Historically, health care usually involves in-person, face-to-face interaction between medical professionals and patients.  In remote and isolated areas, in-person, face-to-face interactions are hindered by barriers such as distance and time constraints.  These obstacles can make providing medical treatment exceptionally expensive. By merging technology and health care, however, state policymakers are creating new opportunities for medical professionals and patients to interact in more efficient ways. The use of technology in health care -- often called telehealth -- utilizes broadband applications to remotely monitor patients, facilitate collaboration between medical professionals, exchange medical data and images, and instantaneously provide efficient emergency service to remote areas.  Making health care more accessible and convenient for patients and providing better quality of care to certain patients, all while reducing travel associated with medical care and providing cost savings to the health care system. 

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Benefits of Telehealth:  Expanding Access to Health Care While Reducing Costs

The potential benefits of telehealth include increasing access to and quality of medical services, while also reducing medical costs.   Although the benefits for isolated areas is especially clear, a range of patients will benefit from networking of our health care system.

Telehealth can provide rural areas or communities facing medical staff shortages with enhanced medical care and opportunities:  In rural areas where it can sometimes be difficult to access medical care, especially care that requires a specialist, broadband and telehealth can connect doctors and patients via high-tech, virtual interstates. Video consultations, video collaboration and the ability to transmit high resolution images from a rural clinic to a specialist or urban medical centers can help address hardships associated with travel to see doctors for patients.  

Residents of rural communities generally have less access to medical care.  While traveling to a doctors visit can be a hassle or inconvenience for anyone, it is often more taxing for those living in isolated locations, patients suffering from a chronic illness, or those with disabilities. Telehealth applications, such as remote monitoring,  remote consultations, and image sharing can substantially decrease the amount of travel associated with medical services.

In addition, telehealth programs not only help often underfunded rural medical centers leverage the resources at better funded urban hospitals, but such programs can also help smaller clinics network with major medical centers, increasing, in certain circumstances, the ability of these clinics to offer state of the art care. Instead of driving hours to have an expert examine an X-ray or scan, a rural patient can have the necessary test done close to home and have the images sent to a doctor in any other state.                  

The Georgia REACH Program:  In Georgia, telehealth has been used to save lives and minimize the negative effects of strokes on rural citizens.  The REACH(Remote Evaluation of Acute Ischemic Stroke) program uses high-speed broadband to allow doctors to examine the patient, determine the type of stroke and prescribe the correct medicine all via video conference.  The telehealth program connects 10 rural hospitals with the neurology department at the Medical College of Georgia.  After an individual suffers a stroke there is a short three hour time-period to diagnose if the stroke was caused by clotting or bleeding. 

Depending on diagnosis, the right course of treatment is instituted.  Since the time it would take to transport a patient from rural Georgia to a qualified treatment center is longer than the 3-hour time-period when diagnosis must occur and treatment should be administered, previously there was little rural hospitals could do for stroke patients.  Today, thanks to telehealth rural hospitals have the ability to collaborate with specialist at larger medical centers and more effectively treat stroke victims.

Teleheath allows sharing of Medical Resources: Telehealth can also help communities share medical resources when shortages exist.  In Maryland a handful of hospitals facing a shortage of emergency room doctors are planning on use physicians in Wilmington, Delaware to remotely monitor intensive care patients.  

According to the American Telehealth Association, agencies that use remote monitoring technologies can provide home care in a more timely and targeted way than scheduled home visits would typically allow. Mechanisms,like this, that can potentially increase early interventions or assist in more routine care, are central to better symptom management, increasing patient compliance with medications and treatments, and potentially reducing the amount of time patients must spend in the hospital. 

Telehealth can increase training for medical professionals:    In medical facilities equipped with broadband, videoconferencing can allow medical practitioners to take part in professional development opportunities without having to travel or be too far from their patients.

Telehealth has the potential to reduce health care cost: According to US Telecom, the utilization of telehealth technology has the potential to "deliver huge cost savings to America's health care system of over $300 billion annually."  Aside from the cost savings associated with remote monitoring, it is estimated by the Center for Information Technology Leadership, that from "a baseline of 2.2 million patients transported each year between emergency departments at a cost of $1.39 billion in transportation costs, technologies could help avoid 850,000 transports with a cost savings of $537 million a year." For example, a recent State University of New York study found that patients using "telehealth to manage congestive heart failure experienced a reduction in overall health care costs of 41%."  

Further, telehealth seems to offer some relief to the strain the aging baby-boomer population will place on the health care system. 

 

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Making Telehealth a Reality

Although telehealth is not a new concept, its promises have yet to be truly realized.  The obstacles to achieving the full potential of telehealth include the lack of broadband technology, the current payment structure of the American health care system, and how physicians are regulated by the government.

One of the most significant barriers to large scale proliferation of telehealth has been the lack of deployment and adoption of broadband, especially high-capacity broadband, capable of supporting telehealth, particularly advanced telehealth applications. Without increased broadband deployment and commitments to expand individuals digital skills, development and adoption of telehealth technology will be slow, and the full cost savings of such technology may never be realized.

The Federal Communication Commission (FCC) has recognized that broadband is a means to efficiently deliver health care services.  The Commission has stated that broadband deployment in rural America one of its top priorities. Last year, the FCC announced in a press release that is had allocated "$417 million for the construction of 69 statewide and regional broadband telehealth networks in 42 states and three U.S. territories under the Rural Health Care Pilot Program."  For some examples of projects funded by the Rural Health Care Pilot Programs click here.

State legislatures need to invest in broadband deployment so that their residents can start to use advanced technological applications such as telehealth. 

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Reforming Medical Licensing Rules

Currently, doctors who want to practice medicine in more than one state must apply for a medical license in each individual state.  As of 2007, more than 35 state medical boards have restrictive licensure language in place.  However, according to Stateline.org a model state law drafted by the Federation of State Medical Boards, creates reciprocal agreements among states, allowing doctors with a license in any participating state to practice in all other participating states.  To date, just 10 states  Alabama, California, Minnesota, Montana, Nevada, New Mexico, Ohio, Oregon, Tennessee and Texas have passed the statute, according to the Center for Telehealth and E-Health Law.

A report financed by funds from the US Department of Health and Human Services, Office of the National Coordinator for Health IT (ONC) under a contract with the National Governors Association Center for Best Practices for the State Alliance for e-Health outlined models that may aid in reducing barriers to interstate practice. Some of the models outlined in the report include: 

• • Endorsement: State boards can grant licenses to doctors in other states that have the same standards. This model will allow states to maintain their standards. 
  • Reciprocity: Many states allow out-of-state licensed [providers] to receive an in-state license through abbreviated licensing processes such as endorsement, registration, or reciprocity. This can help reduce the some of the barriers to being licensed in multiple states, such as administrative nuisances and cost.  
  • Mutual recognition:  Licensing authorities voluntarily agree to accept the licensing policies and processes of the licensee's home state.
  • Registration: Permits a health professional who wants to practice in another state on a part-time basis to inform the other state's board of his intention and agree to be within that state's jurisdiction.
  • Limited licensure system: Allows for the delivery of certain specific health services within defined parameters. 
  • Certain licensure exceptions exist where a doctor who is unlicensed in a certain state can, at the request of a referring physician, practice medicine in that state. 

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Changing Medical Reimbursement Policies

The lack of uniform and comprehensive reimbursement policies is another serious barrier to the adoption of telehealth.  For telehealth technology to become an accepted part of health care practices, Medicaid must lead by example and reimburse providers for telehealth services. Once Medicaid shows public support and acceptance for the use of telehealth, private payers will be more likely to reimburse for such services. The Centers for Medicare and Medicaid Services' (CMS) web site notes that, "[m]edicaid reimbursement for services furnished through telehealth applications is available, at the state's option, as a cost-effective alternative to the more traditional ways of providing medical care."  

Currently, at least 35 states reimburse for telehealth services.  According to a 2004 study, "at least 27 states reimbursed for telehealth through Medicaid." What services were covered by Medicaid, however, "looked different state to state":

 

• Medical consultations or treatments: 22 states 
• Psychological consultations or treatment: 12 states 
• Home health: 2 states 
• Case management: 2 states 
• Patient education (diabetes): 1 state

In 2008, states continued to enact some form of telehealth medicaid reimbursement legislation, however, not every bill covered the same level of services. 

• In Washington, SB 5930, Governor Gregoire signed on May 2 legislation that allowed the state funded health care plan to among other things pay for telehealth when doing so is cost effective.  The bill also includes provision to have the state study and identify any "existing barriers and opportunities to support implementation, including needed changes to state or federal law."
• In Utah, HB 16 allows for "certified services to be reimbursed under the State Medicaid plan."
• The Colorado state legislature passed SB 68, which permits Medicaid reimbursement for mental health services. 

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Conclusion

Telehealth has the ability to improve access and quality of care as well as reduce overall costs to the health care system. However, in order to see the full benefits of telehealth, there must be an increased commitment to increasing the deployment to and adoption of broadband capable of supporting telehealth applications.  In order for states to be able to leverage the applications of tomorrow they must foster universal and affordable broadband strategies, as well as address licensing and Medicaid reimbursement issues.