Jul 21, 2010

The doctor may be in. Or the doctor may be hundreds or thousands of miles away. In either case, telemedicine can enable physicians to improve patient care. But the technology faces regulatory barriers.

Telehealth is bringing treatment to rural patients in Colorado. In June, health insurance carrier UnitedHealthcare and Centura Health, Colorado’s largest health care provider, launched Connected Care, which uses telehealth technology to give patients in four rural Colorado communities expanded access to physicians and specialists. “The goal of the Colorado Telehealth Network is to improve patient safety, increase access to care, reduce health care costs and allow providers to focus on the needs of the patient,” said Steven J. Summer, CEO and president of the Colorado Hospital Association.

Telemedicine also allows healthcare to expand outside the doctor’s office. Medication-management vendor CompuMed, partnered with California School Health Centers Association to use CompuMed’s CardioGram and CardioGramKids electrocardiogram (ECG) telemedicine technologies in more than 150 school health centers throughout California.

It’s programs like those in Colorado and California that are driving adoption of telehealth nationwide.

“We have clients who are really looking at telemedicine from a strategic standpoint,” said Gerard Nussbaum, director of technology services at the Health Care Consulting Group, Kurt Salmon Associates.

Of course, doctors have consulted each other for years, relying on telephones and conferences, telegrams and journals, as well as crowded hospital rooms. Networking technology combined with security and videoconferencing solutions now bring the doctor to the patient, and a growing number of hospitals are tapping into this invaluable resource.

Telemedicine will reshape treatment, with 89% of healthcare decision-makers predicting that telehealth will transform healthcare in the next decade, according to a study by Penn Schoen Berland for Intel.

The anticipated doctor shortage, too, could promote the use of telemedicine. Based on current graduation and training rates, the United States could face a shortfall of up to 150,000 physicians in the next 15 years, the Association of American Medical Colleges estimated.

At first, the shortage will likely be for primary physicians, but specialists will also come into demand. By 2020, the nation could be short up to 4,000 cancer doctors, the American Society for Clinical Oncology reported. One reason for the increased demand is the aging population — including, ironically, a growing number of retiring oncologists, the study found.

A Healthy Habit

The main reason for investing in telemedicine is to improve patient outcomes, respondents to the Intel study said. Other returns on investment include more complete clinician access to patient data, and early identification of health issues. Telehealth can cut financial costs by reducing the need for patient readmissions by up to 25%.

Telemedicine has been a technology-show staple for years but is now a reality. “Cisco has been advertising this on their home page for a while, but now we are really seeing it,” said Ryan McGowan, technology solutions engineer, at distributor Ingram Micro.

The market for telehealth and home health monitoring will reach $7.7 billion by 2012, compared with $3 billion last year, according to Data Monitor. Some of the billions of dollars the federal government allocated to healthcare spending are directed toward telehealth — $12 billion will go to broadband access, facility construction and telemedicine initiatives, according to Gartner.

A Tough Regimen

Perhaps the most difficult component of beginning a telemedicine regimen has nothing to do with technology. Rather, it has to do with credentialing.

“Current CMS [Centers for Medicare and Medicaid Services] regulations require that hospitals and [critical access hospitals] receiving telemedicine services privilege each physician or practitioner providing services to its patients as if such practitioner worked onsite. While the current regulations permit the use of third-party credentialing verification organizations, the hospital’s or CAH’s governing body retains responsibility for all privileging decisions,” Nussbaum said.

CMS proposed revised conditions of participation (CoPs) that would allow hospitals to rely on information provided from another location, rather than being forced to conduct their own individual appraisals and examinations of credentials, he said. The goal is to simplify the process for smaller hospitals that do not have the necessary resources.

In June, however, CMS delayed the requirement to implement telemedicine standards until March 2011. It originally had set a deadline of July 15, 2010, for Joint Commission accredited hospitals to implement new elements of performance to conform to Medicare’s credentialing and privileging requirements for telemedicine services.

The subject is getting attention everywhere. During the American Telemedicine Association meeting in May, President Barack Obama’s federal CTO Aneesh Chopra said CMS was “actively working” to address the Joint Commission Standards for Credentialing and Privileging, especially the area of telehealth across state borders.

No matter whether the doctor is three feet or 3,000 miles away, if the diagnosis is accurate, the treatment is correct and the cure works,  that’s a good bedside manner.

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