Malcolm Gladwell describes it as “the moment of critical mass, the threshold, the boiling point,” or the moment when a cause or philosophy is embraced by the many instead of the few. It seems safe to say that telehealth hasn’t reached that point … yet. But would we know it if or when it arrives?

The idea of a tipping point was examined at several conferences this past year, but the conversation was focused on mobile health, arguably one segment of the telehealth industry. At the mHealth Initiative’s conference earlier this year in Chicago, and at the World Congress 3^rd Annual Leadership on mHealth this past July in Cambridge, Mass., and the Institute for Health Technology Transformation’s August Summit in Seattle, it was generally concluded that mHealth had reached its tipping point when physicians started bringing their own smartphones into the hospital and demanding access.

As Claudia Tessier, president of the mHealth Initiative, pointed out in Seattle, the mHealth revolution is being led from the ground up, by physicians and patients demanding mobile access to health information. And it’s up to the providers and payers to catch up.

That kind of “revolution” isn’t happening in telehealth. What is happening, and what has been happening for the past couple of years, is a slow-growing network of pilot projects, each working to prove that telehealth can improve the delivery of healthcare. From UPMC in Pittsburgh to UC Davis in California to the Mayo Clinic in Minnesota to Ochsner in New Orleans to Alaska’s network of tribal health centers, healthcare providers are trying to find the “aha” moment when telehealth makes it to the mainstream.

That moment likely won’t be happening soon, until these pilot projects start reporting results. And if advocates are looking to the nation’s capital for guidance, they’ll have to be content with small steps, like CMS’ efforts to amend credentialing guidelines to allow telehealth programs to operate across state lines, or the FDA’s efforts to regulate mobile medical apps. On the other hand, no one is too happy with the lack of progress being made on a national broadband network.

Maybe telehealth needs a celebrity. Remember when protecting patient information entered the limelight, thanks to a little motorcycle accident in New Jersey involving George Clooney? Suddenly everyone was scrambling to make sure their patient records were safe and secure, and every lost laptop and oft-viewed patient file made the national news feed. Maybe Brad Pitt could break his leg while hiking in remote Montana and need a video consult from a specialist in Dallas to save his million-dollar limb. …

But seriously, folks, the future of telehealth hinges on physician acceptance, and today’s physicians aren’t yet ready to throw their support behind new technology at a time when they’re struggling to make a living. They won’t change their workflows unless they’re certain they’ll get reimbursed for their efforts, and for the time being that reimbursement formula isn’t changing. Furthermore, they need good, solid evidence that any changes they make will be for the better, and won’t just move things around to come up with the same results. They need to be convinced.

So while telehealth advocates celebrate the relatively small victories – the life of a stroke victim saved through a teleneurology consult, improved lifestyles for people with chronic conditions living at home – they’re still waiting for their tipping point.