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Study: Retail Telehealth Offers As Many Challenges As Opportunities

A report in Health Affairs argues that the use of telehealth in consumer-facing and retail environments offers many opportunities for improved access and health, but those opportunities need to be balanced with new policies.

Source: ThinkStock

By Eric Wicklund

- The emergence of retail telehealth networks and the looming presence of big-name players like Amazon and Walmart in the healthcare space means consumers are on the cusp of true anytime, anywhere care. But is this a good thing?

A new report by some experts in the connected care field – including Partners HealthCare’s Joseph Kvedar and former American Telemedicine Association President Peter Yellowlees – argues that the nation’s healthcare landscape may not be ready for this type of care. There aren’t enough safeguards in place, they write, to protect sensitive patient data or to ensure that healthcare providers aren’t crowded out of the market by less-regulated commercial programs.

“Retail outlets have access to a wealth of consumer data, and health care organizations have access to medical data,” Yellowlees, a professor of psychiatry at the University of California at Davis and senior author of the study, says. “While some convergence is already happening through data brokers selling consumer data to health care organizations, the precision, granularity and flexibility to analyze the data could be much more significant when retail organizations have access to both health care and retail-data sources directly.”

Yellowlees and Kvedar, Partners’ Vice President for Connected Health and a professor of dermatology at Harvard Medical School, partnered with Keisuke Nakagawa, a postdoctoral scholar in the Department of Psychiatry and Behavioral Sciences at UC Davis Health, to write the report, which appears in this month’s issue of Health Affairs.

The three authors say the nation’s embrace of consumer-facing telehealth may improve access and raise the national bar on health and wellness, but there are too many avenues of poorly regulated or unchecked healthcare access that could end up doing more harm than good.

READ MORE: How One Urgent Care Clinic Uses Telehealth to Find its Niche

“Current policies are insufficient to address the opportunities and threats created by these new developments,” they argue.

The report identifies four areas of connected care which need to be examined in more detail:

  1. Net neutrality and telehealth accessibility.  Federal and business policies that designate how telecoms apportion bandwidth and charge for its use may affect providers who deliver telehealth to underserved populations or during crises like natural disasters. Likewise, those policies may prevent providers from creating lower-costs or healthcare-specific services. “The effect of net neutrality on telehealth will depend on the specifics of the policy and its implementation,” the report states, “but more research and analysis could help inform the design and implementation of such policies and may be a significant factor in determining future patient access to care.”
  2. Data privacy and security. As more non-healthcare organizations jump into the healthcare space through telehealth and mHealth platforms, the potential for protected health information to show up in the wrong place expands dramatically. And the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule isn’t equipped to deal with these new channels. “Although these exceptions were intended to facilitate care delivery, payment, and efficient operations, reevaluation of these guidelines may be warranted given significant changes in technology and the health care market since the guidelines were last revised, in April 2003,” the report states.
  3. When protected health information and consumer channels collide. The rise of consumer-facing mHealth devices and the “smart home” means more opportunities exist for health data to move beyond the healthcare network. And large corporations – including consumer tech and retail companies – are scooping up both consumer and health data. “Policies regarding permission and consent may need modification to take these scenarios into account,” the study notes. “Because some patients may agree to certain data collection and use, guidelines will have to be developed to ensure that patients have a clear understanding of how organizations are permitted to use their data and when their authorization is required.”
  4. Provider flexibility. While these new telehealth channels give consumers new access to healthcare providers, they might hinder solo and small practices who suddenly find themselves competing with retail outlets, supermarkets, pharmacies and payer-provider networks. It’s up to those small, independent practices to use telehealth to their advantage. “Telehealth offers physicians an alternative to these single-employer contracts and creates opportunities to have more flexible working arrangements by allowing individual physicians to contract with multiple payers, provider groups, and retail outlets,” the report says. “Policies that support increased provider flexibility and practice independence are important considerations in an increasingly competitive environment, as more physicians are struggling with work-life balance, burnout, and depression.”

Going forward, the three researchers argue that policy makers need to take into account new methods and channels for healthcare delivery. This fast-changing landscape may improve access for consumers and open new doors for providers, but it also increases opportunities for misuse.

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