According to an article published in the Herald Journal, the history of telemedicine can be traced back to the 1920s, when patients on ships at sea would connect with physicians on shore through radios. With innovation in technology, telemedicine services were provided through interactive television in the 1970s and via video conferencing in the age of digital technology.
However, the evolution of telemedicine has been curtailed in every period of time – lack of technology in the early 20th century to government regulations in the 21st century – which has added to the skepticism of physicians.
Barriers to adopt Telemedicine healthcare
Under the government’s Affordable Care Act, focus has shifted to cost-effective, quality patient care that has given rise to different approaches of healthcare delivery such as Accountable Care Organizations and telemedicine. However, there are certain barriers to adopting telemedicine at a practice:
1. Barrier to establish patient-physician relationship
This is the major concern for primary care and specialist physicians, who haven’t introduced telemedicine at their practices. Initially, they hesitate that the use of telemedicine will hinder them from developing effective patient-physician relationship, which will affect outcomes.
2. Barrier to prevalent practice workflow
Another barrier that most physicians face is disruption to prevailing workflows. Physicians have adapted to changes in the health IT industry by implementing EHRs technology at their practices and designing new workflows accordingly.
However, they are hesitant to adopt telehealth, fearing that it will not be possible to incorporate this approach with the current workflow that is suitable for the new technology they have spent heavily on.
3. Barrier to medical practice beyond state borders
State and federal laws regarding physicians’ license and reimbursement procedures create a barrier to telemedicine adoption. According to the law, physicians should be licensed to provide medical services in the state they have physical presence in and where they provide telehealth services.
Moreover, changes to reimbursements – shift from value to volume – make it harder for practices to collect from patients via telemedicine.
Benefits of Telehealth services
Despite an air of skepticism among providers, telemedicine is growing by leaps and bounds. Medical Economics, quoting statistics from an IMS research, said over 300,000 patients were monitored via telehealth services for various health problems including cardiac, mental health and diabetes in 2012. The report further said that the number is expected to increase to 1.8 million by 2017.
Assisting home care patients
Telemedicine has made a difference in lives of home care patients by providing telehealth services. Its effectiveness can be measured from the success of a healthcare program introduced by the Veterans Health Administration (VHA) Department that aimed to provide telehealth services to home care patients with chronic diseases.
The services were provided via vital sign monitors, videophones, digital cameras – specifically for wounded patients and those having skin-related issues. Within four years of starting the program, 30,000 patients enrolled to receive telehealth services bringing down hospital visits by 19% which helped in saving costs.
Assisting patients in rural areas
Telemedicine has been particularly helpful in providing efficient and quality health service to patients living in rural and remote areas. Rural primary care physicians have used telehealth approach to facilitate their practice and patients by:
- Providing quality healthcare within the community
- Saving cost and time on travelling to city
- Making medical care available round the clock
- Providing emergency care to patient prior to transporting them to hospital
- Making initial diagnosis prior to specialist consultation
- Consulting with specialist
Assisting primary care physicians
Primary care practices have faced setback because of increase in specialist practices and changes in the health IT sector. According to a study, Primary Care: Current Problems and Proposed Solutions, a shortage of over 40,000 primary care physicians is expected by 2025.
Telemedicine has played a role in primary care health as it has proven to be a successful approach to provide cost and time effective healthcare to patients, resulting in patient retention.
- Primary physicians can team up with specialists to provide healthcare
- Facilitate hospitals in providing post-surgery general medical care according to specialist instructions
- Providing cost effective care in nursing homes
- Giving privacy to patients suffering from diseases that are still stigmatized in closed communities, like HIV and mental health issues
Solutions to Barriers for Telehealth
Dr. Adam Darkins, chief consultant for telehealth services at the U.S. Department of Veteran Affairs (VA) has emphasized on the importance of relationship between patients and their physicians for telemedicine system to function effectively.
Dr. Jason Mitchell, director of AAFP’s Center for Health IT clarified that telemedicine is not different from regular medicine practice. He explained that only difference is the mode of interaction between the doctor and the patient.
However, the government needs to make certain provisions in order to remove barriers that hinder success of telemedicine.
- Flexibility in practice license for telehealth physicians: Telemedicine providers should be given relaxation to practice medicine in states other than their own. This way government can cover the shortage of primary care physicians and facilitate them to recruit patients to meet their costs.
- Modify reimbursement policies: With changes in insurance policies, patient payments have become a major part of collections. This will create further problems for practices to collect payments from patients who have received consultation via telemedicine.
Changes under the Affordable Care Act are all about providing cost effective, quality healthcare services to patients that can be achieved through telemedicine system. This system is particularly beneficial for small to medium practices that can provide services to more patients, while saving time and money.