Telehealth: Into the Mainstream?
April 11, 2014
Telehealth, and its subset telemedicine, offer an expansion of health care delivery options, particularly in remote locations. It extends across a range of technologies, allowing patients to seek diagnosis, treatment, and other services from clinicians by electronic means. Telephone, videoconferencing, computers, and apps are all employed. In its most established form, hospitals and medical centers use telehealth to reach patients in underserved rural areas. The military makes use of telehealth around the globe; some states and their universities practice telemedicine over dozens of counties; other initiatives try to solve access problems in specific communities.
Telehealth proponents suggest that these technologies can relieve medical workforce shortages and the unequal distribution of clinicians in the United States. For patients, telehealth can mean connecting with medical expertise not locally available, saving time, money, and travel; reducing unnecessary hospital visits; and improving the management of chronic conditions. Telehealth can also serve as a vehicle for continuing medical education. In some cases, telehealth has been shown to save money for health systems, hospitals, insurers, employers, and Medicaid programs.
But telehealth also faces ongoing challenges. States require physicians to be licensed in the state in which their patients are located, regardless of the physician's location. Most clinicians have not been trained in telehealth. Security concerns linger. Remote prescribing and malpractice insurance can be problematic. Which patients should have access to telehealth and how it will be reimbursed are questions without fixed answers.
This Forum session looked at the extent and evolution of telehealth in the United States, reviewed examples of its current use, examined its promise and its challenges, and explored next steps. For a more in-depth discussion of the issues involved see the Forum's recent issue brief.
Karen E. Edison, MD (bio)
Philip C. Anderson Professor and Chair, Department of Dermatology
Medical Director, Missouri Telehealth Network
Director, Center for Health Policy
University of Missouri Health System
For a more in-depth discussion of the issues involved see the Forum's recent issue brief.
See also a recent RAND study of Teledoc services, "Analysis of Teledoc Use Seems to Indicate Expanded Access to Care for Patients Without Prior Connection to a Provider," published in the February 2014 issue of Health Affairs.