Telemedicine is one of the most promising advances in medical care in our generation. In fact, it sometimes feels as if it came straight out of the frames of a science fiction movie. Virtual doctor consultations, long-distance vital sign readings, and remote medication prescriptions are all possible via video conferencing. And interest in telemedicine is growing. More than 70% of health providers are offering telemedicine in some form and New Hampshire recently passed a bill adding support and funding to telemedicine for its residents.
Yet a number of barriers to the adoption of telemedicine exist. Many aspects of healthcare do not fully translate in a telemedical environment or fail to meet patient confidentiality or security regulatory standards. And just how far will government agencies go to better position insurance rules to accommodate telemedicine? We’ll look at four major obstacles that telemedicine will have to overcome in order to be embraced by healthcare providers, policymakers, and the public.
1. Defining What Telemedicine Means
The first barrier telemedicine must overcome is defining what it involves with regard to healthcare services, insurance coverage, and legal concerns. Varying definitions on the federal and state level and a lack of cohesive recognition by insurers, including government-based insurance coverage provided by Medicare and Medicaid, introduces confusion around what qualifies as telemedicine and what is covered under insurance.
Defining who can treat who and in which states is crucial to promote telemedicine buy-in across the board.
It’s important that any definition of telemedicine discuss interstate medical licensing and certifications. The need for medical licenses and certificates is a critical element not only legally, but when insurance benefits and out-of-pocket patient costs are added to the mix. Defining who can treat who and in which states, while understanding how and from where payments will be submitted, is crucial to promote buy-in across the board, from medical practitioners to state medical boards.
2. Unraveling the Insurance Benefit and Cost Conundrum
Establishing a telemedicine program requires an outlay in funds to cover everything from video equipment costs and patient monitoring devices to software clinical support. Incurred patient costs then become part of this mix, creating a volatile administrative combination of inefficiencies and red tape. These can easily be settled through the development of an insurance benefits process that allows virtual patient services to be covered.
Providing arguably the largest barrier to telemedical services is the fact that Medicare Part B only provides insurance coverage for telemedical services to those residing in HPSAs (Health Professional Shortage Areas), or areas outside of MSAs (Metropolitan Statistical Areas). While potentially helpful for patients that reside in rural areas, those living in highly populated metro areas who have limited mobility options are largely left on the sidelines.
Legislation efforts in many states are seeking to open the doors to telemedical activities to improve the accessibility of medical care.
Complicating this picture is the reactive way that insurance companies still process claims. Typically insurers wait for a claim to be submitted before determining how much, if any, of the claim it will pay out. Slow and tedious, this process will need to be modernized before telemedicine can reach its potential.
While these issues may paint a stark picture of the future of telemedicine, there are positive signs on the horizon. Medicaid does not have the same restrictions and limitations on telemedicine and has been one of the primary forces driving it forward. Legislation efforts in many states are seeking to open the doors to telemedical activities to improve the accessibility of medical care. And as telecommunications companies bring new products with advancing capabilities to the market, the appeal of telemedicine is becoming too great to ignore.
3. Addressing Rural Internet Bandwidth Concerns
The limitations of Medicare Part B mentioned above have impeded the progress of telemedicine particularly when combined with the challenges of providing high-speed internet services to rural areas. Widespread “dark” internet areas are prevalent in rural America. According to the National Rural Health Association, rural patients make up 25 percent of the country’s population but are serviced by less than ten percent of the nation’s physicians.
This makes it crucial that rural broadband access be addressed if telemedicine is to reach those outside the care of a physical doctor. Initiatives such as the Project Echo program for rural communities are working to bridge technology gaps so that telemedical services can be provided to those that need them. Until this barrier to the adoption of telemedicine is overcome, thousands of patients that could benefit from telemedical services will be sitting on the sidelines.
4. Managing Patient Confidentiality and Data Security
Managing confidentiality and securing the contents of a telemedical session are critical in gaining a patient’s trust in the system. While regulatory aspects such as HIPAA provide a layer of patient protections, this may not be enough to fully protect the patient during the course of a remote appointment. A variety of security factors must be considered.
Public wifi connections in places such as coffee shops and libraries make it very difficult for confidentiality to be achieved.
Healthcare providers will need to work with their patients to ensure that the patient is not inadvertently placing their data and medical histories in harm’s way. For example, patient privacy information packets will need to include verbatim instructions on the appropriateness of certain locations for having a session. Public wifi connections in places such as coffee shops and libraries make it very difficult for confidentiality to be achieved.
Perhaps the most challenging aspect of securing a patient’s confidentiality is ensuring the security of the device the patient is using to place a video call. Out-of-date antivirus software, unknown malware, and some browser add-ons can all work against the security of the patient’s information. One solution might be to provide the patient with the basic equipment needed to make a video call in order to reduce the risk of an endpoint security breach, though this could be denied by an insurance provider or limited funds on the part of the patient.
What’s Next in Overcoming Barriers to the Adoption of Telemedicine
While the acceptance of telemedicine by the healthcare industry seems to be moving at a snail’s pace compared to other industries where video conferencing solutions are ubiquitous, signs of hope continue to trickle into the news. Campaign pushes made by many Democratic Presidential hopefuls, including Joe Biden and Pete Buttigieg, have emphasized telemedicine as a means to improve healthcare, especially for veterans and the rural population. These endorsements may help overcome longtime barriers to the adoption of telemedicine. As pressures grow on the healthcare industry to find next-generation solutions to reduce costs while increasing patient access to services, so should the lobbyist pressures on Congress and state legislatures. Technology makes so many of today’s life tasks easier; isn’t it time for this important innovation to trickle into healthcare as well?