Healthcare needs new solutions that will positively impact the patient, as well as help their clinician provide the best treatment possible. In this article I will define and differentiate between telehealth and telemedicine, discuss the current trends in telehealth and finally provide you with ideas on how to improve telehealth.
The Health Resources and Service Administration defines telehealth as, “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.”
Telehealth is a more extensive program that can also include non-clinical services, such as training or meetings. Telemedicine typically refers to remote clinical services and specialties.
Past Telehealth Model
Back in the 90’s and even as recent as the first decade of 2000, telehealth was difficult to get implemented. Technology and billing were the two main roadblocks to implementing a successful telehealth program.
In order for the telehealth program to communicate, most organizations had to use Integrated Services Digital Networks (ISDN) lines to transmit data. ISDN used telephone lines as their network and were maintained by phone companies. The pricing model was very expensive due to the large the amount of telehealth data and video that had to be transmitted.
The other issue was billing. Many insurance companies denied claims for medical care that included telehealth because they did recognize the legitimacy of the service.
Combine this with the technology problems and telehealth was doomed to fail. However, the idea behind telehealth was too good to fail for long.
Current Telehealth Model
The current model for telehealth has come a long way. Insurance companies now recognize the value in telehealth and high-speed networks have evolved beyond telephone lines. However, a new roadblock has developed with the implementation and acceptance of telehealth — interoperability!
In the current model for telehealth, and more specifically telemedicine, the primary care provider (PCP) refers their patient to a specialist. A specialist is a clinician trained in a healthcare specialty, such as dermatologist. The specialist reviews the patient’s medical history and meets with them via video conference.
The new problem is how to get the patient’s health information shared between the PCP and the specialist.
The PCP and specialist each have their own electronic medical record (EMR), and the systems can’t communicate with each other. You may be thinking just use the Health Information Exchange (HIE) to connect the separate systems and problem solved, right? WRONG!
Not all specialists and PCPs want to connect their EMR to the HIE. Also, not all EMRs are the same, which creates disparate systems even when both parties agree to connect to the HIE.
The costs to connect these disparate systems are high and most specialists don’t have a large technology department, if they have one at all. Therefore the costs and effort of connecting disparate systems has created a barrier in developing interoperability.
Not all healthcare organizations have this problem. The larger healthcare organizations that can afford developers and tech support have developed their own solutions.
This leaves an opening for a team of developers to create a solution to tackle interoperability and keep the costs to implement low.
Disruption Telehealth Model
So we’ve identified the problem as having disparate systems that need to share data bidirectionally. We should include the need for real-time sharing of data and a system that is easy for the clinician to use.
As it stands now, most PCP’s working in a clinic setting are playing a numbers game; they need to see as many patients as possible each day. That methodology will eventually go away with the managed care model, but for the next couple of years it is all about the numbers.
Clinician’s want a system that can be used within their EMR. As I stated earlier, most clinicians have to see a large amount of patients every day, so they don’t have time to use multiple EMRs and still be effective with patient care.
Another thing to keep in mind is the architecture of each EMR is very different. Some utilize SQL while others use Oracle. Additionally, the support teams (nurses, medical assistants, etc.) in clinics are usually larger and more experienced than in the specialist’s office.
I’ve found that specialist practices typically include one or two doctors and a small support team. They are usually very light on an information technology support team, if they are even lucky enough to have one.
This is a tough problem to solve. The complexity of having different EMRs and trying to meet the PCP and specialist needs is a big obstacle. However, I have seen amazing new technology solutions developed that have solved difficult problems just as complex as this. My hope is there are talented people working on this problem as we speak.