Telemedicine: The New Paradigm for the Delivery of Healthcare
There is a new paradigm for the delivery of healthcare and it is called telemedicine. Well, it is a paradigm if one assumes there is agreement on what it is. It is new if one overlooks the fact that the common concepts of it were pioneered in the early 1900s and have been in practice since the early days of the space program. When discussing telemedicine, it is probably more correct to say that societal and technological forces at play are converging to make practices falling under this umbrella term the major disruptive market force in healthcare that will reshape the practice of medicine for generations to come. That is pretty close to a new paradigm.
In this series of articles, we explore concepts falling within the grand description of telemedicine. We highlight practical and regulatory challenges for telemedicine practitioners along with emerging strategies for meeting those challenges. To make this exercise meaningful, we review core telemedicine concepts, discuss the rules currently existing applicable to the practice, identify rules in the making, identify those areas in which providers need to be vigilant and attempt to predict the direction in which these trends will take healthcare in the ensuing years.
The problems that occur any time long existing practices, explosive technological advances, and changes in societal attitudes converge into a new model are well known. Regulations, both formal and practical, which have developed incrementally do not lend themselves easily to wholesale restructuring. Analogous practices may be well established in one setting and deemed cutting edge in another. The thoughts of “academic scribblers,” which oft serve as the bases for policy decision making, have long since diverged in multiple directions. All these factors are strongly at play as health care consumers, practitioners, and regulators begin to consider the roles telemedicine will play in health care. To give context to these observations, we start with some basics.
In its simplest terms, telemedicine is the use of digitized information and telecommunications technology to deliver healthcare. NASA pioneered the concept to keep astronauts in space healthy. Rudimentary application of these technologies allowed nurses at their stations to monitor multiple patients down the hall in telemetry beds. Providers quickly discovered that digital x-rays could be read every bit as well, and far more efficiently, by transmitting data digitally to a radiologist in a central location serving multiple facilities than walking an x-ray film down the hall to a radiologist on-site. The fact that most important health care data can be digitized, combined with the movement away from the notion that health care requires face-to-face contact, has opened up a world of opportunities.
Today, people carry around more telecommunication power in their pockets and purses than many businesses had access to a generation ago. Healthcare consumers have higher expectations that their needs will be addressed on their terms and on their timetable. Researchers see the ability to remotely collect and harvest healthcare data as the key to new insights and better outcomes for patients. Overlaying this environment, there is the enormous and ubiquitous pressure to find new ways to drive down the costs of delivering healthcare. Rightly or wrongly, telemedicine is hailed as the emerging response to all these issues.
While the technology and potential applications for telemedicine have continued to mushroom, fundamental questions are yet to be resolved. If the key information necessary to make major healthcare decisions can be discerned and communicated electronically, what is the future of direct patient/provider interaction that has been the hallmark of medicine since time immemorial? How should regulators assure that the health care system continues to deliver quality care? How should providers be financially incentivized to embrace the meaningful efficiencies these approaches can provide?
These questions and many others are central to changes occurring right now. As one studies the response to the changes, one sees an even more fundamental question: is telemedicine an entirely new model or is it the same practice of medicine with new tools? The manner in which one answers this question will often lead to very different responses in how to regulate, promote, and understand telemedicine. One senses that many regulators have still not addressed this fundamental question, as often responses seem individually geared to one way of thinking. Medicare reimbursement – which often sets the framework for all third-party reimbursement – has seemingly grown up piecemeal around the practice. Nearly every other year, someone in Congress suggests a revised Telehealth Parity Act. Closer to home, Wisconsin administrative boards are, for the first time, working on regulations for telemedicine. Medicare has been developing payment rules and criteria, and private insurers and employers are deciding how to follow suit. This issue is being grappled with at many different levels.
In the next article in this series, we explore the different delivery models that comprise telemedicine. We begin by describing basic telemedicine concepts and the state of telemedicine in this country. From there, we can explore the emerging regulatory structures governing telemedicine. We can then turn to the key practical consideration for providers, such as reimbursement through Medicare and related issues under the False Claims Act, quality-of-care issues, privacy and security, efficient credentialing, and privileging models and conclude with a look at current emerging issues in telemedicine delivery.