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What Telehealth Needs to Become Ubiquitous

Telehealth could soon change healthcare forever, making medical care more accessible to more people, saving money and time in the process. But a few other major changes need to happen first, according to two prominent physicians.

Nancy Crotti

Withings blood pressure monitor
New medical device tools are making it increasingly easy to remotely share vital signs with doctors. Shown here is Withings' wireless blood pressure monitor. (Image courtesy of Withings)

Telehealth could soon become much more widespread than it presently is, despite the challenges the technology faces, say Eric Topol, MD, director of the Scripps Translational Science Institute, and E. Ray Dorsey, MD, professor of neurology and director of the Center for Human Experimental Therapeutics at the University of Rochester Medical Center.

"Evidence abounds for the proximity of a 'tipping point' in telehealth, in which adoption moves beyond early adopters, who are focused on the technology, to the majority, who are focused on pragmatic applications," Topol and Dorsey write in a just-published New England Journal of Medicine article.

Don't miss the MD&M Minneapolis conference and expo, September 21-22, 2016.

The American Telemedicine Association (ATA) defines telemedicine or telehealth as "the use of medical information exchanged from one site to another via electronic communications to improve a patient's clinical health status." Telemedicine, according to ATA, includes applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.

Topol and Dorsey cite the more than 2 million telehealth visits to the U.S. Department of Veterans Affairs in 2014, and predictions by major health organizations of greater telehealth use in coming years. Kaiser Permanente of northern California predicts that it will have more virtual than in-person visits this year. By 2020, Mayo Clinic plans to remotely serve most of its projected 200 million patients.

By that same year, the global telemedicine market, estimated at $14.4 billion in 2015, is projected to hit $34 billion, according to Mordor Intelligence. If a recent ATA conference in Minneapolis is any indication, companies large and small are angling for some of that money.

There's certainly money to back the telehealth revolution. Venture capital funding in digital health has nearly quadrupled, from $1.1 billion in 2011 to $4.3 billion in 2015, the authors note.

So, what are the barriers, and the authors' proposed solutions?

Barrier Solution
Limited and fragmented insurance coverage, and fears of increased costs and of abuse of a telehealth system Stronger evidence, particularly through rigorous studies, of telehealth's ability to improve access to care at a reasonable cost; expansion of commercial insurance coverage through state telehealth parity laws, and of Medicare coverage of telehealth; set flexible; limits on usage of high-cost remote services
Lower quality of patient-physician relationship, physical examination, and care with remote visits than with in-person visits Combine remote care with in-person care; use simple, inexpensive medtech for remote clinical assessments, such as vital signs
Fragmentation of care Create integrated telehealth delivery systems; have all providers use interchangeable electronic health records
Potential for narcotic abuse Make first visit in-person or limit remote prescriptions
Legal issues, such as state licensure laws, credentialing at multiple sites, and liability Hasten implementation of Interstate Medical Licensure Compact; pass the federal TELE-MED Act of 2015 to expand telemedicine coverage to all Medicare beneficiaries; allow reliance on hub sites to confer privileges; obtain informed consent that acknowledges the limitations of and alternatives to telehealth
Social and geographic factors that limit access to telecommunications technologies Increase broadband access nationally; provide smartphones or related technologies to underserved populations to boost access to care; provide outreach and technical support to those with limited access or familiarity with new technologies

The authors acknowledge other potential problems, such as privacy breaches, and an overreliance on technology to monitor health. But they end the report on a hopeful note of how telehealth can improve health globally.

"Historically, the healthcare that has been received by a person has been a function of who a person is (e.g., with respect to age, sex, class, race, and creed) and where he or she lives, thus leading to profound social and geographic inequities," they write. "Increasingly, with the narrowing of the digital divide and the ubiquity of smartphones, telehealth can enable more people to receive care."

Nancy Crotti is a contributor to Qmed.

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