Laws, other hurdles hinder telehealth

Telehealth could improve access, boost health care quality, cut costs and contribute significantly to homeland security, but the sector is fraught with barriers hindering its further adoption, according to a new Commerce Department report.

Telehealth generally is defined as the use of telecommunications and technology to provide medical diagnosis, treatment, and consumer and professional information over long distances. But there is a patchwork of state policies for licensing and reimbursement, as well as other legal and financial hurdles, the report states.

So although technology now enables doctors to talk to and treat patients across state lines, some state laws actually forbid that. "It may be like practicing without a license," said Phillip Bond, Commerce's undersecretary for technology.

There needs to be a greater coordination among the public and private sectors as well as a greater adoption of information technology by the health care industry, which is still heavily reliant on paper, according to the report. That could help propel the market for such technologies.

In 2004, the estimated investment in telehealth goods and services is about $380 million, which is about 1 percent of the total domestic health care technology market of about $80 billion.

"This report shows that telehealth is a growing and evolving industry with much potential," Bond said, pointing to a global opportunity as well. "Long-distance diagnostics and treatment, and improved access to health information and education are just some of the benefits of telehealth. That is good news for consumers and the country as a whole, especially in rural America."

There are also no industrywide telehealth standards that contribute to a lack of interoperability among systems. However, the American Telemedicine Association and National Institute of Standards and Technology have teamed up to develop and market adoption of such standards, starting with diabetic retinopathy as a test case. The approach could be replicated toward other standards, Bond said.

The report states that the departments of Defense and Veterans Affairs have actually invested in research and development in this area, but the civilian sector has yet to tap into that experience through technology transfer.

The value of telehealth to homeland security and public health in general also has been largely overlooked. "For example, development of epidemiological detection and surveillance information systems by the Centers for Disease Control and Prevention and various states should not overlook the hundreds of telehealth networks as a currently available infrastructure," according to the report.

The report, titled "Innovation, Demand and Investment in Telehealth," is available at www.technology.gov/reports/TechPolicy/Telehealth/2004Report.pdf.