The New England Journal of Medicine Looks at the State of Telehealth | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

The New England Journal of Medicine Looks at the State of Telehealth

July 16, 2016
by Mark Hagland
| Reprints
The analysis in The New England Journal of Medicine of telehealth looks at some of the challenges and opportunities facing the developers of telehealth initiatives

The widely regarded New England Journal of Medicine on July 14 released online an article reviewing the “State of Telehealth,” authored by E. Ray Dorsey, M.D. and Eric J. Topol, M.D. The eight-page article focused on three broad trends that the authors see as shaping the trajectory of telehealth activity in the United States.

“The first” of the three trends, Drs. Dorsey and Topol state, “is the transformation of the application of telehealth from increasing access to healthcare to providing convenience and eventually reducing cost. The second is the expansion of telehealth from addressing acute conditions to also addressing episodic and chronic conditions. The third,” they say, “is the migration of telehealth from hospitals and satellite clinics to the home and mobile devices.”

As the authors note, “Just as the motivation for telehealth is expanding, so are its applications The earliest applications for telehealth were for acute conditions, such as trauma and stroke. In 1999, ‘telestroke,’ the provision of acute stroke care from a remote neurologist to a patient in an emergency department, was introduced to increase access to a highly effective time-sensitive fibrinolytic therapy (tissue plasminogen activator). In just 15 years,” they point out, telestroke became mainstream, and the largest care provider for patients with stroke in the country is now not a major medical center but a telemedicine company. More recently, telehealth has expanded, by means of diverse care models that include school visits by medical assistants, video calls, telephone calls, and online algorithms, to include care for episodic conditions, such as sinusitis.”

In looking at the third trend, the authors note that “Initial telehealth applications delivered care to patients in institutions such as hospitals and satellite clinics, which frequently required expensive technological systems and on-site clinical or technical support. With increasingly available broadband and portable diagnostic technologies,” they emphasize, “telehealth is rapidly moving to the home. For persons with chronic conditions, including the 2 million elderly persons who are essentially homebound, the patient-centered medical home will increasingly be the patient’s home.”

Among the key issues the authors look at are the limits and fragmentation of current insurance coverage for telehealth; issues around the quality of the patient-physician relationship, and fragmentation of care among multiple providers, and the potential for abuse (e.g., via the overprescribing of narcotics), legal issues, including state licensure laws and credentialing issues; and social issues, including the digital divide between middle-class patients with easy access to the Internet, and economically disadvantaged patients lacking that access.

Still, they conclude, “Despite financial disincentives and substantial barriers, telehealth continues to grow and is likely to spread over the next decade. The increasing number of reimbursement models will provide fertile ground for the growth of telehealth…” And, they say, “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.”

 

 

Get the latest information on Health IT and attend other valuable sessions at this two-day Summit providing healthcare leaders with educational content, insightful debate and dialogue on the future of healthcare and technology.

Learn More

Topics

News

Study will Leverage Connecticut HIE to Help Prevent Suicides

A new study will aim to leverage CTHealthLink, a physician-led health information exchange (HIE) in Connecticut, to help identify the factors leading to suicide and to ultimately help prevent those deaths.

Duke Health First to Achieve HIMSS Stage 7 Rating in Analytics

North Carolina-based Duke Health has become the first U.S. healthcare institution to be awarded the highest honor for analytic capabilities by HIMSS Analytics.

NIH Releases First Dataset from Adolescent Brain Development Study

The National Institutes of Health (NIH) announced the release of the first dataset from the Adolescent Brain Cognitive Development (ABCD) study, which will enable scientists to conduct research on the many factors that influence brain, cognitive, social, and emotional development.

Boston Children's Accelerates Data-Driven Approach to Clinical Research

In an effort to bring a more data-driven approach to clinical research, Boston Children’s Hospital has joined the TriNetX global health research network.

Paper Records, Films Most Common Type of Healthcare Data Breach, Study Finds

Despite the high level of hospital adoption of electronic health records and federal incentives to do so, paper and films were the most frequent location of breached data in hospitals, according to a recent study.

AHA Appoints Senior Advisor for Cybersecurity and Risk

The American Hospital Association (AHA) has announced that John Riggi has joined the association as senior advisor for cybersecurity and risk.