It is an old but true adage that government moves slowly. While change may be swift, your local, state, or federal regulator is not.
Many of us who work in policy choose to believe that this slow pace allows for a positive outcome in the end. As rapid evolution in the market is afoot, too quick a response by government could have a negative impact on innovation. However, it is reasonable to expect the tortoise to catch the hare eventually.
It is in this context that I have experienced the rapidly expanding telehealth industry. One of the ironies I’ve come to enjoy is the now daily onslaught of emails and articles highlighting the new and exciting opportunities in telemedicine. While the names may be new and the level of attention has certainly increased in recent years, telemedicine and the practice of telemedicine is anything but new.
As a life-long space nerd, I know NASA has been using telemedicine to monitor the health of American astronauts since the early 1960s. Sure, the technology has gotten astronomically (pun intended) better, but the core concepts of connected care remain the same.
As technology has allowed telemedicine to be a viable method to deliver care in a relatively cost-effective manner for providers, in recent years there has been a great deal of activity at both the federal and state levels to remove regulatory barriers impeding the delivery of care via telemedicine.
Many speak of the rise of telemedicine as a fait accompli. Now that technology has made it readily available to providers and patients, of course only good can come from this increase in access.
However, as advocates have been successful in removing dated statutes and rules that restricted a now viable form of care delivery, regulators have been faced with a new question – how do increase access via technology while protecting patients and ensure quality oversight?
This is the scenario that the New York Office of Mental Health (OMH) faced when confronted with a shortage of providers to address behavioral health needs in the state. OMH describes their approach to this problem:
Technology has made it possible to increase access to behavioral health care in situations in which on-site services are not available due to distance, location, time of day, or availability of resources by using telepsychiatry. Use of telepsychiatry has rapidly expanded throughout New York state.
In August 2016, OMH announced the adoption of new regulations, expanding the use of telepsychiatry from OMH-licensed clinics to any providers licensed under Article 31. This added an estimated 250 mental health providers – including Comprehensive Psychiatric Emergency Programs, Inpatient Programs, and Partial Hospitalization Programs. This year, OMH further expanded the pool of available practitioners by allowing OMH-licensed providers to contract with telepsychiatry/telemedicine companies for distant/hub services. Our goal at OMH is to ensure that all New Yorkers have access to behavioral healthcare services.
To ensure oversight and maintain quality, even for those contracted companies located outside the state, OMH reviews these contracted arrangements to ensure quality will be maintained. OMH will also allow providers who contract with an accredited telemedicine company that meets state requirements to be considered as meeting state regulations.
To my knowledge New York is the only state that has taken this approach to meet the needs of patients while maintaining their oversight functions through direct review or the use of accreditation to ensure patients receive high quality care.
Research on the impact of telemedicine is still relatively thin and to date has produced sometimes conflicting results. However, one thing is certain, as telemedicine grows, if not in adoption then in advertised potential, a focus must be on policies that promote quality.
There is a growing recognition of the need for increased focus on quality in telemedicine. The National Quality Forum (NQF) recently released a framework on telehealth quality measurement.
As regulators and stakeholders focus on the potential to increase access, we must consider how providers and telemedicine companies maintain a quality of care that is at least, if not better, than care delivered in a provider’s office. It is not enough simply to increase access, as access to poor quality is access denied.