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Telemedicine: Past, Present, and Future

By September 19, 2019 No Comments

As American healthcare systems strive to improve patient access to medical care while reducing healthcare costs, there is now a growing interest in the field of telemedicine. In 2016, an estimated 61% of US healthcare institutions and 40% to 50% of US hospitals used telemedicine. From 2012 to 2013, the telemedicine market grew by 60% (1).  According to WHO, telemedicine is the delivery of health care services by health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries (1). There are two types of telemedicine programs. Synchronous programs take place in real time between the patient and healthcare provider. This includes virtual appointments that are conducted using the patient’s smartphone, tablet, or computer with a camera. Asynchronous programs, on the other hand, are not live and involve the transfer of images, videos, and other clinical information that a healthcare provider views and responds to at a later time. In this case, patients may wear medical devices to monitor and track health information (e.g. blood pressure) in a personal health application that they forward to their healthcare provider (1).

The greatest benefit of telemedicine is its ability to improve access to care while reducing costs (1). Telemedicine gives these patients access healthcare when they need it. Currently, about 59 million Americans reside in health professional-shortage areas, which are rural and urban areas where there are shortages of primary care providers. Telemedicine can provide these patients with reliable access to healthcare when they need it (1). It also provides access to care to patients without reliable transportation or those who may be too sick to travel long distances. For some patients, such as those with cystic fibrosis who do not want to come to the hospital for fear of contracting multiple antibiotic-resistant bacteria, a virtual office visit may be safer. At the same time, telemedicine helps to reduce healthcare costs by improving patient engagement and outcomes, enabling primary care providers to conduct appointments without additional office staff at any time (thereby extending office hours and availability), and by reducing unnecessary office and emergency room visits and hospital admissions. Additionally, telehealth maximizes access to mental health care (2). Mental health visits involve little hands-on physical assessment and have more to do with speaking with the patient. By taking advantage of telemedicine via video communication, patients are able to get a swift consultation (2).

While the benefits of telemedicine are valuable, there are some barriers and challenges associated with its implementation. Limited reimbursement has curtailed the widespread use of telemedicine. Although rules for reimbursement are evolving, telemedicine still represents a small amount of total healthcare expenditures. In 2015, Medicare spent approximately $14.4 million on services delivered via telemedicine—less than 0.01% of total spending on healthcare services (1). Currently, 31 states and the District of Columbia have telemedicine parity laws that mandate private commercial insurers to pay for telemedicine services (1). Unfortunately, there is a lack of uniformity in the specifics of these laws, resulting in variations in reimbursement rates. Furthermore, a large number of insurers such as Medicare and Medicaid and many self-insured plans do not fall under these mandates. Another significant barrier to the expansion of telemedicine services is the existence of inconsistent state medical board regulations. For example, some states require an in-person visit prior to the provision of any telehealth service (3). In cases of health systems that have locations in more than one state, providers may need to apply for and pay to maintain multiple licenses, given that current interstate licensing laws vary across states (1). Obtaining these licenses is a cumbersome and expensive process for physicians.

About 50% of all adults in the United States have at least one chronic disease (1). Recent data suggest that virtual chronic disease management represents an untapped market for telemedicine. A new paradigm of care, the model of “connected health”, promises to reduce costs and improve quality by working with clients proactively (4). In this model, individuals monitor their own health, which results in fewer visits to physicians and inpatient hospital stays. The demand for telemedicine services is expected to grow exponentially as baby boomers age, and home-based care will likely continue its exponential growth as a means to help keep older patients in their own homes and better manage their conditions (4). Demands for quality, patient safety, and more options will help change the reimbursement picture and open the door for more telemedicine applications, new technologies will emerge to meet this need, and the use of existing measures, such as biometric authentication, will become more common (4).

References

  1. Boling, P. A., Chandekar, R. V., Hungate, L. A. B., Purvis, M., Selby-Penczak, R., Abbey, L. J., … Msn. (2019, March 28). Telemedicine: Past, present, and future. Retrieved from https://www.mdedge.com/ccjm/article/189759/practice-management/telemedicine-past-present-and-future/page/0/1
  2. Snell, M. (2019, April 1). 5 Ways Telehealth Is Taking Modern Healthcare to the Next Level. Retrieved from https://healthtechmagazine.net/article/2019/04/5-ways-telehealth-taking-modern-healthcare-next-level
  3. Rheuban, K., Shanahan, C., & Willson, K. (2014, December 1). Telemedicine: Innovation Has Outpaced Policy. Retrieved from https://journalofethics.ama-assn.org/article/telemedicine-innovation-has-outpaced-policy/2014-12
  4. Alvandi, M. (2017, March 10). Telemedicine and its Role in Revolutionizing Healthcare Delivery. Retrieved from https://www.ajmc.com/journals/ajac/2017/2017-vol5-n1/telemedicine-and-its-role-in-revolutionizing-healthcare-delivery?p=2

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