Telemedicine poised for tipping point despite remaining hurdles

The health industry has reached a tipping point for telemedicine to become a standard of practice nationwide, according to panelists speaking at U.S. News and World Report's Hospital of Tomorrow conference in the District of Columbia on Tuesday.

The panelists, whose work with the technology range from teleradiology and teleICU to telesurgery and teleoncology, spoke about its growing role in healthcare and the hurdles that remain for implementation.

Billing, reimbursement and licensure still remain the biggest barriers to expansion of the technology, the panelists said.

In terms of telemedicine adoption and integration, Jonathan Linkous (pictured), CEO of the American Telemedicine Association, said policy is extremely important but not nearly as important as it used to be because "so much of telemedicine is now going on despite" that fact.

He added that payment remains a big issue, including related issues like FDA regulation of mobile devices and federal policies dealing with accountable care organizations and their use of telemedicine.

The other major issue, Linkous said, is state licensure and using telemedicine across state lines.

"The fact that every state medical board decides on their own what they believe best practice in medicine is, which is going to vary from state to state, presents a real problem," Linkous said.

The Federation of State Medical Boards recently completed the drafting process for an interstate compact for physician licensure.

Restrictions by the Centers for Medicare & Medicaid Services also have limited the use of telemedicine in many states, Robert Satcher, assistant professor of orthopedic oncology at the University of Texas' MD Anderson Center, said at the event.

He said those restrictions have had an impact on cancer care applications in particular. However, he said those restrictions have begun to be loosened.

Despite the barriers, patients have had no qualms about embracing the technology, according to the panelists.

"Patient acceptance has never been an issue in telemedicine," Linkous said. "It clearly is a step in the direction of providing better patient care, and patients recognize that."

Satcher echoed those comments, saying any barriers to acceptance of the tools are typically removed on after patients see the convenience of the services.

For physicians, though, it may be a different story--especially in the ICU, according to Steven Fuhrman, eICU medical director at Sentara Healthcare.

"Physicians, you may know, are authority centric. They like to be the captain of their own ship. They don't like to have someone standing next to them to impact their care of their patient, let alone someone remotely," he said.

Preliminary work is required to generate an acceptance, to establish a consensus vision for the care in the ICU and the care of the patient, Fuhrman said.

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