Feature Story

The Doctor Is In: Barriers to Telehealth Adoption Slowly Coming Down

Dr. Keith W. Vrbicky

Telehealth.

We've seen that word bandied about frequently. In brief, telehealth comprises not only physician-patient interactions but information and educational services that foster awareness of treatments, medical conditions, good health practices and diagnoses.

And while telehealth is becoming more widespread, NTT DATA, a Tokyo-based IT services provider, indicated in its Trends in Telehealth white paper published earlier this year that "the healthcare industry is historically a late adopter of technology and this has proven to be a barrier to all new solutions that rely on technology."

This has included telehealth. The Information Technology & Innovation Foundation (ITIF) said that the widespread adoption of mobile devices like the iPad and iPhone, as well as deploying mobile broadband networks, "means that a large number of Americans have access to low-cost, high-quality video conferencing capabilities. While telehealth services will certainly not replace all in-person clinical visits, they have the potential to be an important alternative and in many cases, while also saving money and increasing convenience."

Demand for telehealth services is growing -- the Pew Internet and American Life survey found that last year, 59 percent of U.S. adults looked online for health information. And ITIF noted that in specialties where most of the patient interaction is verbal, e.g., neurology, genetic counseling, psychiatry – research has indicated that telehealth services are just as effective as face-to-face visits.

To date, some of the barriers to building telehealth programs have included regulatory policies, existing payment structures, corporate boundaries, and IT architectures (broadband access, for example). While it would take another few posts to fully elaborate, here are two issues:

Care Standards

Some states, noted ITIF, require telehealth to involve real-time communication; others allow asynchronous messaging between patients and providers. There are also no national telehealth standards so each state sets its own laws and regulations – a potential legal obstacle for physicians who want to practice medicine in multiple states.

Interoperability

Almost 80 percent of office-based physicians now use an electronic health record system. But ITIF said that not all electronic health record systems are interoperable – and patients don't always have access to their data. "These interoperability problems will need to be resolved so that telehealth providers can store and access patient information." ITIF recommended that the Office of the National Coordinator for Health Information Technology should continue to use incentives for interoperability to spur progress towards this goal.

Nonetheless, the barriers are slowly coming down, especially with the evolution of technologies that are accommodating more capabilities using less bandwidth. The International Journal of Environmental Research reported last November that cloud computing continues to grow with the utilization of high-speed mobile devices which also support the development of mobile health concepts.

"Technology innovation also includes developing new technologies such as handheld telemedicine kits, biosensor recliner chairs, telemedicine robots, and sensors to detect a person falling. As an indirect form of teleconsultation, research is underway to investigate the role that computer avatars may play in enhancing care for conditions such as alcoholism," noted the Journal.

So going forward, ITIF, for instance, has recommended that policymakers should:

Adopt a standard definition for telehealth;
Establish a single, national license for telehealth providers;
Create technology-neutral insurance payment policies;
Promote interoperability among state prescription drug monitoring programs; and
Fund research to continually improve and lower the cost of telehealth programs.

Telehealth is not a standalone concept – it's rapidly becoming an integral part of healthcare services – from what was once a research topic to being a part of mainstream medicine. And telehealth technologies, noted NTT DATA, have quickly matured. But companies must build a telehealth system "that can fit within their existing technology platform today, as well as support their technology roadmap and that of their customers' tomorrow."

Return to: 2014 Feature Stories