Victor Camlek, Principal Analyst, Frost & Sullivan
Telehealth, sometimes referred to as telemedicine, is a combination of telecommunications services combined with advanced medical device technology and cloud-based platforms used to deliver healthcare to patients not in the same physical location as the provider or caregiver. Telehealth represents a new way to approach many aspects of healthcare. From a market landscape perspective Telehealth can be viewed according to these four core major segments:
Remote Patient Monitoring (RPM)
Mobile Health (mHealth)
Personal Emergency Response Services (PERS)
RPM involves the use of medical devices that can collect biometric readings from a patient who is away from the hospital and is being monitored from their home or other remote settings. Medical-grade RPM includes devices that have received a 510 (K) clearance from the US Food and Drug Administration (FDA) or an exemption from the need for this process. Medical-grade RPM’s offer the safety and precision required to track patients with chronic conditions or receive post-acute care away from the hospital. RPM devices include blood glucose monitors, blood pressure monitors, pulse oximeters, etc. In an RPM system, several devices are included based on the patient’s condition. Data is collected and securely transported to a site that can filter and create the path for actionable alerts to be issued when necessary. RPM systems may reduce hospital stays and prevent read missions. It is also important to note that mass-market activity trackers, sensors, and applications also exist, but these alternatives are generally not utilized for the monitoring of serious medical conditions.
"Telehealth represents a new way to approach many aspects of healthcare"
Virtual Visits include a variety of ways that patients may have direct medical consultations with a physician. These sessions may be video-based using broadband connections or audio-based phone calls. The benefits to the patient include the ability to have access to a board-certified physician at any time of the day who can assess a medical condition and either prescribe a treatment regimen or facilitate the next step. Virtual visits are gaining traction as various employers and health plans provide coverage for these services on a per-member-per-month basis.
mHealth is a growing component of Telehealth that includes the use of mobile devices, such as smartphones or tablets, wearable monitoring devices, and computers. mHealth also provides connectivity within systems, safe and secure data transport and long-range transport using cellular networks. Furthermore, mHealth includes a growing number of health-related apps. Perhaps the most exciting aspect of mHealth involves the potential for the Internet of Medical Things (IoMT). The IoMT will permit numerous sensors and devices to be connected to patients regardless of their location.
PERSincludes a range of devices that can transmit an emergency alert to a first responder in the event of a fall or other medical emergency. This segment includes a range of devices, some of which require the patient to activate the process manually, while more advanced systems can start a medical alert even if the patient is unconscious.
In addition, there are emerging market opportunities in a variety of therapeutic areas. In fact, these systems include a mix of remote and in-hospital or hospital enterprise network services. Examples of therapeutic area opportunities include telebehavioral health, teledermatology, telecardiology, between others. There are also opportunities to manage patient drug regimen adherence, and expand the use of telemedicine kiosks. Some hospitals employ telehealth to fill the gaps they have in intensivist staffing and neurologists. Tele-ICU and tele-stroke networks have been established and have proven to be effective in the provision of life-saving emergency responses.
Although the benefits associated with telehealth have been demonstrated, including positive results derived from studies, a formidable array of challenges continue to prevail. For example, the successful results are countered by concerns about sample sizes and whether these studies are scalable. Therefore, there is no one study that has been endorsed as conclusive proof of concept. In contrast, some studies have even raised doubts about the quality of care via telehealth. Concerns, such as potential over-prescribing of antibiotics, spurious patient tactics to get certain drugs, to increased costs associated with large scale adoption of telehealth have been raised.
There are also issues pertaining to out-of-state licensure. Despite an Interstate Medical Licensure Compact that offers a path for telehealth practitioners to practice out of their home state, there are only 19 states participating as of the time of this article and many hurdles exist before this measure will fulfill its apparent purpose.
Another challenge to robust implementation of telehealth involves the fact that in the US, each state determines how telehealth or telemedicine is defined and which services may or may not be performed.
The list of challenges must also include prevailing concerns among patients, providers, and payers about security and privacy of patient-generated healthcare data. This, despite requirements that all telehealth providers must conform with HIPAA and the availability of safe and secure data transport services active in the market place.
Perhaps the most significant challenge to a universal practice of telehealth in the US involves the lack of standardized reimbursement policies. Whereas some states have implemented parity coverage for telehealth, many have not. There are also variables in the way Medicaid covers telehealth-based on parameters defined by each state. There are remaining issues associated with CMS policies and coverage of Medicare beneficiaries for telehealth. Although the CMS has displayed increasing interest changes have been based on annual policy implementation. As of this moment, Medicare is far from robust in the way it covers telehealth.
In addition to many of these long-standing challenges, the current national debate associated with the repeal and replacement of the Affordable Care Act creates uncertainty about the prospects for telehealth. While some experts believe this debate fuels the potential to accelerate the cause of telehealth there are others who fear a large-scale dismantling of the system, especially involving Medicaid, which could become a barrier to the growth of telehealth.
In summary, telehealth remains poised to become a new way of doing things that can improve the quality of medical care for millions of people. Yet, this capability remains far from universal acceptance. There are many advocates within our political system and The American Telemedicine Association is a proactive resource influencing elected officials to come on board with the telehealth agenda. Yet, the pathway forward will be difficult. One prevailing sentiment among experts that could prove to be the determining factor that will promote progress involves the notion that we must get to the point where the term “telehealth” or “telemedicine” is no longer a distinguishing descriptor. These experts envision a breakthrough whereby telehealth is blended into the standard practices and protocols that comprise high quality, cost-effective, and accessible healthcare. In this scenario, telehealth services and systems will be part of the norm rather than the disruptive force that opponents to wider implementation of these services currently fear.