Lessons on Telemedicine in Rheumatology: Thinking beyond the Coronavirus Disease 2019 Pandemic

During the COVID-19 pandemic, telemedicine was rapidly deployed to meet the clinical needs of patients with rheumatic diseases worldwide. Rheumatologists were forced to care for patients with all rheumatic diseases, regardless of disease activity, and limited evidence was available to guide provider decision-making regarding telemedicine appropriateness for outpatient rheumatology encounters. As the COVID-19 pandemic progressed, the ongoing provision of rheumatology telemedicine care in the U.S. was made possible by (1) emergency telemedicine waivers that permitted rheumatologists to legally practice across state lines; and (2) increased telemedicine reimbursement rates from the Centers for Medicare and Medicaid Services. Telemedicine research in rheumatology expanded exponentially, and patterns began to emerge regarding multilevel factors associated with telemedicine appropriateness for patients with rheumatic diseases. Rheumatology practice patterns also evolved to address the unique challenges of providing virtual care, such as the use of patient-reported outcomes and physical examination modifications to remotely assess disease activity. Moving beyond the COVID-19 pandemic, telemedicine has the potential to increase access to rheumatology care by utilizing finite rheumatology clinical resources in more efficient and innovative ways. However, barriers to more fully integrating telemedicine into routine rheumatology care remain, including training the rheumatology workforce, suboptimal reimbursement rates for telemedicine services, variability in state telemedicine laws, and the need to build telemedicine support networks of interdisciplinary and interprofessional care team members. As the use of telemedicine in rheumatology continues to evolve, it is vital for rheumatologists to maintain a patient-centered focus in the continued delivery of safe, effective, and equitable rheumatology care.