If there's one technology that has the potential to fundamentally change access to healthcare in rural areas, it's surely telehealth. Small and rural hospitals are already taking advantage of the technology for services that are especially well-suited to virtual care, such as dermatology and other consults that benefit from today's high-definition digital cameras and monitors.
Teleradiology's been around in one form or another for a while—it doesn't really matter where images are read, as well as they're read and reported accurately. Telestroke and e-ICUs are also showing up in an increasing number of organizations.
That's backed by the 2011 HealthLeaders Media Industry Survey of technology leaders, which found 46% of respondents already have one or more telemedicine programs in place. Another 41% say they'll have one in place in one to five years.
But there's so much more that the healthcare industry could do—especially with the increase in faster and more reliable networks, wireless devices, high-definition digital images and video, and the ubiquitous mobile device.
This week CMS lowered one of the biggest barriers to telehealth when it implemented a new credentialing and privileging process for physicians and practitioners who provide telemedicine services.
Under the new rule, hospitals will no longer be required to credential and grant privileges to each physician and practitioner who provides telemedicine services to its patients from a distant hospital or other telemedicine location. Instead, hospitals can rely on the credentialing and privileging decisions of the distant hospital.
And the physician's home hospital—presumably the larger organization, although some small hospitals do lend out their own specialists—will be responsible for the credentialing process.
The problem is that there are still lots of questions about telehealth. If care is delivered across state lines and the states have different regulations, which rules count? Who's responsible for medical errors and who answers to lawsuits? Who keeps the medical record of the visit? Who's responsible for making sure the medical information is secure? Should insurance companies reimburse virtual visits at the same rate as in-person visits? In fact, do they have to reimburse them at all?
There are other folks who are working to come up with answers to these questions. Lawyers, for example, have drafted contracts that deal with malpractice liability. And more payers are recognizing that care delivered with telemedicine technology is likely just as effective as care delivered in person and definitely more cost-effective than allowing a patient to go without care until his or her condition worsens.
Those who see the potential that remote health has to improve access to healthcare—healthcare leaders, clinicians, professional associations, policy-makers, payers, patients—are all working toward answering these questions. You can read about some of those advocates and the work they're doing to advance telehealth in Does E-Health Stand a Remote Chance? the February HealthLeaders magazine cover story.
It took them a while, but the government managed to come up with a simple and elegant answer to the credentialing question. Surely we can do the same for the rest.