Telehealth is a promising new avenue for providing greater access to care for countless patients. However, not all healthcare organizations are ready to press forward on a fully developed program. Technological limitations, lack of standardizations associated with reimbursement and processes, and the costs required for investing in the necessary infrastructure are just a few of the reasons adoption remains slow.
Despite the challenges, implementing the level of telehealth that can provide benefits on a wider scale is entirely possible, and in doing so, the healthcare industry stands to transform the level of care we can provide to patients, all while cutting costs, says Adam Darkins, MD, President and CEO at Empiricon, LLC., and former chief consultant for telehealth at the U.S. Department of Veterans Affairs.
Darkins will deliver a keynote session, Moving from Pilot/Small-Scale Telehealth Programs to Large-Scale Operations: Making the Quantum Change, at the Telemed Leadership Forum 2018: ROI of Telehealth,hosted by URAC and Telemedicine Magazine.
A Changing Field
Through telehealth, the improved connectivity between patient and doctor can help curb rising healthcare costs by promoting patient engagement and preventive care. Both are promising approaches to improving patient chronic disease management, with chronic disease accounting for nearly 86 percent of the nation’s $2.7 trillion annual healthcare expenditures, according to the CDC.
The fundamental model of healthcare delivery however remains to be one of brick and mortar, says Darkins – a patient comes in, gets treated, and is sent home. “With the need to manage people with chronic conditions, and the means to do so virtually, rather than in hospitals, this is not necessary how it needs to be done now,” says Darkins.
The addition of a telehealth system, where a patient is seen by the physician remotely, invites a number of wrinkles and concerns to the existing system, such as, whether costs will increase if these services are funded under fee-for-service models, whether the ROI on telehealth will prove positive, and what legal implications might arise from this new delivery method.
Standardization and Accreditation Necessary to Move Forward
While many health systems have created telehealth pilot programs, few have extended those programs into a larger scale implementation, says Darkins. The challenge of “going to scale” lies is in the complexities of healthcare itself and associated legal, regulatory and professional frameworks within it.
“Healthcare is complicated and requires standardization,” says Darkins. “Pilot projects are often established on a set of relationships which works for a small-scale project. But to go to scale, the complexity of healthcare requires the need for explicit processes that are widely agreed upon and adhered to.”
For example, without a uniform agreement on obtaining patient-informed consent for telemedicine services, if a disagreement about this occurs in a telemedicine consultation, it can be confusing and anxiety-provoking for a patient. It is very difficult to extend services across larger networks if arrangements for scheduling telehealth consultations and associated privacy and billing mechanisms are determined by relationships at a local level.
“If the underlying processes to support virtual are not seamless, robust and efficient this compromises the trust of patients’ and clinicians’ in a telehealth network,” says Darkins. “Establishing and maintaining quality requirements like these, and ensuring safety begs the question of the role for standards and accreditation.”
New payment models and cheaper, more reliable technology make telehealth a more attractive proposition for healthcare, says Darkins. But it needs to be included as part of a system’s overall healthcare delivery plan in relation to the impact it will have on access to care and its quality and cost in meeting the health needs of a patient population.
For Darkins, the question is not whether telehealth will become a greater part of healthcare, but rather, “how” telehealth will be implemented.
“In my opinion you have to be able to establish quality, and have quality management arrangements in place in advance if you plan to take telehealth into routine care,” says Darkins. “You need to find a way of linking [telehealth] into the accreditation process because telehealth interfaces with other traditionally delivered services that are accredited; as well as determine how standards are ensured for the telehealth component of services themselves… accreditation ties into standards and business processes…URAC is doing great working with stakeholders in understanding and introducing these.”