HD31 - Barriers to the Implementation of Telemedicine in Virginia


Executive Summary:
Telemedicine is broadly defined as the use of telecommunications technology to deliver health care services and health professions education from a central site to distant areas. For purposes of this study, telemedicine means the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data and education using "store and forward" systems such as image transfer and interactive audio, video and data communications.

A diverse collection of technologies using telecommunications as a method for health care services delivery, telemedicine systems can be characterized by the type of information sent such as radiographs or clinical findings and by the means used to transmit it.

Current Scope of Telemedicine

Interest in the field of telemedicine has increased dramatically in the 1990s. At least thirteen federal agencies have begun telemedicine research and demonstration programs. Many states are using their own resources to build state-of-the-art telemedicine systems, some with capital investments exceeding $50 million.

Telemedicine is not universally supported. While some view it as a valuable tool for providing specialty care services to under-served areas, others consider it a serious misallocation of increasingly scarce health care dollars.

Approaches to Telemedicine by Other States

The goals for state involvement in telemedicine development include:

• Ensuring equity in access to technology by improving the distribution of telecommunications resources.
• Providing funding for program development.
• Coordinating and facilitating state planning and policy development through a statewide coordinating body.
• Serving as public consensus builder in support of telemedicine and as facilitator in program planning.
• Managing components of program implementation by using state resources and state capabilities.
• Facilitating regulation that supports and enhances telemedicine, specifically related to provider licensure, confidentiality, reimbursement and health insurance regulation, malpractice and credentialing.

Effectiveness of Telemedicine

For patients in rural areas, telemedicine provides access to consultations with specialists as well as the analysis of diagnostic tests rapidly without having to spend the time and money to travel to urban medical centers. However, very little telemedicine is actually being done. The proliferation of telemedicine may depend less on technology and more on the willingness of insurance companies and the federal Health Care Financing Administration to reimburse health care providers for the cost of remote diagnostics and consultation.

While reimbursement is a major factor holding back the growth of telemedicine, other barriers need to be addressed if telemedicine is to become a widely used tool for providing access to health care in rural Virginia. Currently, telemedicine is not widely practiced in Virginia or the United States due to a number of other barriers, including physician acceptance of new technological tools, licensing and hospital credentialing requirements, as well as legal restrictions and uncertainties, including privacy issues, regulatory barriers and inadequate financing.

Barriers to Telemedicine

At present, the barriers to telemedicine do not reflect inherent limitations in technology that compromise the clinical process but rather societal practices and restrictions. The evolving nature of telemedicine is witnessed by the large number of pilot projects under way. The need exists for further research, less to determine whether telemedicine works, than to determine when and how best to utilize it in the Commonwealth.

Recommendations to address each of the barriers identified in the report were developed by the Telemedicine Study Committee and are as follows:

Reimbursement for Telemedicine Services. To provide a basis for telemedicine reimbursement policy in Virginia, the Legislature should encourage and support universities, public and private payers and other organizations to study the cost effectiveness of telemedicine services.

Telemedicine Acceptance. Research studies and pilot projects should be conducted, both on the need for telemedicine as well as its effect on practice patterns, community hospitals and related issues, which will demonstrate the actual impact of telemedicine on a community.

As a way of overcoming the lack of widespread physician acceptance of telemedicine and the lack of familiarity with related technologies, medical schools and continuing medical education programs should provide telemedicine training in their curricula.

Licensure and Credentialing. The State Board of Medicine should be encouraged to adopt a policy for the practice of telemedicine which will assist in achieving the maximum quality of care for as many citizens of the Commonwealth as possible.

Legal and Medical Malpractice Liability. In the practice of telemedicine, jurisdiction should occur subject to the same laws as currently apply to other forms of medical practice. Once the issue of licensure for the practice of telemedicine is resolved, however, a study may be necessary to determine how resolution of this issue impacts liability.

Confidentiality. The following steps should be taken to ensure the confidentiality of electronic medical records created or associated with the practice of telemedicine:

• Apply existing confidentiality protections, including informed consent where appropriate.
• Implement security in as current a technology as possible.
• Once the issue of licensure for the practice of telemedicine is resolved, a study may be necessary to determine how resolution of this issue impacts privacy.

Telecommunications Regulation. The Legislature and the State Corporation Commission are encouraged to take all actions necessary to ensure compliance with the principles enunciated in the US Telecommunications Act of 1996 and the approved recommendations of the Joint Board.

Cost. The medical community, providers of technology, and communications companies should be encouraged to fund and share the responsibility for establishing needed telemedicine sites and for identifying the most appropriate and cost-effective telemedicine applications.

Infrastructure Planning and Development. Initiatives should be encouraged and supported to ensure the continued growth of cost-effective statewide telecommunications networks capable of delivering maximum health care services to the rural communities.

Telecommunications service providers in the Commonwealth should be encouraged to participate in providing "last mile service" to Virginia's rural communities.

Benefits Discovery. The Department of Health should be requested to coordinate, in conjunction with other agencies, a study and needs assessment to determine the deficiencies existing in health care services in rural Virginia which could be met by telemedicine.