Telehealth Utilization inResponse to the Novel Coronavirus (COVID-19) Pandemic in Orthopaedic Surgery

Robert L. Parisien, MD; Max Shin, BA; Michael Constant, BA; Bryan M. Saltzman, MD; Xinning Li, MD; William N. Levine, MD; David P. Trofa, MD


J Am Acad Orthop Surg. 2020;28(11):e487-e492. 

In This Article

Abstract and Introduction


Introduction: The purpose of this investigation is to assess the current utilization of telehealth capabilities at academic orthopaedic departments in the United States and to determine how practice patterns have been directly influenced by the coronavirus disease 19 (COVID-19) pandemic.

Methods: Orthopaedic surgery programs participating in the Electronic Residency Application Service were identified. One hundred seventy-five (175) programs were presented with a seven-item questionnaire addressing whether each program is using telehealth services in response to the COVID-19 pandemic.

Results: Of the 175 Electronic Residency Application Service participant orthopaedic programs, 168 responded for a total response rate of 96%. Of the 106 institutions using telehealth services, 88 (83%) cited the COVID-19 pandemic as the impetus for implementation of telehealth services. Institutions located in the Northeast and South regions were markedly more likely to offer telehealth services. Heat map analysis demonstrates an associative overlap of regional "hot spots" with direct comparison of COVID-19 cases in the United States and orthopaedic departments providing telehealth services.

Discussion: This study demonstrates the impressive measures academic orthopaedic institutions are taking to meet the needs of our patients by identifying a notable increase in new telehealth offerings throughout the United States with a positive correlation with COVID-19 disease burden.


Rapidly evolving, modern information technologies have provided a host of options to improve communication across all fields, including medicine. Telehealth broadly refers to the use of electronic information and telecommunications technology to deliver and support health-related services including both clinical and nonclinical as well as provider education or medical training via the internet, video conferencing, wireless communications, streaming multimedia video, and store-and-forward telemedicine. Under the umbrella of telehealth is telemedicine, which specifically refers to the delivery of clinical care to a patient without an inpatient visit, often performed via secure Health Insurance Portability and Accountability Act (HIPAA) compliant video conferencing. It is typically used for follow-up visits of established patients, management of chronic conditions, specialist consultations, and medication management. More specifically, in a peer-reviewed article describing modern telemedicine, Sood et al[1] defined it as a "branch of e-health that uses communications networks for delivery of healthcare services and medical education from one geographical location to another." The authors also explained that telemedicine can also be used as a way "to overcome issues like uneven distribution and shortage of infrastructural and human resources." Furthermore, telehealth can provide a safe means of delivering clinical care when the dangers of interpersonal contact outweigh the benefits of standard patient visits, as we are currently experiencing during the coronavirus disease 19 (COVID-19) pandemic.

Telehealth services have been used in several documented roles within orthopaedic practice including remote consultations, outpatient care, postoperative evaluations, and rehabilitation.[2–6] Despite such publications highlighting utilization and benefits of telemedicine, to the authors' knowledge, it is not widely regarded as a standard service or patient expectation among most orthopaedic practices in the United States. Furthermore, there are a specific set of challenges associated with implementing telehealth services including the need for additional technological equipment, medical provider training, additional staff, patient education, altered reimbursement schedules, and absence of in-person physical examination, among others. Furthermore, there is a challenge to adhere to the HIPAA compliance, which often requires careful implementation of secure communication channels. However, given the unprecedented evolution of the COVID-19 pandemic, the federal government has suspended the established HIPAA compliance requirements and related telecommunications for telehealth services. In addition, the Centers for Medicare and Medicaid Services announced expansion of telehealth services on an emergency basis via the 1,135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. This waiver allows for Medicare coverage of "office, hospital and other visits furnished via telehealth across the country and including in patient's places of residence starting March 6, 2020."[7] This has greatly increased the providers' ability to maintain continuity of care for patients at a time when social distancing, self-isolation, and quarantine have become the new norm.

The purpose of this investigation is to assess the current utilization of telehealth capabilities at academic orthopaedic departments in the United States and to determine how practice patterns have been directly influenced by the COVID-19 pandemic. The authors hypothesize that orthopaedic departments have only recently begun to implement telehealth services in response to the pandemic with most those departments located in regions of high disease burden.