Barriers of TelemedicineBarriers of Telemedicine Melvin Young, Danny Shipman University of Texas at Austin

♦ Abstract

Telemedicine has been mentioned as a possible revolution in health care for several decades, but has not been widely used in America. A literature search indicated that barriers preventing its adoption include issues of state-regulation, info-ethics, and the lack of reliable data and statistics, particularly regarding costs. Providers can be hesitant to adopt a system which does not have a long history of case studies. It can be asserted that interventions by the federal government could facilitate the growth and spread of telemedicine in the United States.

♦ Introduction

♦ References

The state of telemedicine, the provision of clinical services through audiovisual media, has remained relatively static in the last several decades. There are three primary categories of telemedicine: remote monitoring, store-and-forward, and interactive services. Only the store-forward method, the transfer of medical data which does not require the doctor or specialists to be present, has been thoroughly adopted. This has been despite the incredible technological advancements in the last three decades involving personal PCs and broadband access to the internet. Telemedicine has promised cheaper yet effective care particularly to those who are the neediest. For example, remote monitoring would allow excellent care for homebound individuals or those suffering from chronic illnesses. Interactive telemedicine could allow for certain types of care such as history reviews or ophthalmology assessments with the same effectiveness as face-to-face meetings. What are the barriers preventing the vast potential of telemedicine from taking form in the U.S.?

Davalos, Maria. 2009. Economic Evaluation of Telemedicine: Review of the Literature and Research Guidelines for Benefit—Cost Analysis. Telemedicine and e-Health. 15(10). Gupta, Amar. 2010 The Unconstitutionality of Current Legal Barriers to Telemedicine in the United States: Analysis and Future Directions of its Relationship to National and International Healthcare Reform. University of Arizona. Hein, Matthew. 2009. Telemedicine-An Important Force in the Transformation of Healthcare. US Department of Commerce. Luo, John. 2008. Telemedicine-Is It Time Now? Primary Psychiatry. 15(2): 27-30. Stanberry, B. 2000. Telemedicine—Barriers and Opportunities in the 21st Century. Journal of Internal Medicine. 247: 615-628.

Wootton, Richard. Telehealth in the Developing World. London: Royal Society of Medicine, 2009.

♦ Results ♦ Results

I would like to thank David Wanser and Diane Kneeland for their assistance in this project. I would also like to thank Leanne Fields for her administration of the HIT program.

It is easy to expect government influence on the health care system to strengthen in the coming decade. This is already being shown in the mandate of EHR implementation and meaningful use requirements. From there, a domino effect could take effect. Government influence could mean the introduction of national guidelines which could resolve the privacy, security, and info-ethical issues. Telemedicine could be encouraged by the federal government as both a method to improve quality of care and in cost savings. According to the study “Telemedicine – An Important Force in the Transformation of Healthcare”, the use of telemedicine to reduce the frequency of visits to physician offices and hospital emergency rooms can potentially lead to greater convenience and compliance for elderly and home-based patients. Much like in EHR implementation, financial incentives must be supplied to encourage adoption of telemedicine. In its current state, providers frequently bear the most odious burdens in implementation of telemedicine programs. The recent passing of the health care reform bill during the Obama administration could be the first domino to fall leading to future health care reform and the eventual adoption of telemedicine.

♦ Conclusion

♦ Acknowledgements

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Privacy & Security issues• Issues with clinical data

• Ownership of the data after it’s been sent to a referred specialist• Regulation of proper disposal of data• Security of data transmission• Issues of consent

Info-ethical issues• Patient-provider relationship

• Impersonal nature of a teleconference could turn health care delivery into something as mechanical as an assembly line• Reliance on telemedicine could cause poor diagnosis compared with face to face visitations

• Provider-provider relationship• Delineation of responsibilities• Determination of standards of practice• Determination of blame in case of malpractice

Regulation• State

• Difficulty in deliver of care across state borders due to differences in law

• Federal• Almost no national guidelines

Technological barriers• Interoperability

• Different physicians or specialists may use different standards or software which may cause compatibility issues • National guidelines to resolve these type of issues does not exist

Economic barriers• Cost of infrastructure

• Hardware• Software• Delivery• Maintenance• Training

• Coverage• Rural areas, which would see the most benefits, have a population more likely to be uninsured• Rural areas have a less robust infrastructure

• Insurance• Very limited Medicaid and Medicare coverage • Very few private insurers have significant telemedicine reimbursement

Melvin Young (512) - 791-2795myoung01@mail.utexasedu

Danny Shipman (782) - 558-6232dannyshipman@gmail.com

♦ Contact

Table from Economic Evaluation of Telemedicine

The graph represents number of telemedicine cases and costs in the Pacific Island Health Care Project. This project was a program to facilitate referral and treatment of indigenous people of the USAPIs. Graph from Telehealth in the Developing Word