The health care system in the United States is at a critical inflection point. Approximately more than 100 million people in the U.S. are either uninsured or underinsured, and the access to comprehensive care persists to be a barrier to well-being and health—many of these low-cost or free public health centers for the disbursement of primary care (Sundstrom, DeMaria, Ferrara, Meier & Billings, 2019) . Often than not., the community health centers are not equipped to provide care for patients with chronic or complex conditions such as Alzheimer's disease, diabetes, cancer, rheumatoid arthritis, heart diseases, and other illnesses that require highly specialized physicians (Eze, Mateus & Cravo Oliveira Hashiguchi, 2020) . Although clinics can issue referrals, patients are frequently faced with barriers such as the distance of travel, out of pocket expenditure, long wait times, and other limitations resulting in patients not receiving the vital care that they need (Rajasekaran, 2020) . Thus, this trend leads to increased hospital readmissions, escalated emergency room visits, worsening conditions, reduced quality of life, and sometimes death, all of which can be averted with timely access to comprehensive care at the right time (Mann et al., 2020) .
Telehealth is the use of information and communication technologies to provide health care and related services that support patient care, health education, and administrative activities irrespective of the patient's location (Sundstrom, DeMaria, Ferrara, Meier & Billings, 2019) . Telehealth is a healthcare service delivery model that is aimed at increasing the convenience to patients while receiving care, increase access to care in regions where the physician-patient ratios are inadequate, and improve access to care in both rural and urban settings (Mann et al., 2020) . Compounding the already existing challenges is the novel COVIDE-19 pandemic, which has increasingly proliferated across the nation (Eze, Mateus & Cravo Oliveira Hashiguchi, 2020) . In the last seven months, the health care system has been pushed to its breaking point, and most departments are severely strained, making it impossible for patients to gain access to the critical care that they need. Efforts to lessen the spread of the virus and protect at-risk populations have created confusion about when and how patients should seek preventative care as well as manage the already existing chronic conditions.
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Community health centers are experiencing challenges in providing care to patients, inadequate PPE (personal protective equipment) to keep both patients and staff safe during the pandemic as well as the need to adopt telehealth services. Frontline primary care providers have become increasingly stressed, traumatized, and burned out in caring for patients at all points of care (Mann et al., 2020) . The care for patients with severe conditions such as cancer, diabetics, and attention deficit hyperactivity disorder, as well as planned surgeries, has been postponed for fear of getting ill (Eze, Mateus & Cravo Oliveira Hashiguchi, 2020) . All these challenges advocate for the prompt adoption of telehealth in all hospital settings across the United States to reduce the risk of cross-contamination during the pandemic caused by close contact, while increasing access to care and reducing the spread of infections while allowing patients to continue with their diagnostic, therapeutic processes (Rajasekaran, 2020) .
Lobby to Legislators
In theory, the effectiveness and convenience of telemedicine should be the reason that the federal government and healthcare institutions to implement it nationwide. However, some challenges prevent the spread of telemedicine, and in many cases, these discourage physicians and practices from trying it at all (Sundstrom, DeMaria, Ferrara, Meier & Billings, 2019) . Finance, licensure, existing health disparities, and broadband gaps are some of the challenges for the progress of healthcare, and they have proven to be significant obstacles.
To begin with, federal and licensing laws prevent the adoption of telemedicine because policies and regulations vary across states. This requires that physicians and providers to obtain medical licenses from different states that they would want to practice. In other cases, providers are asked to pay exorbitant fees in order to practice across states (Eze, Mateus & Cravo Oliveira Hashiguchi, 2020) . In addition, after obtaining the required licensure to practice medicine across states, providers are requested to adhere to state medical practice regulations that are diverse and, at times, conflicting (Rajasekaran, 2020) . These policies and regulations limit the geographic footprint of providers who only have licensure to practice in the state where they reside, which obstructs the impactful benefit of telemedicine, which is to connect patients and doctors at a distance while improving patient outcomes (Huston, 2014) .
Reimbursement policies by the federal government are primarily focused on Medicare, and they have imposed limitations in the provision of telehealth services, both by geographically and the facility, as well as what services, are covered. To complicate matters further, states dictate different Medicaid policies creating telehealth regulations and laws that vary across the nation (Eze, Mateus & Cravo Oliveira Hashiguchi, 2020) . The legislated telehealth laws have parity both in coverage services and payments. While payment parity may encourage physicians to adopt telemedicine, enforcing equal payment platforms may limit the cost-effectiveness of telemedicine because the meaningful adoption of telemedicine relies on statutory language (Huston, 2014) .
The successful implementation and adoption of telehealth in rural areas require the expansion of internet access (Sundstrom, DeMaria, Ferrara, Meier & Billings, 2019) . All the initiatives in the adoption of telehealth require a steady internet connection, and the unavailability of broadband disproportionately affects rural areas. The unavailability of internet access challenges the ability of individuals to participate in telemedicine in the comfort of the homes. This is exacerbated further by constrained access to smartphones as mobile health and remote patient monitoring systems need access to smartphone applications (Rajasekaran, 2020) .
Based on the above challenges in the adoption of telehealth and related services, I believe that state regulation in the delivery of telehealth services can be leveraged by patients who prefer access to medical care remotely (Mann et al., 2020) . State regulations can allow telemedicine to expand the geographical areas that doctors and hospitals serve; thus, patients in rural areas would not need to travel for treatment and routine consultation with primary care providers (Huston, 2014) . Since primary-care providers serve local patients, state-level regulations could offer reimbursements by state-licensed insurers and medical boards as an incentive. Private and health insurance is sold and regulated at the state level (Sundstrom, DeMaria, Ferrara, Meier & Billings, 2019) . Through laws, state regulations can allow payers to decide how telehealth can help them meet their coverage obligations. Through this, payers can contact third-party providers to provide telehealth services to their members.
The federal government can encourage states to sign the Interstate Medical Licensure Compact that will help in streamlining the process for providers and physicians in the application of licensure in other member states (Eze, Mateus & Cravo Oliveira Hashiguchi, 2020) . The federal government can also pass a law that authorizes the provider's location as the location in which the provision of care takes place for the purposes of licensure and payments (Huston, 2014) . In turn, this will safeguard the authority of state medical boards in granting licenses, while allowing providers to treat patients remotely in other states.
Lobbying for the Adoption in all Health Care Settings
The first step in getting support from Congress is the identification of the topic for a change. The issue that I have selected is "Deeper Integration of Telehealth and Related Services in Healthcare." The second step would be to acquire like-minded individuals who share the same vision from providers to physicians and people from different parts of the community (Sundstrom, DeMaria, Ferrara, Meier & Billings, 2019) . After the group has been formed, we will schedule a meeting request through a letter submitted online. This will be followed by directly seeking an audience with the leaders or through phone calls. The letter will introduce the name of the group, an overview of the change project, and the roles played by different members of the group.
The Relevance of Telemedicine in Healthcare
Telemedicine is a poorly adopted concept in all health care settings across the United States. In the era of COVID-19, telemedicine has regained popularity; thus, the federal government and insurers are looking to telehealth to provide care to patients in their homes (Rajasekaran, 2020) . COVID-19 was declared a global pandemic in March 2020 by the World Health Organization, which led to many people across to country to be placed under shelter in place orders, social distancing and quarantine recommendations for suspected cases as well as the inadequacy of PPEs has forced the delivery of in-person health care to migrate to telehealth (Sundstrom, DeMaria, Ferrara, Meier & Billings, 2019) . These measures have been put in place to reduce the risks of exposure to COVID-19 and to avoid overstretching emergency departments and urgent care centers. The rapid spread of COVID-19 has challenged the entire healthcare system in the United States from hospitals to first responders and to medical practitioners. Primary care providers have been adversely impacted by the lack of PPEs, institutional stress in the care of infected people, the delivery of care to other patients, and insufficient testing (Eze, Mateus & Cravo Oliveira Hashiguchi, 2020) . Through telemedicine, the use of virtual visits via smartphones can be used in addressing routine management in the delivery of care and to determine the need for in-person care, online, or patients can use app-based questionnaires before showing up to the emergency room or for urgent care visits (Huston, 2014) .
Integration of Telehealth in Clinical Practice
In primary care, telehealth is used to triage both urgent and non-urgent medical requests to providers and physicians when offices are closed for routine follow-ups and prescription refills and check-ups for patients with chronic conditions (Sundstrom, DeMaria, Ferrara, Meier & Billings, 2019) . The benefits of integrating telehealth into clinical practice include better relationships between physicians and patients and improved patient and population health outcomes (Huston, 2014) . These benefits are a result of increased engagement between patients and physicians in their day to day health care needs through smart devices. In clinical settings, telemedicine has the ability to increase access to and the quality of health care services, as well as reduce costs for both patients and providers. In addition, telemedicine facilitates the delivery of specialized services for remote populations on time, save transportation costs for patients and physicians, and facilitate the access to education for physicians and nurses (Sundstrom, DeMaria, Ferrara, Meier & Billings, 2019) . The unprecedented factors brought about by COVID-19 have led to the use of telehealth solutions for assessing, managing, and treating patients while maintaining physical distance where possible. The adoption of telehealth by providers and clinicians could help protect susceptible patients and populations by keeping them out of emergency rooms and clinics, triage individuals virtually to evaluate for COVID-19, and treat patients with non-COVID-19 symptoms complex or chronic conditions while preserving limited critical care resources (Rajasekaran, 2020) .
The Integration of Telehealth in Clinical Settings
As positive case and death increased, and the methods to mitigate the spread of COVID-19, questions were raised concerning how modern childhood was impacted and the growing concern of severe mental health consequences among children associated with the public health crisis and extreme mitigation measures (Gurwitch, Salem, Nelson & Comer, 2020) . This prompted providers serving children and families to move to implement technology-based remote services, including mental health services for children and families. With the restrictions on telehealth services eased by federal and state governments, mental health therapists proceeded to implement telemedicine services to ensure the continuity of care for families and children for pre-existing mental health concerns that are at risk for problems facing traumatic and stressful conditions (Gurwitch, Salem, Nelson & Comer, 2020) . Additionally, there is an increase in the number of families seeking mental health services across the United States based on the trauma associated with quarantine and isolation.
COVID-19 has utterly changed the telehealth landscape, not just in the United States but across the world (Huston, 2014) . In the wake of shelter-in-place orders, social distancing advisories, and the lack of personal protective equipment, traditional-in-person care delivery has been forced to telemedicine. These unique factors have led the federal government and practices to rely on telehealth solutions for managing, assessing and providing treatment to patients while keeping social distance wherever possible (Huston, 2014) . Health care institutions are redesigning operations and adopting telemedicine services to protect patients and the clinical workforce alike. Payers across the country have begun fast-tracking reimbursements so that care can be delivered in virtual settings (Huston, 2014) . In support of the transition, the federal government has made some changes to the telehealth policies that include the elimination of licensure requirements, the expansion of coverage across settings and the loosing of HIPAA privacy requirements that permit technology to be used to communicate.
In the wake of these provisions, the FDA (Food and Drug Administration) sanctioned LabCorp’s Pixel as the first at-home sample kit for COVID-19 testing. The self-collection kit by the company encompasses nasal swabs, saline, and a protected package for sending the contents back to lab corp. Telemedicine companies such as Vitagene, and Him & Hers are offering home-collected, saliva-based test kits. The examination by the three companies is conducted by RUCDR Infinite Biologics which has collaborated with Spectrum Solutions and Accurate Diagnostics Labs. The FDA approved the tests on May 7, 2020.
Summary of Telehealth
The breakthroughs in information and communication technologies and increased access to a secure internet have enabled the deployment of telemedicine tools for extending healthcare and wellness services. Today, healthcare is moving in the direction of preventive medical services for lifelong individual health management. The blending of healthcare with ICT has resulted in the development of networked services such as health information exchange, precision medicine, and telemedicine. Before the pandemic, the spending on telehealth and related services was estimated to exceed $113 billion by 2025, with a projected annual growth of over 20 percent. COVID-19 has temporarily changed health care delivery and insurance. Infectious diseases such as MERS-CoV, SARS-CoV, and COVID-19 have caused an imbalance in the social order, and they are known to cause severe gastrointestinal or respiratory difficulties when they infect people. As a result, this has prompted the need to institute telemedicine services that can be used to diagnose and prescribe the applicable treatment for fear of secondary and tertiary infections.
Since the invention of the telephone and the radio, remote health care has been in existence but in limited forms. Telehealth involves two-way exchanges, store and forward services that include the transmission of patients’ information to establish diagnostic and remote patient monitoring. The onset of COVID-19 changed the way individuals accessed and received care. In response to the pandemic, the federal government and health insurance companies took steps to increase access to telemedicine by increasing payments to telehealth providers, the ease of licensure for physicians, and Medicare waived restriction on telehealth services for Medicare Part B beneficiaries. Thus, COVID-19 has driven the rapid development of telemedicine to be used in both urgent and non-urgent care.
The adoption of telehealth could change how health care is delivered across all settings. The most immediate beneficiaries will be underserved populations with increased access to care as well as urban areas.
References
Eze, N., Mateus, C., & Cravo Oliveira Hashiguchi, T. (2020). Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation. PLOS ONE , 15 (8), e0237585. doi: 10.1371/journal.pone.0237585
Gurwitch, R., Salem, H., Nelson, M., & Comer, J. (2020). Leveraging parent–child interaction therapy and telehealth capacities to address the unique needs of young children during the COVID-19 public health crisis. Psychological Trauma: Theory, Research, Practice, And Policy , 12 (S1), S82-S84. doi: 10.1037/tra0000863
Huston, C. (2014). Professional issues in nursing . Lippincott Williams & Wilkins.
Mann, D., Chen, J., Chunara, R., Testa, P., & Nov, O. (2020). COVID-19 transforms health care through telemedicine: Evidence from the field. Journal of The American Medical Informatics Association , 27 (7), 1132-1135. https://doi.org/10.1093/jamia/ocaa072
Rajasekaran, K. (2020). Access to Telemedicine—Are We Doing All That We Can during the COVID-19 Pandemic? Otolaryngology–Head and Neck Surgery , 163 (1), 104-106. doi: 10.1177/0194599820925049
Sundstrom, B., DeMaria, A., Ferrara, M., Meier, S., & Billings, D. (2019). “The Closer, the Better:” The Role of Telehealth in Increasing Contraceptive Access Among Women in Rural South Carolina. Maternal and Child Health Journal , 23 (9), 1196-1205. doi: 10.1007/s10995-019-02750-3
