Where is telehealth and why is it taking so long to get here?

The Broadband Breakfast Club sponsored an excellent dialogue this morning (October 13) on telehealth. Four doctors, one from the army, one from the veterans’ administration, one regarded as the “father of telehealth”, and one from Kaiser Permanente presented on what it is and why it is good. Since many of our member institutions have medical schools, I thought it would be a good place to learn something about broadband and its relationship to telehealth.  What I learned:

• Telehealth is an old idea…. in fact over 40 years old.
• Hospitals are an old idea… they are related to the industrial revolution and are as “Victorian” as factories and assembly lines. The deliver of medical services is moving away from the hospital model to more preventive care and care for chronic illnesses delivered to the home, school or workplace.
• Health care delivery is focusing less on a single doctor’s expertise and more on a “team” of professionals working together for the patient.
• To be efficient, both financially and based on healthy outcomes, emphasis needs to be on the services that are in greatest demand and how to make their deliver the easiest and most cost-effective.
• The cell phone (smart phone) will be the key for both health monitoring and delivery of information such as test results and prescriptions. The bulk of health services do not require a great deal of bandwidth but the availability of bandwidth is an incentive for better services being offered.

The conversation was so convincing that most of the audience questions were focused on “what are the barriers”, “why don’t we have this”?  With the healthcare reform debate raging in Congress… we should all be asking this. Their responses: 

• Cost/benefit: 90% of healthcare in the US is delivered by small independent practices. Where telehealth is being successfully deployed is in large systems such as the army, the VA, and Kaiser Permanente where the “system” benefits directly from lowering costs. Telehealth must be mandated or made cost-effective for doctors to readily adopt it.
• Regulations: Outdated regulations such as state licensing and reimbursement schemes hinder adoption.
• Medical schools: They often are focused more on research and diagnosis than “patient care”. Young tech savvy students may change that, but more emphasis should be placed on the technologies of health service delivery.
• And finally, patients (that means us) need to demand it!