The Evolution of Telehealth: Predictions for 2014 and Beyond

"What if I told you that at the bank down the street there's one banker that's yours and you have to do all of your banking with this one person? You'd probably say, that's a neat idea, but I have a banking app."  

For Shahram (Shez) Partovi, MD, the founder of telehealth company Emerge.MD, the analogy to the banking industry shows how far behind healthcare is in terms of providing easy access to essential services. While banking and many other industries have embraced remote connections and the ability to interact online, in healthcare, "we're still doing it the way our grandfathers did it," he says.

"None of us would dream of going back to banking like that," says Dr. Partovi. "As we progress and move forward in healthcare there will be a time where we won't be able to imagine going to the doctor's office for every little thing."

To Dr. Partovi, this increase in access is inextricably linked to increased care quality. By allowing a patient to see by the appropriate physician at the most appropriate time, regardless of physical proximity, the patient will get the care he or she needs, and available healthcare resources will be used as efficiently as possible.

Telehealth also has the potential to not only increase access to the most appropriate physician but also access to any physician, inherently improving quality. "If you can't even see a physician, the discussion of quality is irrelevant," says Dr. Partovi.

Currently, telehealth services are mostly used for specialized care, such as telestroke and behavioral telehealth programs. These services, while a step in the right direction, are often too focused on connecting a physician, often a specialist, to a patient.

"We need to turn it around and make it patient-centric, make it about connecting the patient to the caregiver," says Dr. Partovi.

The shift to patient-centric care will bring with it increased use of telehealth to connect with primary care physicians and nurses, the providers patients need to see most often. "This is where telehealth is going, and this is how it will improve outcomes as the patient moves across the system of care," he says.

Dr. Partovi is not the only one who sees a healthcare future dominated by telehealth. A recent article in Forbes predicted the telehealth industry will balloon to $2 billion in revenue within the next five years, due in part to an expanded patient base under the Patient Protection and Affordable Care Act and the current physician shortage.

Federal and state level regulatory changes are paving the way for an expanded use of telehealth. According to the American Telemedicine Association, 23 states and Washington, D.C., have enacted legislation mandating coverage for telemedicine services by both commercial insurers and/or Medicaid, with similar legislation proposed in nine other states. Additionally, a bill introduced in the House of Representatives this fall would allow certain Medicare providers to administer telehealth services across state lines without obtaining multiple state licenses."There are so many legislative initiatives propelling the adoption of telehealth right now," says Dr. Partovi. "They will help telehealth expansion."

The promise of telehealth has not been lost on companies outside the healthcare industry. Google's recently-launched Helpouts, a video-chat platform, supports HIPAA compliance, allowing medical providers to consult with patients through a Helpout. A number of healthcare providers have joined and are currently offering certain telehealth services using the platform.

However, Dr. Partovi sees a future where telehealth is not served through a third-party provider but is fully an extension of the hospital or health system. The regulatory and clinical requirements of a hospital or health system for telehealth services mean attempting to use a publicly available platform like Google would be unnecessarily constraining, he says. "[Helpouts] are good in that they raise consumer awareness of telehealth," he says. "But I think telehealth will have to be an enterprise feature."

Telehealth as an enterprise feature will also allow healthcare providers to use the infrastructure for more than patient consults. Facilitating interdepartmental or interorganizational meetings between physicians to discuss a case, allowing residents to participate in rounds remotely and providing mentorship opportunities between seasoned nurses and junior nurses in rural areas are a few of the other uses for telehealth services Dr. Partovi has seen yield positive results for organizations around the country.

"Every institution I've seen that has taken the lead with telehealth has ended up doing more with the system than what they originally put the system in for," he says. More uses and improved outcomes are just around the corner, he says, as more organizations realize the benefits of telehealth. "It's an evolutionary process," he says. "It will change the way we connect with healthcare, for the better."

More Articles on Telehealth:

Health IT Legislation to Watch in 2014
Bipartisan Legislation Would Create Federal Definition of Telehealth
Telehealth Provisions Added to SGR Repeal Bill

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