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Telemedicine lecture

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Eric Anderson

on 12 June 2016

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Transcript of Telemedicine lecture

Metropolitan statistical area
Health Professional Shortage Area
State administered program for low income individuals and families.

Telehealth & Telemedicine
Telehealth: (HRSA definition)
Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.
Eric R Anderson MD, PhD
Balanced Budget Act of 1997
Federal Register 1998
BIPA 2000
Medicare Prescription Drug and Modernization Act of 2003
Medicare Fix Bills 2006, 2007
Health Care Reform Act 2010
Accountable Care Act 2011

Different forms of Healthcare delivery
Telemedicine: (ATA definition)
Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status
Utilization: Dependent on reimbursemt
Each state is free to determine what medicaid will and will not cover for telehealth

Federal health insurance program for people 65 and older, or with certain disabilities.
"Today, no one clinician can retain all the information necessary for sound, evidence-based practice. No unaided human being can read, recall, and act effectively on the volume of clinically relevant scientific literature."
IOM report
Access to specialty care
Absence of expertise = poorer quality of care
Fragmented/episodic care = less likely to control disease
Transfer costs to the patient/community/state

Geographic disparities
Interactive 2 way video conferencing
Store and forward
Remote monitoring

What about the rest?
Immobile urban beneficiaries
-Nursing homes
-Rehab centers
The story of the rural doc
Medicine is a team sport
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press, 2001, pp. 1, 13-14, 236, 237
A large body of evidence
Thank you!
Where do we go from here?

Continue to push legislation for better reimbursement

Continue to work towards a uniform telemedicine licensure

Continue to develop new workflows and models of care that maximize patient care and minimize administrative obstacles

Continue to educate physicians, patients, and payers
Telemedicine allows for:
Improved access to care
Improved quality of care
Decreased health care usage and overall costs
Current barriers/obstacles:
Poor reimbursement
Multi-state licensing
Regulated by each state regarding the practice of medicine within its boundaries
Enforced by the state boards
Ensures that physicians meet academic and clinical competence standards to protect the public


Can be used as an anti-compete device
Can harm a population by restricting access if none exists locally
Can protect providers but the non uniformity between states may expose them to liability risk.

Describe Telemedicine and how it is used
Understand the barriers to implementation
Understand the benefits of telemedicine

CMS can affect the way medicine is practiced

Affect change in the practice of medicine by altering reimbursement
There has been a recent change to reimburse for transitions of care
Also areas that are eligible for telemedicine services have been redefined.
State specific reimbursement
Dynamic and constantly changing
35+ states have legislation regarding telehealth/telemedicine reimbursement
Incentive is to:
Decrease health related transport costs
Improve access
Improve patient outcomes
Feb 7, 1906
- Willem Leister Einthoven sent an EKG over telephone lines, the first example of modern telecardiology.
We have come a long way
April 15, 1924
- "The First Exposition of Telecare": The Radio Doctor

"Radio News" magazine from April 1924.
August 14, 1955
- The Nebraska Psychiatric Program

The first to practically use closed circuit television and radio transmitted records for treating psychiatric patients." (Source: History of Telemedicine)

Communicated with norfolk state hospital 122 miles away.
May 24, 1965
- NASA'S IMBLMS Outline Released

Integrated Medical Behavioral Laboratory Measurement System (IMBLS).
The IMBLMS document describes an "essentially complete telemedicine system that could ultimately connect the entire nation."
Coverage for home telehealth

17 states cover some form of home telehealth
videoconferencing/remote monitoring/etc
11 use the Health home option
Social Security Act -section 1915
Allows for states to provide coverage for home health/remote monitoring
Better care coordination for high risk beneficiaries
multiple chronic conditions
Reduce Costs
Decreased transfers (Hosp, EDs, prisons, NHs)
Decreased readmissions
Decreased Length of stay

Improved Quality of Care and Outcomes
More continuous care = better disease control
Immediate care where needed
Stroke, ICU, psychiatry, etc.

States have a choice
Do nothing
Follow the status Quo (Medicare)
The Future
Direct to consumer telehealth
Telehealth: (HRSA definition)
Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.
What is telemedicine?
How can telemedicine help rural docs?
Full transcript