- The organization that recently defined “store-and-forward” telehealth says this is the first salvo in an ongoing battle to make the industry meaningful.
The healthcare landscape is littered with outdated or vague words and phrases, say members of the Connected Health Initiative, a year-old offshoot of ACT | The App Association that’s been tasked with exploring the intersection of healthcare and technology. And that’s not only plaguing federal and state efforts to regulate the industry – it’s keeping payers from reimbursing the technology.
“There are 50 million definitions out there for eHealth,” jokes Brian Scarpelli, the ACT’s senior policy counsel and a CHI member. More importantly, he says, “there are conflicting messages” within state and federal agencies that affect how eHealth, mHealth, digital health, connected health, telehealth, telemedicine and all those other terms are used.
“It can get very confusing,” adds Alexandra Cooke, a tech policy professional with ACT and fellow CHI member. “In some cases it’s not the word itself [that is confusing], but how it applies to healthcare or how it’s used.”
This, in turn, makes it difficult for healthcare providers to embrace the technology and make it sustainable.
An obvious example is asynchronous – or store-and-forward – telehealth. While some organizations define the term loosely enough that it encompasses most activities in which health data is captured, stored and sent to another location for analysis, others impose limits. In states like Arkansas, officials have argued that store-and-forward telehealth should not include online questionnaires filled out by a consumer and sent to a healthcare provider.
That type of murkiness prompted the CHI to create what it calls a “consensus document” – a formal definition designed to appeal to all the stakeholders in healthcare. The document defines asynchronous or store-and-forward as “the sharing of data from one party to another through the use of a device or software that records, stores, and then sends such data via any communications or technological means.”
“We realized that we had to define, at least initially, the term,” says Scarpelli. “What we’re looking to do is work from the ground up, creating [definitions] that shape the way [healthcare providers and payers] recognize and use these tools.”
That store-and-forward debate leads directly to another murky phrase: “the doctor-patient relationship.” While some in healthcare feel that such an interaction can only be properly defined by a face-to-face encounter, others say the relationship can be formed online, perhaps even on the phone. The dispute has led to an ongoing battle over telehealth access in Texas and caused the American Medical Association to squabble for more than a year before it could agree on a code of ethics for telehealth.
Scarpelli, who’d been director of government affairs for the Telecommunications Industry Association (TIA) before joining ACT a year ago, says even government entities are having a hard time defining the industry. While the Centers for Medicare & Medicaid Services operates on a rather strict set of definitions for telehealth and telemedicine, he says, the Office of the National Coordinator for Health IT (ONC) takes a much broader view on the topic.
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“They seem to be running on parallel tracks that never seem to intersect,” he says.
And that’s where the industry could suffer. The AMA’s definitions for such concepts as asynchronous telehealth, teledermatology, wellness, health management, remote monitoring, medical-grade data and “originating sites” – just to name a few - play an important role in the development of Current Procedural Terminology (CPT) codes, which are used by CMS to determine reimbursement to providers.
Scarpelli praises the AMA for recognizing that telehealth and telemedicine play an important role in future provider reimbursements – CHI has, in fact, sent its position paper on asynchronous telehealth to the AMA’s Telehealth Services Workgroup, which is tasked with defining new CPT codes to serve the telehealth industry. But he recognizes they have a tough road to hoe.
“We’re going to have to develop consensus definitions for a lot of different terms,” he says. “And there are a lot of stakeholders who will want to contribute.”
Whereas the store-and-forward definition was the first step, Scarpelli and Cooke expect to “hit the ground running” in 2017. Expect to see a lot of discussion, many different points of view, and most likely several more consensus documents. “We’ll certainly be busy,” Scarpelli says.