The Barriers and Benefits of Telehealth Technologies
It’s not uncommon for people today to conduct a wide range of daily tasks and business remotely. From online banking, to grocery shopping, to airline reservations, and even registering your child for school, telecommunication technology offers convenience and flexibility that has quickly become part of the expected way of living in the modern world.
However, one area that continues to face major hurdles in adoption of telecommunications – despite great potential – is the arena of “telehealth,” or the remote delivery of health care services and clinical information.
According to the Council of Accountable Physician Practices (CAPP) – a group that recently published a primer on the adoption of telehealth practices – the reason for this lag is deeply ingrained in the public mindset and in the health care business structure.
While many current telecommunication services like banking or shopping can function easily without an in-person interaction, the value of a physician is often connected to his or her ability to literally lay hands on a patient. The person-to-person interaction in a doctor’s office notion is “hard-wired” into the health care delivery system through tradition, culture, and payment, and the idea of reducing this interaction is difficult to envision.
However, the CAPP argues that this concept is not fully in-line with modern medicine, and that the value of telehealth is its ability to augment – not replace – the in-person care of a physician or clinical staff. In fact, much of a physician’s job is to manage and guide patients through vast amounts of information, helping a patient by listening, measuring, balancing, consulting, teaching, and weighing risks and rewards. These are all tasks that can be supported by telecommunications tools.
According to the CAPP’s guide (PDF), today’s telehealth technologies can be divided into three broad categories:
- Audio, visual, or web-based technologies that facilitate two-way, real-time communication between patients and providers (also, an important tool of communication between providers within a care team)
- Remote monitoring that allows providers to observe patients in real-time; for example, a remote-controlled video camera that allows a physician to monitor patients in an ICU
- Asynchornous “store and forward” technology that transmits information from patients to providers without requiring simultaneous engagement; for example, an automatic email sent to a physician that includes a patient’s blood pressure data from a wearable device
In reviewing the state of current telehealth technologies and adoption, the CAPP report emphasizes that the key benefit of telehealth is to help overcome time- and distance-related barriers to care. While telehealth does have the potential to help reduce overall costs, this should not be viewed as the primary benefit; instead cost-savings will most likely be seen over the longterm. The immediate focus should center on improving access, quality, and efficiency in healthcare.
The CAPP guide outlined six critical principles stakeholders should consider in helping transition telehealth from a concept to a working business model for the industry. They include:
- Telehealth must integrate – not fragment – care.Telehealth tools are most effective when used within an already-established relationship between patient and provider. Rather than replacing a relationship, telehealth becomes simply an additional way to encounter a patient’s provider or system, offering a new means of delivering integrated, comprehensive care, and supporting the capability to provide value-based care.
- The primary benefits of telehealth are improved quality, access, and convenience, as opposed to short-term cost-savings.Short-term savings should not be considered the most important feature of telehealth. In most cases, the use of telehealth will not fully replace visits but instead augment it. Potential cost savings will be seen more in the long-term as telehealth tools support access and, subsequently, preventive care and disease management, helping reduce the need for more costly interventions in the future.
- Fee-for-service (FFS0 payment policies are a primary barrier for widespread adoption of telehealth tools.Payers must look for ways to liberalize the rules for telehealth reimbursements, with both FFS arrangements and the use of capitation, bundling, and other risk-sharing agreements. Medicare has recently signaled its intent to move in this direction, but it’s currently unclear what impact this will have.
- Lack of uniformity in public and private regulatory structures also inhibits the use of telehealth.For example, state licensing boards must work together to address the challenge of providers needing to be licensed in all 50 state to provide telehealth services.
- Patient education is a key area of focus for telehealth tools and value.The CAPP study found that patients are more likely to try telehealth technology if their physician or clinic staff suggested these services. Patients need to be taught how and when these tools can augment in-person care, the technology benefits and limitations, and even the privacy implications of using the tools.
- Stakeholders must continue to invest in research on best practices.Evidence-based research is imperative to help develop clinical guidelines, expanding to include more complication conditions and specialties, as helping develop clinical workflows into daily practice.
The future of telehealth is undeniably bright and full of potential. Through organizations like CAPP, and the cooperation and input from the network of physicians and clinical staff, there may soon be a day when patients feel comfortable embracing telehealth tools to make their daily lives healthier and their interactions with their health care providers more regular and efficient.