The Next Step in Health IT? Virtual Doctors Visits

Amid congressional discussion about making electronic health records widespread, senators have turned their attention to laws governing virtual medical care, often called telehealth. 

During a recent hearing, Sen. Brian Schatz, D-Hawaii, noted that telehealth services, which could include using wireless medical devices to monitor patients while they're at home, are not always reimbursable under Medicare. For instance, he said, some reimbursements are available for patients in rural settings, but not urban ones. 

Lawmakers “have got to push providers to reimburse for telehealth services,” Schatz said during a hearing convened by the Subcommittee on Communications, Technology, Innovation and the Internet. “Medicare has to lead the way," he added.

Congressional interest in telehealth legislation is building. During the hearing, Sen. Roger Wicker, R-Miss., said he planned to introduce the Telehealth Enhancement Act, aimed at expanding Medicare reimbursement for telehealth services, as well as access to high-speed broadband especially in rural communities.

Last February, Sen. Deb Fischer, R-Neb., introduced the Preventing Regulatory Overreach To Enhance Care Technology with Medical Devices Act  -- the PROTECT Act -- intended to modernize the Food and Drug Administration's definitions for health IT, she said. 

During the hearing, Jonathan Linkous, chief executive of the American Telemedicine Association, noted that the lack of broadband connectivity was a barrier to widespread telehealth delivery. 

“The wonder of advanced technology-delivered health care is useless if you don’t have access to broadband," he said. "Access to broadband is no use if you don’t have remote health services that are made available by providers, and providers aren’t going to provide those services if Medicare and other payers don't pay for it -- and if state and federal regulators don’t pave the way in easing the regulatory burden."

And while the Federal Communications Commission has focused on bringing broadband to citizens' homes, "we do need to start looking at this issue as 'broadband to the person'" instead of tying connectivity to physical locations, Linkous added. 

For instance, he said, a particular smartphone application lets physicians working in neonatal intensive care units monitor infants' vital signs, regardless of the physician's location. 

During the hearing, Sen. Ed Markey, D-Mass., warned lawmakers about the security risks telehealth services could pose.  

"We’re moving from the old era were you went into the doctor's office, the nurse would open up her cabinet and pull out up your file hand it to the doctor," Markey said. "And now, because of these new technologies we are entering an era where these records through telemedicine can be just out there. So concomitant with the efficiency which these new technologies make possible, you also need a discussion about what the privacy rights are."

"My sense is that you need a law" establishing standards for transmitting health information securely and privately, he added. "You need something that the bad guys know is going to get them in trouble if they [break into medical records] . . . you need some standard that good guys are going to meet every time."

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