Telemedicine has been bandied around as one of the next big things along with AI, robotics, and gene therapy. Thus, startups are cropping up that aim to strike it big in the telemedicine arena. In fact, telemedicine has been around for a while, but every year many of around 10 million or so patients in the US are unaware that they’re being provided telemedicine services. According to Dr. Ateev Mehrota, a Harvard professor of medicine, between 1 – 1.5 million online consultations have been conducted in 2016. But that pales in comparison to the about 1 billion in-person visits annually so the potential for growth is definitely there.
But one major concern being voiced is many of these companies and ventures are being drawn into by hype and are not fully appreciating the many challenges that telemedicine faces. A 2012 workshop summary entitled “On the role of Telehealth in an Evolving Health Care Environment” (published by the Institute of Medicine of the National Academies) cited several telemedicine barriers that included hype, money, regulations, adoption, technology, evidence, and success.
One major question is whether telemedicine is capable of delivering on its promised cost savings. At least one study has shown that instead of telemedicine reducing the number of doctor visits, patients are actually using it as a complement to the more expensive in-person doctor consultations. This, of course, drives up medical costs, defeating one of the rationales given for expanding telemedicine services to a wider swath of the population. Related to this, there’s also worry that overcharging stemming from myriads of unnecessary telemedicine services could mount. Part of the reason is it’s difficult to monitor if most patients are actually receiving telemedicine services being billed, for example, to Medicare.
Licensure and regulations involving interstate telemedicine practice have also become major impediments to a swifter and broader adoption of telemedicine. Obviously, requiring in-person consultations prior to providing telemedicine services, as many state medical boards do, are too burdensome for patients and doctors physically separated by state lines, let alone by some remote distance separating them within a state. Even more difficult are the requirements that a physician be licensed to practice in a state where the remotely located patient resides and those that limit the practice of telemedicine services to certain providers only. And we’re not even talking about other regulations that the FDA and FCC impose.
Still another major hurdle faced by the growing telemedicine practice has to do with the sharing and integration of patient data. For example, it’s not always easy for a physician who provides telemedicine services to obtain a patient’s medical record from the patient’s primary physician, assuming the latter is willing to share the requested patient information. The lack of or limited access to a patient’s medical record also raises the issue of the quality and reliability of telemedicine services in which the telemedicine providers are forced to deal with incomplete knowledge of a patient’s medical history. Lack of access to patients’ medical records could further compound the problem of misdiagnosis, which raises the specter of even more malpractice litigation. Another important question is: If the chronic shortage of medicial practitioners already casts a heavy burden on the present health care system, wouldn’t it exacerbate the already heavy workload of medical practitioners considering that telemedicine makes it much easier for patients to obtain or demand online consultations?
Finally, a significant issue that the present telemedicine ecosystem is grappling with is Medicare doesn’t provide much by way of reimbursement in the fee-for-service system. Any reimbursement Medicare pays for are mainly restricted to “rural” areas, some providers or institutions, and for certain procedures only.
For companies looking to enter the telemedicine business despite the present hurdles they’ll face, one question to ask is does one want to develop or provide telemedicine products, specialize in data collection, integration, storage, and analysis, or become a major telemedicine and telehealth service provider?
More telemedicine articles can be found here.
