Telehealth boom could break down distance barriers

Telehealth still must overcome obstacles to reach predicted potential

The combination of an ever-greater reach of the Internet and wireless technologies, the need to deliver health care services to isolated populations and the movement to reduce costs is pushing telehealth — health care delivered at a distance — into a more prominent role.

It’s been around in some form for many years, but it’s always been a relatively small niche in the overall health care universe. But that will soon change, according to United Kingdom-based market watcher InMedica, which predicts a more than $1 billion worldwide market for telehealth by 2016, which could jump to $6 billion by the end of the decade.

Home monitoring of patients, particularly to manage chronic diseases such as hypertension, diabetes and congestive heart failure, is one big reason underlying this expansion, said Diane Wilkinson, research manager at InMedica.

“Many public health care systems now have targets to reduce both the number of hospital visits and the length of stay in hospital,” Wilkinson said. “This has led to a growing trend for health care to be managed outside the traditional hospital environment, and as a result, there is a growing trend for patients to be monitored in their home environment using telehealth technologies once their treatment is complete.”

There have been some large-scale trials in Europe and the United Kingdom, but by far, the most established market for telehealth is in the United States.

The Veterans Health Administration (VHA), for example, has set a goal of having 92,000 of its patients using telehealth services by 2012. At the end of September 2010, just over 71,000 veterans were enrolled in the VA Care Coordination/Home Telehealth program.

A service called Clinical Video Telehealth (CVT) is also being used to provide treatment for remote and rural veterans who might not be able to travel to VA hospitals and medical centers and whose closest outpatient clinic might not have the staff or facilities available at a regional VA medical center.

CVT has proven especially adept at delivering treatment for veterans in this situation who suffer from post-traumatic stress disorder. Since 2007, well over 100,000 veterans have received mental health services via CVT, according to the VHA’s Office of Rural Health.

The active military is also looking to telehealth to help it better deliver health services to its personnel, particularly those out in the field and in remote locations. One example is the Army’s Tele-behavioral Health System, which aims to deliver mental health services to soldiers on the battlefield. A pilot program began in October 2010.

Col. Hon Pak, the Army Medical Department’s chief information officer, traveled to Afghanistan last year to try to gain a better understanding of the technology challenges in those warfighting conditions and to see what IT solutions could be used to deliver better medical care there.

“I learned a lot about behavioral health on the battlefield,” he said in an interview with the Military Health System’s magazine, The Gateway. “We are still learning about reducing the perceived stigma of behavioral health, the importance of local leadership and its impact on mental resiliency in a very difficult environment, such as Afghanistan.”

The Tele-behavioral Health Initiative will be one component of a Comprehensive Behavioral Health System of Care campaign that the Army is rolling out, Pak said.

The Health and Human Services Department is actively involved in trying to establish a number of regional telehealth resource centers around the country that will provide assistance to health care organizations, health care networks and health care providers to implement telehealth programs to serve the needs of their rural and medically underserved populations.

The HHS’ Health Resources and Services Administration recently awarded three grants of close to $1 million each to organizations launching telehealth centers in Maine, Indiana and Michigan. Those new centers will join nine other regional centers already established in other areas.

What’s been missing so far are incentives that would push providers to using telehealth more. Private insurers, Medicaid and Medicare pay for some telehealth practices, mainly for interactive consulations. But the American Recovery and Reinvestment Act does not include telehealth in the meaningful-use incentives for adoption of health IT, which are aimed mainly at hospital and physician adoption of electronic health records.

Neither are health regulations as now written all that amenable to physicians using telehealth. Although providers can use telehealth over wide areas and across state lines, the requirements to enable them to do that can be onerous. To work across state lines using telehealth, providers have to be licensed in each state that they use the technology and they may have to meet specific, individual state regulations.

HHS is at least trying to meet some of these objections. Medicare, for example, will now allow telemedicine to be delivered by a provider who is credentialed with a distant hospital as long as there are telemedicine agreements in place between hospitals. Previously, hospitals had to credential each physician to use telemedicine.

Once better regulations and incentives are in place, the situation is primed to meet the kind of future for the market predicted by InMedica.

About 200 telemedicine networks in the United States already connect hospitals with nearly 2,000 outlying clinics and community health centers in rural and exurban areas, according to a recent paper from UnitedHealth’s Center for Health Reform and Modernization. However, these links are now mostly used for education or to perform administrative functions, it said, and fewer than 10 percent of rural hospitals are engaged in remote monitoring of patients.

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