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Checking up on Telehealth: A look at the pros and cons of remote care in North Carolina

Novant Health - New Hanover Regional Medical Center
Benjamin Schachtman
/
WHQR
Novant Health - New Hanover Regional Medical Center

The pandemic changed regulations around telehealth and helped usher it further into the mainstream. Its benefits — convenience and flexibility — have made it popular, although there are drawbacks to remote care, as well.

This reporting project was made possible by a grant from the Fourth Estate Fund.


The pandemic helped push telehealth, especially for mental healthcare, into the mainstream. Concerns about security, quality, and accessibility remain, but several practitioners from around North Carolina said they've seen telehealth's potential and are optimistic about the future.

Telehealth provides essential medical services such as clinical healthcare, counseling and therapy, public health and health administration, remote first aid and diagnostics, checkups, and more.

The trajectory of telehealth services

There is an estimated $247 billion in outpatient spending opportunity nationwide on virtual settings, including urgent care, office visits, home health services, and tech-enabled home medication administration, according to a white paper published by Atrium Health earlier this year.

Asia Schmidt is a licensed clinical addiction specialist and certified clinical supervisor based in Raleigh, North Carolina.

She started administering teletherapy during the COVID-19 pandemic. In her practice, she has noticed that telehealth care is becoming increasingly effective in meeting clients' needs efficiently.

"The trajectory of telehealth has been interesting to see develop, especially due to the uprise of modern technology," Schmidt said.

Prior to the pandemic, she had been informed by former clients about how they would sometimes wait months to be matched with a therapist for in-person sessions.

"Through teletherapy, we can better differentiate the level of care needed for our clients. Based on the feedback I hear; they have noticed a lot of progress from it," she said.

Advantages of telehealth

Schmidt has witnessed an uptick in health providers ensuring telehealth services, such as teletherapy, in all regions of North Carolina.

The primary advantage she’s noticed with telehealth is that more clients have positive success stories, and have been happier receiving their healthcare this way. In addition, she has felt it reduces overall travel and wait times.

"I truly enjoy seeing a client's progression over time. An important aspect is seeing how they respond to adversity and evolve," Schmidt said. "I think there is this unrealistic expectation that progress is linear. However, to see clients reframe their mindset is inspiring."

Disadvantages of telehealth

Telehealth has also presented several hurdles. One of the leading difficulties is its utility in internet service deserts, where access to technology is either limited or unavailable.

“For someone who may live in a more rural area within the state, connectivity can be a prevalent issue for them to receive virtual healthcare,” Schmidt said.

Health practitioners have also said they cannot treat everyone through telehealth delivery.

“There are those I cannot serve simply because they are out of my scope,” said Crystal Massey.

Massey is a licensed clinical social worker, and a licensed clinical addiction specialist based in Garner, North Carolina.

“I don’t work with small children on telehealth, or do treatment for people who have more significantly acute illnesses,” she said.

In addition, there has been an ongoing discussion on the security of electronic personal health data, including patient privacy and user experience.

A recent instance is with BetterHelp, one of the largest online psychotherapy platforms.

According to the Federal Trade Commission, “BetterHelp agreed to pay $7.8 million to settle the FTC’s charges, first announced in March 2023, that it used and revealed sensitive consumer data—specifically email addresses, IP addresses, and answers to personal health questions—for advertising purposes.”

As of May, this year, around 800,000 people were eligible for refunds, and other websites under the BetterHelp banner gave reimbursements, such as MyTherapist, Teen Counseling, Faithful Counseling, Pride Counseling, iCounseling, Regain, and Terappeuta.

State policy changes in telehealth

The pandemic helped usher in some important changes for telehealth. According to the North Carolina Medical Journal, "Services that made sense to provide via telehealth were also granted coverage and payment parity with in-person care so long as the services met the standard of care and were conducted via HIPAA-compliant technology.”

Massey said telehealth has changed the way healthcare has been done in the past few years.

“When telehealth was gaining traction, there were temporary policy changes being implemented, especially for public insurance. Now, many of those rules have become a permanent change for how services can be provided,” she said.

Within telehealth, she treats clients for mental health and substance use disorders and provides conference clinical sessions and assessments.

"It is slowly becoming the normality of provided care," Massey said.

Artificial intelligence interwoven with telehealth

One of the key discussions in telehealth is its relationship to artificial intelligence (AI). AI software has already started to provide companies with virtual assistants, and taken a hand in tracking client data, such as diagnoses and test results.

There have been concerns that artificial intelligence could negatively impact the efficacy of remote care. Factors, such as privacy issues, hallucinations, and data security, are becoming a rising threat.

A lack of technological stability in data transmission can lead to risks of losing sensitive information and inaccurate patient data, affecting both the client and the practitioner.

There must be a transparent framework, and health practitioners are observing the positives and negatives of collaborating with this modern technology.

Schmidt highlights how her company has recently deployed AI chatbots to assist clients in obtaining proper medical resources. When training their chatbots, the leading goal is to oversee clinically reviewed content provided by licensed professionals to ensure the ability to provide sustainable feedback.

"In my case, it has securely captured conversations in our sessions, which later makes documenting psychotherapy notes more refined and accurate," she said.

She expressed how accepting the utilization of artificial intelligence has been a gradual process.

"Honestly, it is both scary and exciting. Having had firsthand experience in helping design some of the chatbots, I wonder if this will eventually take our jobs and weaken job security," Schmidt said. "But we might also be able to change the game of therapy in addressing specific needs."

Similarly, Massey said that her company uses artificial intelligence to reinforce its documentation process for virtual sessions. Their providers contribute human oversight to review, alter, or edit the content, and all parties involved must consent to the use of artificial intelligence beforehand.

"At first, I was so against it. However, as time has passed, I have seen how it has saved time and been clinically appropriate for us," she said.

A positive outlook on teletherapy

Eugenia Davis is a licensed clinical mental health counselor, who offers teletherapy. She was previously based in Durham, North Carolina.

Davis admits she did not recognize virtual therapy as an available method for people until the pandemic. After additional research, she learned that several platforms have always offered virtual therapy, and other telehealth services.

According to Atrium Health, “Around 20% of all Medicare, Medicaid and commercial outpatient, emergency department and home health spending could be virtually enabled.”

"I do believe that the convenience of it allows many to remain in therapy. I must say that I also have witnessed many people wanting to return to the office once things started to die down a little with the pandemic," she said.

As a counselor, Davis enjoys watching her clients experience growth, and be able to reflect and gain insight on their emotions and feelings.

“To become a healthier person, with regards to mental health, it requires some work on their part, and to recognize that it is not instantaneous,” she said.

Annette Jackson began her therapeutic journey back in 2021. Residing in Knightdale, North Carolina, she has been an active virtual therapy client.

From her experience, telehealth has been a flexible option to address her mental health conditions.

"Not only is it convenient with my hectic work schedule, but it also allows me to get matched with a therapist who can understand all sides of me, not just something that needs to be fixed," Jackson said.

Disadvantages of teletherapy

However, providing remote therapy does come with some challenges and drawbacks.

Davis mentions a disadvantage of teletherapy is not being able to work directly with children, which is attributed to the need for face-to-face experience.

"Some people require more interaction, especially with play therapy, and I don't feel this can be achieved while being virtual," she said.

Schmidt noted that the intimacy of an in-person session is sometimes lost during virtual therapy.

"The biggest disadvantage I've seen is some people don’t feel the connection, and prefer to meet with people face-to-face," Schmidt said.

And, as with any telehealth service, having access to communication infrastructure – like wifi, internet connection, or high-quality cellular service — is important, Jackson said.

"One disadvantage I have experienced with teletherapy is if the connection is poor, the call can drop," Jackson said.

Comfortability from a virtual therapeutic approach

However, as a client, Jackson has seen how virtual therapy has left no excuses for not attending sessions, which helps her to remain transparent and vulnerable with those around her.

“I can pretty much reach out to my therapist whenever and wherever. I was able to pick my therapist through personality questions, which allowed them to take their time learning about me in time,” she said.

Overall, she hopes more people utilize telehealth.

“Sometimes you just need someone to talk things out with,” Jackson said. “Life isn't meant to be easy, but as social creatures we need human connection, even if that is through telehealth.”

Ana Johnson is a freelance writer, based in Wilmington, North Carolina. Recently, she graduated from Kennesaw State University with a degree in Journalism and Emerging Media. She is attracted to covering issues such as mental health, local history, communities of color, public health, and the performing arts