Online Health Services Research Articles

Implementasi Komunikasi Online antara Dokter dan Pasien melalui Telemedicine di Masa Pandemi Covid-19

Hospitals and other healthcare institutions are required to offer patient-centred, integrated, safe, effective and timely healthcare services. .In the Covid-19 pandemic situation, the use of telemedicine is very important to ensure medical personnel can provide health services to the public without transmitting the Covid-19 virus. The purpose of this study is to determine the success of implementing online communication between doctors and patients through telemedicine during the Covid-19 pandemic. This type of research is literature review. This research uses sources from well-known journals and Googlescholar. The data analysis technique is by using data analysis techniques with discourse analysis. The results of the study show that communication via telemedicine during the Covid-19 period between patients and doctors has had a significant positive impact. Even though there are indeed several studies which state that telemedicine is not effective for diagnosing patients. Telemedicine is successfully helping patients perform Hospitals and other healthcare institutions are required to offer patient-centered, integrated, safe, effective, and timely healthcare services. Technology facilitates access to health, but good quality health services remain a top priority. In the Covid-19 pandemic situation, the use of telemedicine is very important to ensure that medical personnel can provide health services to the public without transmitting the Covid-19 virus. The use of telemedicine is very important to ensure that medical personnel can provide health services. Online health services are an alternative that is needed by the community.

Norwegian general population normative data for the European Organization for Research and Treatment of Cancer questionnaires: the Quality of Life Questionnaire-Core 30, the Sexual Health Questionnaire QLQ-SHQ22 and the sexual domains of the QLQ-BR23/BR45

ObjectiveThe aim of this study was to provide sex-, age-, and morbidity-specific Norwegian general population normative values for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires QLQ-C30, the sexual health questionnaire QLQ-SHQ22 and the sexual domains of the breast modules QLQ-BR23 and QLQ-BR45. MethodsA random nationwide sample stratified by sex and age groups (18–29, 30–39, 40–49, 50–59, 60–69 and ≥70 years) was drawn from the Norwegian National Population Register. Participants were notified through national online health services (HelseNorge) and postal mail. The survey included sociodemographic background information, health-related quality of life assessed by the EORTC questionnaires, and morbidity assessed by the Self-Administered Comorbidity Questionnaire. Multivariable linear regression was carried out to estimate the associations of age, sex and morbidity with the EORTC scale and item scores. ResultsOf the 15,627 eligible individuals, 5135 (33%) responded. Women and persons with morbidities reported lower functioning and higher symptom burden than men and persons without morbidities, respectively, on nearly all EORTC scales. Sex differences were most prominent for emotional functioning, pain, fatigue and insomnia (QLQ-C30), body image, sexual functioning (QLQ-BR23/45), importance of sexual activity, libido and fatigue (QLQ-SHQ22). The score differences between persons with and without morbidity were highly significant and largest in the youngest and middle-aged groups. ConclusionThis is the first study to provide normative values for the EORTC sexual health questionnaire QLQ-SHQ22 and the sexual subscales of the QLQ-BR23 and QLQ-BR45 for all, separately in age groups by sex and morbidity.

Use, satisfaction, and preference of online health services among older adults with multimorbidity in Hong Kong primary care during COVID-19

BackgroundThe use of online and mobile internet and social media has been increasing in healthcare service delivery. However, there is limited literature on the acceptance and use of online health services for older adults with multimorbidity who require more medical care and assistance. This study aims to explore the use of social media in older adults with multimorbidity in Hong Kong primary care and to assess the feasibility and usage of online health services in this population, including satisfaction, preference, and problems encountered.MethodsThis is a cross-sectional study among older adults with multimorbidity conducted between November 2020 and March 2021 in a Hong Kong primary care programme. Online and face-to-face services were offered based on the needs of the participants. Demographic characteristics and health conditions were assessed at baseline. Participants using online services were invited to complete a feedback questionnaire.ResultsThe study included 752 participants, of which 66.1% use social media every day. Participants who declined to use online services were found to be significantly older, live alone, have lower income, have social security assistance, have greater cognitive decline, and be less depressed (p < 0.05). Non-responders to the online questionnaire had fewer years of education and greater cognitive decline (p < 0.05). The median satisfaction with the online services was 8 (interquartile range: 7, 9), and 14.6% of the participants preferred online more than face-to-face services. Lower education levels, fewer internet connection issues, and more self-efficacy on mobile apps were associated with a higher level of online satisfaction after adjustment (p < 0.05). Fewer internet connection issues and more self-efficacy on mobile apps were associated with participants’ preference for online services (p < 0.05).ConclusionsMore than half of Hong Kong older adults with multimorbidity in primary care use social media daily. Internet connection issues can be a significant barrier to the usage of online services in this population. Prior use and training can be beneficial to enhance use and satisfaction in older adults.

Physicians' Online Writing Language Style and Patient Satisfaction: The Mediator of Depth of Physician-Patient Interactions.

Online health counseling (OHC) is increasingly important in modern healthcare. This development has attracted considerable attention from researchers. However, the reality of the lack of physician-patient communication and dissatisfaction with online health services remains prevalent, and more research is needed to raise awareness about important issues related to OHC services, especially in terms of patient satisfaction and depth of interaction (i.e., the product of the number of interactions and the relevance of the content). This study constructs an empirical model to explore the relationship between physicians' online writing language style (inclusive language and emojis), depth of physician-patient interactions, and patient satisfaction. The study obtained 5064 online health counseling records from 337 pediatricians and analyzed them using text mining and empirical methods. The results showed that physicians' inclusive language (β = 0.3198, p < 0.05) and emojis (β = 0.6059, p < 0.01) had a positive impact on patient satisfaction. In addition, the depth of the physician-patient interaction partially mediated this effect. This study promotes a better understanding of the mechanisms of physician-patient interactions in online settings and has important implications for how online physicians and platforms can better provide online healthcare services.

TINJAUAN PERLINDUNGAN HUKUM TERHADAP PELAKU LAYANAN KESEHATAN SECARA ONLINE

Health is a crucial factor in human life. It is an important element in achieving the common welfare and is enshrined in the Preamble of the Constitution of the Republic of Indonesia of 1945 concerning the general welfare. Therefore, health is considered a basic need and a right for every individual. In recent decades, the disciplines of medicine and law have become increasingly intertwined. Online health services have become one of the breakthroughs today that are expected to provide effective and efficient health services. This online health service is commonly known as an online clinic. Online clinic services have both positive and negative impacts. On one hand, online clinic services facilitate the process of health services between doctors and patients without being limited by distance. However, online clinics can threaten patient confidentiality. There are also issues in medical practice in online services because the diagnosis process is carried out online without face-to-face contact with the patient, which could lead to misdiagnosis of patients. This article focuses on the legal protection for online clinic practitioners. The result of this article is that the legal status of online clinics in Indonesia is still unclear because there is no specific regulation that governs online clinics in legislation. Therefore, there is a legal vacuum in the practice of online clinics.

Artificial intelligence: An eye cast towards the mental health nursing horizon.

There has been an international surge towards online, digital, and telehealth mental health services, further amplified during COVID-19. Implementation and integration of technological innovations, including artificial intelligence (AI), have increased with the intention to improve clinical, governance, and administrative decision-making. Mental health nurses (MHN) should consider the ramifications of these changes and reflect on their engagement with AI. It is time for mental health nurses to demonstrate leadership in the AI mental health discourse and to meaningfully advocate that safety and inclusion of end users' of mental health service interests are prioritized. To date, very little literature exists about this topic, revealing limited engagement by MHNs overall. The aim of this article is to provide an overview of AI in the mental health context and to stimulate discussion about the rapidity and trustworthiness of AI related to the MHN profession. Despite the pace of progress, and personal life experiences with AI, a lack of MHN leadership about AI exists. MHNs have a professional obligation to advocate for access and equity in health service distribution and provision, and this applies to digital and physical domains. Trustworthiness of AI supports access and equity, and for this reason, it is of concern to MHNs. MHN advocacy and leadership are required to ensure that misogynist, racist, discriminatory biases are not favoured in the development of decisional support systems and training sets that strengthens AI algorithms. The absence of MHNs in designing technological innovation is a risk related to the adequacy of the generation of services that are beneficial for vulnerable people such as tailored, precise, and streamlined mental healthcare provision. AI developers are interested to focus on person-like solutions; however, collaborations with MHNs are required to ensure a person-centred approach for future mental healthcare is not overlooked.

Investigating the Quality of Life and Its Correlation with Receiving Online Health Services in the Middle-Aged People of Kashan

Background: Quality of life refers to people's understanding of their position in terms of culture, value system in which they live, goals, expectations, standards and priorities. The use of online health services can affect the improvement of people's understanding of health. The purpose of this study was to determine the quality-of-life and its correlation with receiving online health services among middle-aged people in Kashan in 2019.&#x0D; Methods: This is a cross-sectional study that was conducted on middle-aged people in health centers. The samples were 293 people who were randomly selected. Data collection was done with questionnaires on the ability to use health services and quality-of-life. Data analysis was done with Chi-square, Fisher's Exact tests, Independent Samples T-test, ANOVA, Pearson's correlation coefficient and linear regression tests.&#x0D; Results: The average age of 293 participants was 47.5 ± 6.99 with a range of 40-60 years. The average work experience was 23.11 ± 8.01 and the average use of the internet per week was 26.2 ± 20.29 hours. The quality-of-life of 70.3 percent of the participants was average. Linear regression analysis showed that the ability to use services on the health line was predictive (β = 0.363 and p value &lt; 0.001) and explained 14% of the variance of quality of life (p value &lt; 0.001).&#x0D; Conclusion: The ability to use online health services does affect the quality of life of middle-aged people. Therefore, in order to improve the quality of life of middle-aged people in the society, necessary interventions are recommended to increase the use of online health services.

Social Media as A Veritable Tool for Mental Health Support in Nigeria

This study examines social media as a veritable tool for mental health support in Nigeria. The researchers embarked on this study with the intention of achieving four objectives; and based on the intended objectives, four research questions were formulated to serve as a guide for this study. This study is hinged on the Technology Acceptance Model and data was collected using documentation. Findings reveal that mental health issues have been on the rise in Nigeria, and accessing mental health services has always been a significant challenge due to the stigma attached to it. However, with the rise of social media, individuals now have access to mental health services online. Social media platforms have become an essential tool for mental health support in Nigeria. This study also finds out that social media platforms have increased access to mental health support services for Nigerians who may not have had access to them previously due to distance, financial barriers, or lack of mental health services in their communities. The study recommends that social media can be an excellent platform for sharing resources related to mental health support. You can post links to helplines, online support groups, and other resources that people can access when they need help. Encourage others to share these resources with their friends and family members.

General Health Statuses as Indicators of Digital Inequality and the Moderating Effects of Age and Education: Cross-sectional Study.

Considerable effort has been directed to offering online health information and services aimed at the general population. Such efforts potentially support people to obtain improved health outcomes. However, when health information and services are moved online, issues of equality need to be considered. In this study, we focus on the general population and take as a point of departure how health statuses (physical functioning, social functioning, mental health, perceived health, and physical pain) are linked to internet access (spanning internet attitude, material access, internet skills, and health-related internet use). This study aims to reveal to what extent (1) internet access is important for online health outcomes, (2) different health statuses are important for obtaining internet access and outcomes, and (3) age and education moderate the contribution of health statuses to internet access. A sequence of 2 online surveys drawing upon a sample collected in the Netherlands was used, and a data set with 1730 respondents over the age of 18 years was obtained. Internet attitude contributes positively to material access, internet skills, and health outcomes and negatively to health-related internet use. Material access contributes positively to internet skills and health-related internet use and outcomes. Internet skills contribute positively to health-related internet use and outcomes. Physical functioning contributes positively to internet attitude, material access, and internet skills but negatively to internet health use. Social functioning contributes negatively to internet attitude and positively to internet skills and internet health use. Mental health contributes positively to internet attitude and negatively to material access and internet health use. Perceived health positively contributes to material access, internet skills, and internet health use. Physical pain contributes positively to internet attitude and material access and indirectly to internet skills and internet health use. Finally, most contributions are moderated by age (<65 and ≥65 years) and education (low and high). To make online health care attainable for the general population, interventions should focus simultaneously on internet attitude, material access, internet skills, and internet health use. However, issues of equality need to be considered. In this respect, digital inequality research benefits from considering health as a predictor of all 4 access stages. Furthermore, studies should go beyond single self-reported measures of health. Physical functioning, social functioning, mental health, perceived health, and physical pain all show unique contributions to the different internet access stages. Further complicating this issue, online health-related interventions for people with different health statuses should also consider age and the educational level of attainment.

Consumer (dis)engagement coping profiles using online services in managing health‐related stressors

AbstractOnline health services are a rapidly growing coping resource for consumers to draw on in managing health‐related stressors. We apply a (dis)engagement coping lens to understand consumer coping, identify the distinct purposes of consumer coping captured in six coping scales, and develop an inventory (via multiple studies), to measure consumer positioning on these scales. In a final survey (N = 623), we assess the extent to which consumers use online health services, the ways in which they draw on these services as coping resources using the 6‐scale inventory and the influence of health status on coping efforts. We demonstrate that consumer engagement coping efforts with respect to health‐related stressors are largely directed toward direct management of health stressors (e.g., active planning). We also identify how consumers combine multiple ways of coping through distinguishing three coping profiles based on the enactment and perceived helpfulness of the six coping scales and current health status. Our profiles emphasize the need to understand the progress of health conditions as a determiner of coping efforts. Practitioners and policymakers can use this structured understanding of coping efforts to strategically plan future service provision, although some caution is noted with respect to health inequalities.

Telemedicine in Indonesia During the Covid-19 Pandemic: Patients Privacy Rights Protection Overview

During the Covid-19 pandemic, online health services through applications or telemedicine have increased yearly. Many parties are involved in telemedicine to spread the confidentiality of information and patient privacy to various parties. Even though regulations and guidelines regarding telemedicine's implementation during the Covid-19 pandemic are established, personal data leakage still occurs. The problem discussed in this research is: How was telemedicine implemented in Indonesia during the Covid-19 pandemic? And how is the regulation of privacy rights protection for patients who use telemedicine in Indonesia? This research uses a descriptive normative research method with a qualitative approach. The research results show various problems in Indonesia's telemedicine implementation during the Covid-19 pandemic, especially problems related to data protection regulation for telemedicine patients. Based on the author's analysis, no regulations regulate strict sanctions when the patient's data or medical records are not kept confidential. There is no explicit provision that threatens anyone who misuses the patient's data. Thus, it is necessary to have special regulations governing the protection of patients' privacy rights in the use of telemedicine in Indonesia, and Indonesian legislators need to continue the legislative process of the Personal Data Protection Bill.

Experiences and Challenges of Emerging Online Health Services Combating COVID-19 in China: Retrospective, Cross-Sectional Study of Internet Hospitals.

BackgroundInternet-based online virtual health services were originally an important way for the Chinese government to resolve unmet medical service needs due to inadequate medical institutions. Its initial development was not well received. Then, the unexpected COVID-19 pandemic produced a tremendous demand for telehealth in a short time, which stimulated the explosive development of internet hospitals. The Second Affiliated Hospital of Zhejiang University (SAHZU) has taken a leading role in the construction of internet hospitals in China. The pandemic triggered the hospital to develop unique research on health service capacity under strict quarantine policies and to predict long-term trends.ObjectiveThis study aims to provide policy enlightenment for the construction of internet-based health services to better fight against COVID-19 and to elucidate future directions through an in-depth analysis of 2 years of online health service data gleaned from SAHZU’s experiences and lessons learned.MethodsWe collected data from SAHZU Internet Hospital from November 1, 2019, to September 16, 2021. Data from over 900,000 users were analyzed with respect to demographic characteristics, demands placed on departments by user needs, new registrations, and consultation behaviors. Interrupted time series (ITS) analysis was adopted to evaluate the impact of this momentous emergency event and its long-term trends. With theme analysis and a defined 2D model, 3 investigations were conducted synchronously to determine users’ authentic demands on online hospitals.ResultsThe general profile of internet hospital users is young or middle-aged women who live in Zhejiang and surrounding provinces. The ITS model indicated that, after the intervention (the strict quarantine policies) was implemented during the outbreak, the number of internet hospital users significantly increased (β_2=105.736, P<.001). Further, long-term waves of COVID-19 led to an increasing number of users following the outbreak (β_3=0.167, P<.001). In theme analysis, we summarized 8 major demands by users of the SAHZU internet hospital during the national shutdown period and afterwards. Online consultations and information services were persistent and universal demands, followed by concerns about medical safety and quality, time, and cost. Users’ medical behavior patterns changed from onsite to online as internet hospital demands increased.ConclusionsThe pandemic has spawned the explosive growth of telehealth; as a public tertiary internet hospital, the SAHZU internet hospital is partially and irreversibly integrated into the traditional medical system. As we shared the practical examples of 1 public internet hospital in China, we put forward suggestions about the future direction of telehealth. Vital experience in the construction of internet hospitals was provided in the normalization of COVID-19 prevention and control, which can be demonstrated as a model of internet hospital management practice for other medical institutions.

Online counselling and therapy

PurposeIn this edition of digital innovations I will briefly discuss online therapy/counselling.Design/methodology/approachThe online environment can offer a safe space for many individuals to seek support. The virtual world affords many features the offline world does not.FindingsIn this and the next digital innovations feature I want to look at this online support and how people provide, as well as, seek support virtually.Originality/valueIn this edition I will briefly look at online counselling with a focus on young people, who are a client group, research has found, often prefer to access mental health services online.

Health Service Accessibility, Mental Health, and Changes in Behavior during the COVID-19 Pandemic: A Qualitative Study of Older Adults.

The COVID-19 pandemic has affected the access of older adults to health services. The two objectives of this study are understanding the influence of the COVID-19 pandemic on older adults’ access to health services and exploring how health service accessibility during the pandemic influenced older adults’ mental health and self-reported changes in behavior. This study included 346 older adults. Content analysis produced five themes: (1) decreased physical accessibility to health care providers (78%); (2) increased use of online health services and other virtual health care (69%); (3) growth in the online prescription of medication (67%); (4) difficulty obtaining information and accessing non-communicable disease and mental health indicators (65%); and (5) postponement of medical specialist consultations (51%). Regarding mental health, three themes emerged: (1) increased symptoms of anxiety, distress, and depression (89%); (2) the experience of traumatic situations (61%); and (3) the augmented use of alcohol or drugs (56%). Finally, the following changes in behavior were indicated: (1) frustrated behavior (92%); (2) emotional explosions (79%); and (3) changes in sleeping and eating behaviors (43%). Access to health services may have influenced the mental health and behavior of older adults, hence interventions in a pandemic must address their interactions with health services, their needs, and their well-being.

National Health Insurance (JKN) Mobile Application Use Towards Satisfaction of Participants of the Health Social Security Implementing Agency (BPJS) in Madani Hospital in Medan City

The National Health Insurance (JKN) mobile is an application launched by the Social Health Insurance Administration (BPJS) to make it easier for the public to get optimal health services online. The presence of this application is expected to increase the satisfaction of BPJS health participants as users. Consumer satisfaction is a representation of service quality (service quality). Online service quality (e-SERVQUAL) serves to measure customer perceptions of the quality of online mobile application services. This study aimed to analyze the use of the JKN mobile application on the satisfaction of BPJS health participants at the Madani Hospital in Medan City 2021. This study uses a quantitative approach. This type of research is an analytic survey with a cross-sectional design. Sampling is done by using the proportion estimation formula. The research sample was 92 BPJS Health participants who visited Madani Hospital Medan with the criteria of being at least 18 years old and had downloaded and used the JKN mobile application. The data collected was then analyzed using statistical tests including univariate, bivariate and multivariate. The data analysis process uses the help of Statistical Product and Service Solutions (SPSS) software. The results showed that the use of the JKN mobile application was based on the efficiency factor with a p-value of 0.000 and χ2 calculated 30.728, the reliability factor with a p-value of 0.023 and χ2 calculated 7.188, the fulfilment factor with a p-value of 0.002 and χ2 counts 12,841, the privacy factor with a p-value value 0.004 and χ2 count 11.897 affect the satisfaction of BPJS health participants. The most dominant factor influencing the satisfaction of BPJS health participants in using the JKN mobile application is efficiency. The efficiency variable has a significant effect and has a positive relationship to satisfaction. The efficiency variable increases the possibility as much as 62.801 times. The suggestion of this research for BPJS Kesehatan should continue to innovate to develop service features to suit the era of national digital transformation. Be more active and more creative in promoting and socializing the JKN mobile application and must be able to give confidence to the public that the JKN mobile application is well protected. The Medan City Madani Hospital should be more aggressive in socializing the use of the JKN mobile application to patients who use the JKN-KIS card, especially the online queue feature. The utilization of administrative services, especially during the Covid-19 pandemic, can avoid crowds in the waiting room. BPJS health participants should download and install the JKN mobile application on mobile devices to get easy access to health services and provide services online and offline so that access to health services can be done as much as possible.

The role of age and digital competence on the use of online health and social care services: A cross-sectional population-based survey.

ObjectiveOnline health and social care services are getting widespread which increases the risk that less advantaged groups may not be able to access these services resulting in digital exclusion. We examined the combined effects of age and digital competence on the use of online health and social care services.MethodsWe used a large representative population-based sample of 4495 respondents from Finland. Paper-based self-assessment questionnaire with an online response option was mailed to participants. The associations were analyzed using survey weighted logistic regression, exploring potential non-linear effects of age and controlling for potential sex differences.ResultsHigher age, starting from around the age of 60 was associated with a lower likelihood of using online services for receiving test results, renewing prescriptions and scheduling appointments. Good digital competence was able to hinder the age-related decline in online services use, but only up to around the age of 80.ConclusionsOur results suggest that older adults are at risk of digital exclusion, and not even good digital competence alleviates this risk among the oldest. We suggest that health and social care providers should consider older users’ needs and abilities more thoroughly and offer easy to use online services. More digital support and training possibilities should be provided for older people. It is equally important that face-to-face and telephone services will be continued to be provided for those older people who are not able to use online services even when supported.

Perancangan Antarmuka Berdasarkan Evaluasi Usabilitas Penggunaan Aplikasi KlikDokter Untuk Pralansia dan Lansia

The situation and condition of the spread of Covid-19 in Indonesia have forced everyone to reduce the intensity of going out of the house, including activities related to the need for health services. Therefore, a solution is needed so that people can meet their health needs without leaving the house. Taking into account that the elderly as the community group that is most vulnerable to contracting the virus and has the highest mortality rate, it can be said that the elderly is the group of people who most need online health services. Along with the growing penetration of internet usage and the increasing number of smartphone ownership in Indonesia, m-health is the right choice to help people access health services online via smartphones. KlikDokter is an example of m-health or a mobile-based application that provides various online health services. However, it was found that there were complaints that the KlikDokter application was too complicated and difficult for the elderly to use. From this problem, a usability test was finally carried out on the KlikDokter application interface, to identify what interface elements in the KlikDokter application were difficult for elderly users. The research respondents were divided into two groups with 16 and 17 people respectively. The first group is the elderly group aged &gt;60 years. And the second group is the pre-elderly group with ages between 45 to 59 years. A pre-elderly group is a comparison group (control group). This test is carried out by measuring several aspects of usability, namely effectiveness, efficiency, user satisfaction, error, and cognitive load.

The Scope of Telemedicine in Nepal during COVID-19 Pandemic.

The government of Nepal proposed to provide health services for both COVID and non-COVID infected patients through telemedicine.After the outbreak of the COVID-19 in Nepal, the number of people taking online health services, including counselling, increased by 70% as compared to last year in the Kathmandu valley. People being depressed staying alone in isolation and quarantine can get an opportunity to talk and share their problems with doctors through the means of telemedicine. Telemedicine has saved the time, effort and money of people living in remote areas.

Exploring strategies to promote health services online: The role of contextual priming, digital ad type, and health threat orientation in determining the effectiveness of health service ads

Contextual congruence, health threat orientation, and digital advertisement type can influence the effectiveness of online health service ads. To examine these effects, a 2 × 2 × 2 online experiment was conducted with contextual similarity as a within-subjects factor. Results suggest that contextual similarity was positively associated with both attitude toward ads and purchase intention. The data also revealed an interaction effect between digital advertising type and health threat orientation: health ads to address issues of immediate concerns enhanced purchase intention, but only in the incongruent context. Implications of the study were also discussed.

From Therapy to Teletherapy: Relocating Mental Health Services Online

Numerous studies have highlighted a range of potential benefits of teletherapy for clients. Nonetheless, researchers have found that many therapists are reluctant to adopt teletherapy in their work practice. There is a dearth of research about how therapists have appropriated telehealth platforms, either to understand teletherapy practice or to understand the challenges and opportunities for system design. The COVID-19 pandemic offers an unfortunate but unique opportunity to learn more about the experiences of therapists who use a range of therapeutic interventions with a range of client populations. In this work, we explore the following research question: in what ways do telehealth platforms support and challenge the work of teletherapy? We present results of semi-structured interviews conducted with 14 mental health therapists during the first six months of the pandemic in the United States. We present a descriptive account of their experiences as well as a discussion of the ways in which the multi-layered and interdependent nature of two facets of therapeutic work---the therapeutic alliance and the therapeutic interventions---made the transition to computer-supported cooperative work particularly challenging. We then offer a suite of design implications for systems that better support the nuanced and unique work of teletherapy.