The Unfilled Opportunity

June 24, 2013
We’ve come a long way with telemedicine and yet it’s in its “relative infancy,” a recent report from the National Telecommunications and Information Administration (NTIA) revealed. That’s too bad because as the Texas Department of Criminal Justice (TDCJ) showed me, there’s a lot of opportunity out there for it to do more.

I’ve been thinking about telemedicine a lot lately. There is the opportunity it presents and the reality of where it is today.

Telemedicine is in its “relative infancy,” a recent report from the National Telecommunications and Information Administration (NTIA) revealed. The research aptly outlines the reality of the situation—only 7 percent of internet users go online to access medical records, participate in video conferences with a doctor, OR take advantage of remote heart rate monitoring.

That means the number of who have done each of those activities is less than 7 percent. That is not good enough.

While we can acknowledge that telemedicine has come a long way—it has grown 237 percent in five years, according to a report—it still seems like we’ve got a longer way to go still. For example, 8 percent of urban internet users have engaged in telemedicine, according to the NTIA report, while only 4 percent of rural internet users have done the same.

Doesn’t that seem a little backwards? The greatest opportunity for telemedicine care is in the rural backwoods. I was convinced of this, while listening to Mickey Bourdeau, director of technical operations for Correctional Managed Care at the University of Texas Medical Branch (UTMB), for a recent web-only feature I wrote.

The Texas Department of Criminal Justice (TDCJ) invested in telemedicine care for prison healthcare back in the mid 1990s, long before broadband networks revolutionized the internet. With several prisons located in remote, rural areas, and an inability to provide economically, comprehensive care for offenders, TDJC turned to telemedicine, using T1 data circuits to connect providers with patients.

Over the years, the program has evolved and amassed impressive results. A Gartner study of the initiative found that it has led to nearly $1 billion in savings over a 10-year period, while cutting back emergency rooms and doctor office visits by 70 percent and unnecessary medical tests by 45 percent.

There is no question in my eyes that TDCJ represents the opportunity of telemedicine at its best: connecting patients in remote areas with providers that can give them specialized, comprehensive care.

Unfortunately, many rural private institutions aren’t afforded these same opportunities. I’m happy for the prisoners of Texas who can get this kind of care. But what about everyday citizens, not cared for in government funded programs, who have to travel miles and miles to get the same kind of care? The lack of capital funds and sufficient broadband are two of the three things holding back health IT adoption in rural hospitals, I recall Chantal Worzala, director of policy for the American Hospital Association (AHA), saying once.

I do commend the government’s work in attempting to fund various rural healthcare broadband network projects. The Federal Communication Commission’s (FCC) Rural Health Pilot Program has launched many telemedicine networks off the ground. Still, the numbers from NTIA prove that more should needs to be done. These networks are the life blood to telemedicine networks in rural areas. Let’s not put a cap on the investments.

What about reimbursement for telemedicine? In a recent report, the Orem, Utah-based KLAS found that one of the biggest barriers to telemedicine’s adoption is funding. One provider told KLAS that telemedicine could be a lot more successful if the Centers for Medicare & Medicaid Services (CMS) made it a billable consult.

It’s not just the government either. The private enterprise hasn’t done a good enough job in this area. The KLAS report predicts that once the CMS and private payers can figure out a way to come up with better reimbursement methods, “the floodgates to telemedicine adoption will open.”

With so many lost opportunities out there, one can only hope this happens sooner than later.

Thoughts? Feel free to leave comments below or respond to me on Twitter by following me at @HCI_GPerna.

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