Lew Susie Q, Sikka Neal, Erickson Kevin F
Division of Renal Diseases and Hypertension, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Mhealth. 2025 Mar 10;11:22. doi: 10.21037/mhealth-24-61. eCollection 2025.
The use of telehealth in the United States accelerated in 2020 when a coronavirus disease of 2019 (COVID-19) related public health emergency (PHE) was declared. Centers for Medicare and Medicaid Services issued emergency waivers that relaxed restrictions imposed by regulations on geographic locations, originating and distant sites, audio-video-conferencing technology and re-imbursement. This review focuses on the history of telehealth usage for patients with end-stage kidney disease. Patients who receive home dialysis gained widespread access to telehealth in 2019, following passage of the Bipartisan Budget Act of 2018, Sec 50302 by the US Congress. For the first time in telehealth application, the patient's home could be an originating site without geographic restrictions for telemedicine. These earlier regulations will continue even after the PHE expires. While they made telemedicine possible for many patients receiving home dialysis, in practice, the uptake of telemedicine in the home setting may have been sluggish following the 2018 law. Rules governing the frequency of telemedicine visits and other stipulations for home dialysis that were specified in the 2018 law were relaxed in the setting of the COVID-19 waivers, further facilitating the use of telemedicine for home dialysis care. Meanwhile, the in-center dialysis unit became an originating site for the first time during the COVID-19 PHE, with a corresponding sharp increase in the use of telemedicine for in-center hemodialysis care. The waivers enabling the use of telemedicine for patients who receive in-center hemodialysis and further facilitating the use of telemedicine in home dialysis, expire with the end of the COVID-19 PHE unless Congress passes new legislation. Comparisons among the periods before, during and after the PHE can illustrate telehealth's impact and some of its challenges. Most of the literature on telehealth represents observational data. Future studies on telehealth, including clinical trials, could provide information on outcomes and cost savings.
2020年，当2019冠状病毒病（COVID-19）相关的公共卫生紧急事件（PHE）宣布时，美国远程医疗的使用加速了。医疗保险和医疗补助服务中心发布了紧急豁免，放宽了法规对地理位置、原发地和远程地点、音频视频会议技术以及报销的限制。本综述重点关注终末期肾病患者使用远程医疗的历史。2018年美国国会通过《两党预算法案》第50302条后，接受家庭透析的患者在2019年广泛获得了远程医疗服务。在远程医疗应用中，患者的家首次可以成为不受远程医疗地理位置限制的原发地。即使公共卫生紧急事件结束后，这些早期规定仍将继续。虽然它们使许多接受家庭透析的患者能够使用远程医疗，但实际上，2018年法律颁布后，家庭环境中远程医疗的采用可能一直很缓慢。2018年法律中规定的远程医疗就诊频率规则和家庭透析的其他规定在COVID-19豁免的情况下有所放宽，进一步促进了远程医疗在家庭透析护理中的使用。与此同时，在COVID-19公共卫生紧急事件期间，中心透析单元首次成为原发地，中心血液透析护理中远程医疗的使用相应急剧增加。允许接受中心血液透析的患者使用远程医疗并进一步促进家庭透析中远程医疗使用的豁免，将随着COVID-19公共卫生紧急事件的结束而到期，除非国会通过新的立法。对公共卫生紧急事件之前、期间和之后各时期的比较可以说明远程医疗的影响及其一些挑战。大多数关于远程医疗的文献都代表观察性数据。未来关于远程医疗的研究，包括临床试验，可以提供有关结果和成本节约的信息。
