Expansion of telemedicine is expected to be one of the biggest upcoming developments in healthcare; however, as the field of telemedicine grows, it will be crucial for changes in policy to keep pace. Large healthcare disparities exist between urban and rural populations: more than ¾ of the nation’s rural counties are designated as health professional shortage areas. Telemedicine is a successful, cost-effective way to bridge lower level healthcare facilities with higher level resources, consultation and subspecialties and improve healthcare access and delivery. As physicians, we play an important role in supporting timely, thoughtful legislation that allows patients to benefit from telemedicine while protecting adequate standards of care.
Only 24% of rural residents can reach a level 1 or 2 trauma center within one hour, and while 21% of children live in rural areas, only 3% of pediatric intensivists practice in rural area. Using telemedicine, patients can receive high quality critical care in their local emergency department that has been statistically shown to improve outcomes. 1 Beyond acute care in emergency departments, access to all subspecialists is limited or not available at all in rural areas.
Telemedicine can allow a child to see any specialist, be examined, and receive a diagnosis and recommendations for studies and treatments all from her regular physician’s office. Instead of sending a child hours away to see a cardiologist for a murmur, the cardiologist is able to interview the family, see the patient, even listen to her heart and then make recommendations potentially avoiding the trip altogether.
In another example, rural adolescents have twice the rate of suicide as their urban counterparts and have far less access to mental health services2. “Telepsychiatry“ was one of the first applications of telemedicine because special equipment is not typically necessary and because patients often value privacy due to the stigma they may attach to psychiatric services.
Telemedicine’s use in mental health has proven that it is not just for rural communities, and that has inspired other applications. Common mild illnesses in school aged children often result in missed school days and missed work for parents in order to get children to their doctor’s office for visits. School health nurses can use specialized telemedicine equipment to directly consult physicians and therebytreat illnesses such as common colds, rashes, pink eye and even ear infections. This saves time and money and improves school attendance and productivity. These school-based services could potentially even help reduce disease transmission by reducing sick visits and exposure to waiting rooms. Similar technology can be used to help medically fragile children to receive care coordination and well child checks without the challenges of transportation and associated risks.
The application of telemedicine has been varied, from typical office visits conducted with video and phone, to internet-based screening and support groups, to interactive game-like interventions. Studies have shown high levels of patient adherence and significant improvement in symptoms3. This broad and widely accessible net of services allows access for many patient populations previously unreached.
Studies have demonstrated that telemedicine improves patient care in many different settings . In order to continue to support development of this important and broadly applicable technology, policy changes are needed. Policy must both allow for development of the technology while protecting patients and ensuring appropriate standards of care are met. There are telemedicine bills being considered by legislatures around the country. One federal bill, Federal HR 691: the Telehealth Modernization Act of 2015, seeks to establish a federal standard for tele-health by providing definitions and standards for care delivery. While this bill is not expected to directly impact reimbursement criteria, it is proposed as guidance for individual states to base standards. Texas HB 2172 similarly sets up a set of rules that must be met for health benefit plan reimbursement.
Other bills are working toward clarifying statutory provisions related to telehealth and expanding medical sites to include telemedicine services (Texas SB 219 and HB 550,). There is also a planned bill for allowing reimbursement for telemedicine connection to school nurses. Support of thoughtful, timely legislation is needed. As physicians, we must work to educate legislators on the potential of telemedicine and its importance, and advocate for policy that supports its responsible development.
- Heath, Barry, Richard Salerno, and Amelia Hopkins. “Pediatric Critical Care Telemedicine in Rural Underserved Emergency Departments.” Pediatric Critical Care Medicine 10.5 (2009): 588-91
- Frederick, Rivara. “Youth Suicide and Access to Guns.” JAMA Pediatr. (2015).
- Lal, Shalini, and Carol Adair. “E Mental Health: A Rapid Review of the Literatur.” Psychiatric Services 65.1 (2014).