More on telemedicine (Technology, Sept. 2006): Looking toward the future of telemedicine

The healthcare industry, both nationally and globally, has just scratched the surface of possible uses for telemedicine with potential efficiency enhancements on the horizon as well as a future where homes would have "health security systems," according to some leaders in telemedicine.

But there are still important practical questions to be considered before the technology is widely adopted in the United States, such as concerns about return-on-investment and the issue of training and staffing successful programs, says Adam Darkins, MD, MPH, FRCS, chief consultant for care coordination at the U.S. Department of Veterans Affairs (VA).

"Many of the programs that have been done have been on a relatively small scale to date," Dr. Darkins says. "I think what one has tended to see is people are saying 'Well, let's use telehealth' and then use the existing business and telecom models to deliver that care. So at the end of a project, the outcomes are very often the patients are very satisfied, the care outcomes are good, the providers are satisfied, but the bottom line is its going to add nearly 5% or 7% to the costs.

Training and keeping continuity in staff to implement a telemedicine program is also important, so that the initiative can continue once key enthusiasts or implementers move on, Dr. Darkins says. "What you find is that you get a very promising program, and then the key individual leaves, there isn't somebody you can replace them with and so you get no consistency and it disappears."

To this end, the VA has established multiple training centers in different locations for the specific disciplines such as home telehealth and general telehealth.

"Having a telehealth-competent workforce is something which is often not foremost in people's minds, but unless you think of the people processes as well as the technical or the clinical processes, things just don't work."

Integration of electronic methods to share information such as electronic health records (EHRs) also will have a major effect on the future successful use of telemedicine in the United States, Dr. Darkins says.

Will Engle, executive director of the Association of Telehealth Service Providers, a Portland-based international membership-based organization dedicated to improving healthcare through growth of the telehealth industry, believes that the biggest area of growth in telemedicine will be in the homes of patients.

"Home telehealth programs will expand rapidly in the next few years, largely due to home care agencies developing comprehensive telehealth programs that allow them to improve their staff's efficiencies and improve how they manage their populations," Engle says. "Medicare reimbursement accounts for the lion's share of payment for home health services in the United States and they have started to recognize the benefits of telehealth."

With more familiarity on the part of patients and providers, Engle believes that telemedicine adoption will increase.

"The gap between the clinical outcomes studies that show telemedicine is a practical way to provide care and what payers will reimburse for will become nonexistent," he says. "As more pressure is placed upon the U.S. healthcare system by a growing and aging population, payers will turn to telemedicine to create efficiencies and spread out caring resources."