During an eHealth Initiative webinar, “The Use of Telemedicine within an HIE for Chronic Disease Management,” on Feb. 29, much was said about what was holding telemedicine back and what could push it forward. One sign of encouragement that was voiced was that grant-funded telehealth networks could help build the backbone of health information exchange throughout the country.
Barriers to Telemedicine
State and federal policies have failed to keep up with technology, and the issues facing the industry are the same as they were 30 years ago, said Neal Neuberger, executive director of the Institute for e-Health Policy, and president of Health Tech Strategies LLC.
One barrier is the lack of alignment of financial incentives regarding reimbursement for telehealth start-up and capital costs. Neuberger said that the Office of the National Coordinator (ONC) was remiss in not including telehealth in meaningful use requirements.
Another challenge for telehealth adoption is the lack of standardization for data produced by telemedicine devices, said Yael Harris, Ph.D., director of the Office of Health IT & Quality, Health Resources & Services Administration (HRSA). “In order to support the full realization of telehealth, it’s really essential that the data from these remote monitoring devices, video consults, and images that are captured and transmitted through [different] technologies are captured in a standardized format, so they can be incorporated into the medical record and transmitted through the electronic exchange of health information across multiple providers,” said Harris.
Gary Capistrant, senior director, public policy, American Telemedicine Association, notes that the definition of telemedicine, itself, within Medicare and Medicaid is fraught with limitations. “Medicare is discriminating the urban underserved,” said Capistrant. “They don’t see that it has real applications in inner cities. Telehealth is a way to serve the underserved, but those that already have services, but they’re not very convenient.”
Neuberger and Capistrant both agree that physician licensing is another barrier for telehealth and should be streamlined. State by state licensure is anachronistic, Capistrant said, and shouldn’t apply to federal health programs. “When you’re dealing with a person across state lines that means you have to be licensed in state where you are and where they are,” he said. “For many states this is important because they don’t have enough specialists within the states.”
Promoting Telehealth Through Policy
Even though there is no express mention in the meaningful use Stage 2 draft proposed rules, Neuberger is encouraged by the one menu item that states “More than 40 percent of all scans and tests whose result is one or more images ordered by the EP or by an authorized provider of the eligible hospital or CAH [critical access hospitals] for patients admitted to its inpatient or emergency department during the EHR reporting period are accessible through Certified EHR Technology.”
“In the case of critical access hospitals, they can start to get reimbursed for things like PACS, imaging, and radiology,” he said. “I think that is at least a foot in the door and an acknowledgement by the policy committee of the ONC. The work by Gary Capistrant, and the American Telemedicine Association, and others, is beginning to have some effect. It’s recognition that telehealth-like activities need to be accounted for in some way, shape, or form; and I think we’re going to have to build on that in the comment period and would encourage people to seek clarification of that provision.”
Neuberger notes that the more than 200 grant-funded telehealth networks involving more than 2,500 institutions in existence can build a nationwide backbone to help facilitate HIE. Harris agrees and said that telemedicine can aid in supporting the changing healthcare model in our dynamic world.
“The new model of health information exchange must include inputs from social media, cell phones, wireless devices,” Harris said, “as well as other information that could provide a more holistic picture of the patient and better engage patients and physicians as partners in patient care.”