Like other sectors of healthcare IT, telemedicine faces a variety of challenges and opportunities. Some of the challenges include reimbursement models, making telehealth a standard care option and the outsourcing of clinical services.
Recently, the CEO of the American Telemedicine Association (Washington, D.C.), Jonathan Linkous wrote about seven specific trends which will be crucial to the telehealth industry’s immediate and long-term development. Linkous recently spoke with HCI Assistant Editor Gabriel Perna about these trends, getting into specifics about each one.
Jonathan Linkous
Trend 1: The Reimbursement Model
According to Linkous, the shift in the U.S. healthcare system from a fee-for-service model to a managed care model will have an enormous impact on telemedicine. In the fee-for-service model, the use of telemedicine had to get approval by health insurers. Since payers are the ones who pay for the treatment, Linkous says, they often worry about over-utilization with telemedicine and restrict its use.
But under capitated reimbursement arrangements, providers will be empowered to use telemedicine or not. “Those decisions should be made by those who are closest to the patient,” Linkous says.”It should sink or swim on that basis. And we feel confident, when you get to that part, telemedicine will be adopted.”
Linkous says the Veterans Administration has already successfully used telemedicine throughout its system under its managed care model. Additionally, there are a lot of hospitals, he says, looking to use telemedicine more frequently as a way to reduce unnecessary readmissions.
Trend 2: Telemedicine as a Standard of Care
Linkous acknowledges that the routine provision of telemedicine may not become established as a standard of care in the immediate future, but he does see it happening eventually. He says it will likely take a court case, and the instance of a patient suing a provider, to cement the adoption of telemedicine. He says the use of teleradiology within the specialty of radiology will probably help pave the way for other specialties adopting it.
“It [teleradiology] is used by so many hospitals and it is so common that if you don’t have teleradiology it means at certain times you won’t have a radiologist available to view that image, and it will be done by someone who isn’t a specialist or isn’t trained. It is becoming a point raised that could potentially have a case decided on it. We expect that to happen soon. Patients should expect hospitals to use telemedicine to get them to the appropriate specialist,” Linkous says.
Trends 3 and 4: Remote Clinical Enterprises and Virtual Medical Centers
The next two trends are closely linked, according to Linkous, and they both involve using telehealth to perform clinical services remotely. A remote clinical enterprise is when a hospital outsources specialties such as neurology and psychiatry to a vendor that can provide the services 24/7 via telehealth. He says it’s not unlike how in many hospitals, the emergency room is staffed by physicians that work for a third party. As mentioned, radiology has already become a popular specialty to outsource in this regard.
If hospitals prefer to do their own offsite clinical specialty work through telemedicine, this too is a trend, says Linkous. Virtual medical centers are when a large hospital or healthcare provider system puts all of its specialties into one hub, and has all of the specialty work done in that hub via telemedicine. An example Linkous uses is Mercy Hospital. Mercy recently announced it was building a $90 million virtual medical center in Chesterfield, Mo., which will host various clinical specialties to serve patients across Mercy’s four-state area.
Trend 5: mHealth
Mobile health (mHealth) is one of the hottest buzzwords in healthcare technology today. Linkous says there has been an abundance of hype, but the importance of mHealth will be determined by what ideas can actually be deployed and used. He says this means finding out what apps and software can do more than just tell someone how to lose weight.
“We’re talking about clinical care,” he says. “We’re talking about the ability of a patient with a chronic disease to be able to monitor their information on a consistent basis, and send it to a center that keeps track of it for them and lets them know if there is a problem. They can do that over their telephone at home or some other aspect, but the mHealth allows them to be mobile.”
Linkous says for the next two years or so, the hype surrounding mHealth will continue. Many will try and get a piece of the “three trillion dollar pie” that mHealth represents. Once the “dust settles,” he notes, there will be some things that will transform healthcare.
Trend 6: Shift to Networks
For the longest time in healthcare, providers have used a hub-and-spoke approach when using telemedicine to link multiple health centers. This model has one central hospital unidirectionally providing services to connected sites. However, Linkous says, the industry is in the middle of a shift to a network approach, and it relates to the other trends.
“It’s taking the practice of care outside a particular hospital or institution and making it more ubiquitous,” Linkous says. Instead of relying on one hospital or institution to serve as a link between all others, the network approach allows for connectivity between any two providers at any point.
Trend 7: International Expansion
The seventh and final trend involves using telemedicine to make healthcare an “exportable service,” according to Linkous. He says already there are telemedicine networks in other countries such as Canada, Brazil, China and elsewhere that stretch across international boundaries. He sees this eventually happening with healthcare in the U.S.
“Right now your healthcare is largely confined to where you live and your local doctor and hospital,” Linkous says. “That will still be a primary part of it, because physically that’s in proximity. But in many cases, for training, specialty care and other things, you won’t be limited to where you live.”
