The top three barriers to telehealth adoption

Twenty years ago, telehealth appeared on the cusp of revolutionizing care delivery. Back then, substantial barriers existed – technological, cultural and financial – yet most industry visionaries were confident that telehealth must be adopted sooner, rather than later.

Fast-forward 20 years. Telehealth is making progress, but without sound reimbursement models or the maturation of cultural change that both healthcare leaders and patients have hoped for. Many perceived and actual barriers have yet to be resolved, and widespread adoption remains low. To prove the point, just ask the majority of patients in rural areas who require access to advanced diagnostic equipment and medical expertise. They'll tell you stories about having to routinely travel – at great expense and inconvenience – to distant urban areas for access to specialists and medical equipment. Many of these in-person encounters are, in fact, unnecessary. Simple post-surgical wound checks or preoperative visits, for example, do not require face-to-face visits and continue to be handled in this manner only because “it’s how we’ve always done it.”

With the current economic and political climate focused intensely on lowering healthcare costs and enabling access to healthcare, now is the time to accelerate telehealth adoption. The nation's healthcare crisis – soaring expenses, quality discrepancies and poor access – has providers, payers, policy-makers and patients looking for new care models, and virtual healthcare has tremendous potential.

But while telehealth holds great promise, three persistent barriers must continue to be addressed:

Mindsets Need to Change. On the whole, the industry is focused on face-to-face care based only on tradition and fragmented delivery systems where real-time collaboration is impossible. Coordination of care among diagnostic and therapeutic entities, inpatient and outpatient facilities and home care environments is unacceptably low – as is payer reimbursement for this level of interaction.

The clinician mindset must likewise change. In addition to caring for patients, providers today wrestle with financial, regulatory and operational challenges. The perception is that telehealth will only add to the list. In many ways, the challenges of difficult-to-use and complex EHRs project a negative valence onto emerging technologies such as mHealth and telemedicine. Clinicians, however, must look beyond these obstacles and recognize telehealth's capacity to reduce costs while impacting care quality and access – a direction clearly in the best interest of patients. Telehealth is a more humane approach to care and a model that reflects what patients actually want – care based in their communities.

Disconnected Health Information. The technology and infrastructure exists to enable a regional (and, we hope, national) environment for connected health. Yet the lack of standards and interoperability among systems makes widespread connectivity difficult, impeding clinician access to real-time data for medical decision-making. If a patient walks across the street to a different hospital, there is a high likelihood that his or her care will start from the ground up, as any documentation from another system would be inaccessible.

It's time to vault these hurdles. The increased adoption of the EHR and continuity of care document (CCD) nationwide, coupled with industry transitions such as HIPAA 5010 and ICD-10, will help to make it possible. Leaders in semantic interoperability such as dbMotion are solving the challenge of disconnected EHRs and are enabling collaboration between records in the cloud. Provider culture change, aided by government provisions and incentives such as meaningful use, HIE and regional extension centers, will continue to give speed to the maturation of information sharing that underpins telemedicine.

Telehealth Reimbursement. Reimbursement models need to be retooled with less focus on fee-for-service and face-to-face visits so that clinicians and healthcare organizations get paid for the care that is delivered via telehealth. Today, only a limited number of patient encounters are eligible for reimbursement by CMS, typically in areas designed as rural Health Professional Shortage Areas (HPSA) by CMS. Some commercial payers are starting to reimburse more broadly, but blanket coverage does not exist. Many payers fear that supply-induced demand may drive up costs, rather than viewing key areas such as home care and virtualized specialty encounters as significant cost-avoidance tools. Instead of focusing on the method of care delivery, payers and regulatory agencies need to focus on the value and quality that is now available in the cloud using telemedicine. The mindset is gradually coming around, as seen by the recent reimbursement policy adopted by Virginia. Such change is encouraging, as is the growing outcomes-based literature supporting cost avoidance and readmission when using remote monitoring.

Can these three hurdles be overcome? The answer is a resounding yes. Now is the right time for telehealth to gain prominence in helping the industry resolve cost and care quality challenges. The industry must accelerate the pase of adoption when it comes to use of telehealth and develop a foundational understanding of the cultural change necessary to accomplish this. Consumers are empowered and trained to use technology like never before, thanks to the consumer electronics industry, and now these consumers (i.e., patients) are waiting for us in the cloud.

Andrew Watson is the Medical Director for the Center for Connected Medicine in Pittsburgh.