Healthcare: anatomy of telemedicine systems

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Telemedicine allows a physician’s expertise to be used more efficiently “A nurse, physical therapist or other professional who is familiar with the examination process uses the equipment,” Downey says, “and the physician can evaluate the patient’s condition.” In addition, telemedicine can be used to limit the number of healthcare workers who are exposed to contagious illnesses such as ebola, so that the caretakers themselves do not succumb.

The components of the systems developed by GlobalMed are integrated with each other and with third-party software, but the task is not trivial. “Electronic medical records are proprietary products that do not work well with each other,” Downey explains. “As a result, the data can become siloed. Because of the lack of standards, each EMR has to be integrated separately with our products.” Further complexity is introduced if physicians need to see the results of a telemedicine session, just as it does when they attempt to look at records from other healthcare systems.

Role of connectivity

Telemedicine relies on high-speed broadband for transmitting medical records, images and high-quality video. As of June 2010, only about 12 percent of the U.S. population had access to speeds of 100 MB/second or better, according to data provided on the National Broadband Map. However, significant improvements have been made since then.

The National Broadband Plan, developed by the Federal Communications Commission and announced in March 2010, stated as a priority the goal of connecting healthcare facilities to high-speed Internet and fostering telemedicine devices, applications and services. The plan also emphasized the needs of rural and underserved communities. By December 2013, the percentage of the population with access to high-speed Internet had increased dramatically, to nearly 70 percent.

The American Recovery and Reinvestment Act of 2009 provided some funding for expanding the broadband infrastructure, including $7.2 billion for the National Telecommunications and Information Administration (NTIA) and Rural Utilities Service at the Department of Agriculture. Although a disparity remains between accessibility in rural and urban areas, connectivity has been greatly improved in the past few years.

Reimbursement and licensing barriers

Reimbursement and licensing practices have slowed the adoption of telemedicine. “Although Medicare is the single largest payer in the country, because of reimbursement restrictions, the technology is not being used in situations where it could provide great benefits,” says Gary Capistrant, senior director of public policy at the American Telemedicine Association. “Medicare does not cover the use of telemedicine in a home setting, for example, which could improve outcomes as well as save money.”

In addition, licensing regulations pose a problem. “The state-by-state fragmentation of licensure requires that physicians treating a patient in a different state via telemedicine be licensed in both states,” Capistrant says. “This approach does not fit with the needs of Americans in the 21st century.” The licensing requirements are very similar across states, and a more unified model is needed. Some states participate in a compact based on mutual recognition of licenses, but it is more a case of making the multiple license model more efficient, rather than creating a single medical license.

Promising path

As the population ages, the use of telemedicine to support compliance with medication regimes in a home environment is likely to expand into much more routine uses. For example, among older individuals, half the population takes at least three medications, and one-third takes at least eight (including prescriptions, over-the-counter and supplements), so keeping track of medications can be difficult. Reminders via videoconferencing and automated dispensing of medication can aid in compliance and help reduce hospital admissions.

Telemedicine is a dynamic market with excellent growth prospects. It is also a way to provide the right care to the right person at the right time. With several hundred telemedicine networks in place and about 50 percent of hospitals using one or more telemedicine services, the industry has reached a critical mass. Opportunities are present in many areas, including product design, software for integrating information from multiple components such as the proprietary EHRs, process design and development, and management and analysis of the real-time data streams that are coming from those systems. If reimbursement and licensing issues are resolved, the industry will have a promising path forward.

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