Fueled by three converging trends – increasing government support and reimbursement for telehealth services; purpose-built, integrated hardware-software solutions; and the “consumerization of medical devices” – telemedicine is poised to make major gains in the coming year.

An October 2017 survey from KLAS and the College of Healthcare Information Management Executives asked 104 healthcare organizations about their plans for telemedicine deployments. Nearly 60 percent said that they planned to expand an existing program or launch a telemedicine initiative in a new service line.

Respondents also reported that the primary driver for telemedicine expansion is the patient – providing patients with easier access to healthcare services (59 percent), or improving patient experience because of telemedicine (68 percent).

“Telehealth offers a great opportunity to enhance the lives of patients,” said Russell P. Branzell, CEO and president of CHIME. “But it needs to be carefully implemented to meet its potential, and we still face headwinds with reimbursement and integration issues.”

A paradigm shift

While reimbursement has historically been an obstacle to telemedicine, in November the Centers for Medicare and Medicaid Services signaled a shift for broader payments for e-visits, remote patient monitoring and other teleservices for chronic care management.

“Telemedicine has gotten a big boost from CMS, and the rules for reimbursement are likely to change,” said Janet Rushing, systems director for the Center for Telehealth and eICU at Geisinger Health System in Danville, Pennsylvania. “And third-party payers tend to follow Medicare.”

The federal government seems inclined to relax regulatory barriers as well. This fall, a bill permitting interstate treatment for VA patients won broad support in Congress. Rules that prohibit cross-border treatment seem likely to change in many states.

Geisinger is all-in on telemedicine. Beginning in the early 1990s with remote asynchronous services such as cardiology and EKG reads, the system has expanded its offerings to include telestroke services, both inpatient and outpatient consultative telehealth across dozens of specialties, remote patient monitoring, and a nationally known eICU service that it provides to other hospitals. Its latest initiatives are focused on direct-to-patient programs – home telepsychiatry and e-visits, for instance.

“We’re in the middle of a paradigm shift,” Rushing said. “In my lifetime, only the sickest of the sick will be hospitalized. Telemedicine will enable more patients to be seen, diagnosed and cared for in the home, and we need to optimize our systems for those patients who are good candidates for telemedicine. If you can be seen and treated at home, why shouldn’t you be?”

Integration considerations

Even as reimbursement and rules are addressed, providers need to think even more carefully about their investments in telemedicine technology. Will software solutions integrate with the provider’s electronic health record? Will workstation PC peripherals work together to provide a seamless and uninterrupted patient-clinician interaction, even when they are separated by hundreds of miles? After all, ambient noise, bandwidth issues and poorly designed speakers and microphones on computers can detract from a good telemedicine experience and end up inflating the total cost of ownership.

At Geisinger, ensuring that a virtual examination is equivalent in every way to a face-to-face encounter has been paramount. Service interruptions and downtime are not options. James Rafel, IT program director, says the system is constantly monitoring its workstations, telemedicine-specific devices and networks to ensure the highest-quality experience for both patients and providers.

But serving patients in rural Pennsylvania, Geisinger can’t control every aspect of the telemedicine network – some endpoints can only connect via low-bandwidth connections.

“We try to mitigate that when we look at the products we acquire,” Rafel said. “We want to work with vendors who specialize in services that can operate over cell or other low-bandwidth environments. That’s a ‘must-have.’”

On the software side, Rushing says that all of Geisinger’s telemedicine applications integrate with the system’s EHR. And since the EHR has been integrated with Geisinger’s PACS system, physicians are able to take real-time data from a telemedicine encounter and contextualize it with the longitudinal data in the patient record.

That means hardware acquisitions have to be qualified against standards and meet medical-grade criteria. “And that means we work closely with our vendors,” Rushing said. “We just can’t have any old camera on the (workstation) cart. We want to make sure it will enhance the encounter. We have to be aware and ask the right questions before we invest.”

But even when you get the software and hardware integrations right, the success of most telemedicine initiatives will ultimately depend on how patients and providers respond to the new paradigm of care.

“It’s a cultural change,” Rushing says. “Services like remote patient monitoring represent a commitment, a partnership between providers and patients. You have to bring the patient and the family into it – they are now part of the care team.”