A new whitepaper from the Office of the National Coordinator for Health IT outlines the essential factors in a consumer-centered telehealth experience.
The document grew out of a meeting last April in which more than 30 stakeholders focused on one of four scenarios: rural access to care; after-hours urgent care; post-acute passive monitoring; and chronic care passive monitoring.
The authors developed a model showing how diffusion of clinical data and care can create safety concerns and risk higher overall costs. That model shows four possibilities:
- Integrated care with a primary care provider in which all clinical data is kept together
- Telehealth-enabled with the same PCP
- Extended integration with other providers in the network, but data integrated back in the record
- "Outside care," including one-off telehealth visits with providers with whom patients have no previous relationship
The latter scenario provides the greatest risk of fracturing care and data, according to the report.
Beyond the usual concerns about reimbursement and physician licensure in telehealth, the report focuses on concerns especially about telehealth-related data not making it back into the central patient record.
Participants pointed to a number of telehealth options being offered to consumers, including employer-sponsored eVisits with providers such as Teladoc, American Well and MDLive; retail pharmacy telehealth offerings; and payer-sponsored eVisits.
Pharmacy chain CVS Health is expanding its reach as a provider, having recently paired up with American Well, Doctor on Demand and Teladoc. It says it's not trying to replace traditional providers, but rather working with them to deliver care.
Meanwhile, a patchwork of state laws continue to affect adoption of telehealth. The Colorado Medical Board recently adopted flexible guidelines, allowing coverage for people living in cities and not requiring an in-person visit with a physician first. Texas' board, which issued more restrictive rules requiring an established relationship with the patient, is having to deal with issues related to physicians who handle on-call services for colleagues.
To learn more:
- find the white paper (.pdf)