providers and patients alike. Moving forward, health care educators must mobilize resources to rapidly integrate telehealth technology training into the curriculum to prepare the workforce to care for the acutely and chronically ill. Not only did the pandemic force educators to rely on technology to provide the actual education, but in moving forward, must prepare practitioners to provide health care via these evolving modes of delivery, thus reshaping curriculum and force the inclusion of the remote provision of care. This modification of the educational curriculum will impact all sectors of health care education to promote access and efficient care. This global coronavirus crisis highlights the critical importance of research to generate evidence to support the operation of this vital service and needed policy changes. Within this special issue, we present a review of the literature on telehealth interventions designed to combat sedentary behavior among adults with type 2 diabetes mellitus (Howland et al.) and two protocols for randomized controlled trials investigating the impact of a technology-enhanced coaching intervention for Black women with hypertension (Abel et al.) and a mHealth intervention for preventing and reducing perinatal depressive symptoms (Kinser et al.). As you read this special issue we hope you will learn how to advance your research and clinical care using telehealth and mHealth technologies. We suspect innovative technology will continue to evolve and be a driver of rapid transformation in all aspects of health care. As we begin this new year, we wish you good health and hope you will continue to promote technological innovation. It will be interesting to see how this rapidly evolving landscape will look a year from now and if the emergency policy changes by Medicare will be permanent, and if the momentum and acceptance of this mode of health care among consumers and providers will continue.