Advancing technology—the availability of faster and more reliable networks, wireless devices, high-definition digital images and video, and the ubiquity of mobile devices—is creating a foundation for a system of virtual healthcare where neither patient nor caregiver need be in the same place—or even in a clinical setting at all.
The organizations featured in the article include Loyola University Medical Center in Maywood, IL, where Kathleen Webster, MD, director for pediatric critical care and the medical director for the pediatric ICU, can consult on cases from home on her laptop computer. A high-definition monitor and digital stethoscope allow her to see and hear better than she could if she were in the room. "I see a lot of the studies that say telemedicine is equivalent to being there. But I actually think there is a case for saying at times telemedicine is better than being there," she says.
But there are still barriers to adoption: spotty reimbursement, questions about credentialing and other legal and administrative issues, a sometimes sizeable up-front capital investment unlikely to bring an immediate return, and that they can get concrete evidence that remote care is significantly better than care delivered in person.
And while enthusiasm for and anecdotal evidence of telemedicine's potential abound, some say there is simply not enough research to show the effectiveness of telemedicine compared to in-person treatment, especially when it comes to the use of mobile devices.
Texting health reminders to patients and similar tactics have potential and are popular with consumers, but simply sending out text messages doesn't mean that recipients will change their behavior, says Patricia Mechael, PhD, director of strategic applications of mobile technology at Columbia University. "We need to move away from research on user satisfaction and actually look at the impact on outcomes," she said at a recent m-health summit in Washington, DC. There is "a lot of hype around m-health and we need to come back to the reality of what works, what doesn't, and how to integrate mobile technology in a realistic fashion."
For example, in a randomized trial of a home monitoring program at the Wenatchee (WA) Valley Medical Center, the organization showed the program saved 5% net of costs. The number of clinic visits went up—and because patients had already been triaged by case managers, those visits were more productive. At the same time, hospitalizations and emergency room visits declined.
Of course, home monitoring is just one aspect of remote healthcare—the potential for the technology is great. But for telehealth programs to become varied and widespread, payers and healthcare leaders must work to quantify the financial and clinical return on investment. If that happens, expect to see a rise not only in the number of organizations making tentative strides toward remote healthcare technologies but also the number that are planning to invest in the technology to rise in future HealthLeaders Media industry surveys.
In the meantime, leaders at organizations that do have telemedicine programs say it may not be the best strategy to wait for indisputable proof of the technology's worth.
"There is a financial barrier to entrance" to telemedicine, says Yadin David, founder and past president of the nonprofit Center for Telemedicine and eHealth Law and assistant professor at the University of Texas School of Public Health. But healthcare leaders should balance investment with expected ROI.
"Definitely do not wait, because your market share, I believe, will [suffer] if you don't have this type of program available to you. If you're not participating, you might be late for the train. It definitely will not wait."
The annual HealthLeaders Media industry survey includes individual reports on responses from a variety of c-suite titles, including technology leaders.