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Telehealth News

What is the State of the Telehealth Landscape?

By Ryan Mcaskill

In an interview, American Telemedicine Association CEO Jonathan Linkous discusses the current and future of telehealth.

The adoption rate of telehealth services is picking up, but there are still challenges to getting there. Reimbursement rates are picking up, legislation is being debated and healthcare professionals are opening up to using the new technology. But what is the current state of telehealth?

In an interview with, American Telemedicine Association CEO Jonathan Linkous spoke about the current state of telemedicine, where it going and what the challenges are to get there.

mHealthintelligence - Can you give a little background on the American Telemedicine Association and what your goals are?

Jonathan Linkous -We are the American Telemedicine Association and we are 22 years old. Our goal is to transform the delivery of healthcare to use telecommunication technology. When we talk about that, its a very broad definition and we include all sorts of devices including landlines, point-to-point, could be mobile, could be internet or web-browsing type of capabilities. We are not tied so much to the type of technology people think of when they refer to mhealth, we consider it just one of the mechanisms used to transmit or receive healthcare information.

Our focus is on the services. We are very involved with being transformative. Our membership includes a couple hundred companies, several hundred health systems and medical providers, somewhere around 9,000 individuals and we are worldwide.

That’s who we are. What we do is hold an annual meeting. We are involved with developing practice guidelines. We do a lot of work with the medical societies, as well as other types of associations and industries. We have an accreditation program for online consultations and we do a lot of work in government, helping with public policy and online training. We probably have 20 or 30 member groups of various specialty areas. - What is the state of telemedicine today?

JL - Growing at a very, very rapid pace. Telemedicine has been growing two ways. One is by the number of services provided we estimate that somewhere around 15 million Americans will have have services provided by telehealth this year. Also the number of specialities that are provided are expanding. It use large tertiary care centers going out to a rural area with an interactive video but thats a small part of where telemedicine is today.

It’s providing specialty care services, stroke services. For example, about 100,000 people will be seen by a neurologist using telemedicine if they have a stroke and go to the emergency room this year. How many of them will have their lives saved or their outcomes improved?

In radiology somewhere around five to seven million people will have their images read by a radiologist who is actually not located where they are located done by teleradiology.

And then we go into online consultations. Probably 800,000 services this year will be done over the internet or in a direct to consumer web-based service.

Finally we go to mobile devices. We are increasing the number of people using mobile health to track their chronic diseases or physicians that use it to track their patients when they are away from their offices.

So it’s a very broad area that is expanding exponentially. Our goal is to take all of this new innovation and technology and insert it into the ongoing health system. It’s not a stand alone, it’s part of the healthcare systems. There are a lot of new innovations that are coming out everyday and its wonderful and we love it, but for it to really make sense and catch on, and from a development perspective for it to make profits that last, it has to be part of the healthcare delivery system. Organizations need to start adapting the technology that is available. - How has that evolved over, say, the last five years?

JL - Compared to five years ago, there are several things that have changed. The cost of transmission has gone down as broadband has become ubiquitous. We are not there yet, but its getting that way and it’s certainly a lot cheaper than it use to be.

The costs of the associated technology platforms are a lot cheaper becoming more integrated into mainline sources. It use to be a telemedicine service would have standalone technology, a standalone transmission system and standalone software that’s developed. Not it tends to be an adjunct to existing platforms.

You might have an iPhone with downloaded software from the Apple App Store or an online consultation portal that is run through a web-browser or a hospital may bring in a specialist to provide specialty care but they are using it over existing  broadband lines that the hospital already has in place. That has made a big difference.

The second area is that there is now reimbursement as the healthcare system has changed in two ways. The first is that there is more reimbursement for fee-for-services. The other is that we are moving into more broad care where the payment systems are such that you don’t need to justify each and every time you use a telecommunication device, which makes it a lot easier to use those services.

The third thing is that it is being accepted, not only by the healthcare profession and healthcare, but it is going into the C-Suite where the CEOs are actually asking for it and the payers are starting to really reimburse. Also the medical societies that use to be an opponent to telemedicine are now embracing it.

So there are multiple points that are coming together all coming together at the same time. - Where is telemedicine heading?

JL - Growth of course is going to be there and its on a logarithmic scale at this point. Somewhere around 15 million or so Americans are getting those services this year, when two years ago it was probably seven million. It’s grown at that level and we are going to see it continue to grow more and more and become fully integrated.

I think a couple of things are going to happen. One, consumers are going to start to use it and be very aware of it. Up until this point, a lot of telemedicine has been behind the scenes. You were not necessarily aware if a radiologist was reading an x-ray behind the scenes, and that is fine with you and its fine with us as long as it is being used. But now with direct to consumer services, consumers are going to start to say: “ You know, this is what I want and I’m going to have a primary provider that I go to all the time, use this technology. If they don’t, I’m going to go to someone who does.”

When you have consumer demand start to take hold, that is going to be an exponential driver.

The other is that we are finally, slowly getting to the place in healthcare, where ATMs were with banking so many years ago. In my day, if you wanted to get cash out of your bank account, you had to write a check and go to a teller. Now you wouldn’t think of going to a bank that didn’t have an ATM, where you can get access to your money anytime you want.

I think we are getting to that point in healthcare. We are not there yet, but we are getting there. Soon it will be as easy to get services as an ATM card is to getting money out of the bank. - What are the challenges to getting there?

JL - There are a number of challenges to start moving over. Technology is changing so rapidly, you need to be very careful about embracing any one particular mode. That is more of an operational issue I would say.

There is still issues with reimbursement. Private payers and employers are embracing it very quickly. Medicaid through the states are moving pretty rapidly. There were 40 some states that had legislation last year to improve the reimbursement.

Medicare is the slowest to adopt the use of this technology, so it is going to be a few years for them to really come in line to do everything they should. There is some reimbursement now through Medicare and as we move through other kinds of payment mechanisms - the payment for quality rather than quantity - and when those take hold it is going to accelerate it, but we have to move faster than that pace.

And then there some built in issues. For example, physician licensure. A physician must be licensed in every state and now that healthcare is becoming available no matter where you are, if you are located in Boston and travel to Florida and you come down with a bug and just need to talk to a doctor, your doctor in Massachusetts needs to be licensed in Florida. We need to overcome this problem with licensure because technology works against it. There was a similar issue with banks years ago when banks were limited to one place and you couldn’t use an ATM in another state. Well we overcame that and we need to do the same thing with healthcare today.

There are issues yet to be conquered but we are getting there. - Is there a timetable for change? With how quickly technology is evolving, it seems like once you conquer the current hurdles there could be brand news waiting.

JL - That’s a good point. It certainly is evolving and government moves slowly (laughs). But it also moves iteratively. We will have some changes this year, we had some changes last year, we will have some changes the year after, so its moving in the right direction.

There are a number of bills, in particular in Congress which the House introduced, which we have been working with to develop some of the language in there called the “21st Century Cures Bill” that is shaping up to be an important piece of legislation that will help a lot of the digital technology and healthcare move ahead. I don’t know if it will all get passed this year, but the fact that it has very broad, bipartisan support and is endorsed by the leadership, is a sign of where we are going.

I think, teamed with that on the state level, the fact that we have some 40 states that are moving in the direction of putting legislation through the state governors’ offices that mandate private payer insurance or expanding Medicaid reimbursement or other types of incentives, we are beginning to see that tidal wave. We are still in the beginnings of it, but clearly the tidal wave is coming. - Anything to add on the telehealth conversation?

JL - I think it’s an exciting time for healthcare. It’s a demanding time with some challenges to some of the traditional healthcare world. Anyone in the world of hospitals, which are use to using brick-and-mortar and the services provided within that institution are starting to look at it in a different way.

Again, I do the parallel to banking, to entertainment, to education, to libraries, there are so many different areas that have changed so rapidly, the only surprise is that we haven’t have healthcare change quicker than it has. They are a late adopter of technology, but they are catching up pretty quickly.


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