The Role of Telehealth in an Evolving Health Care Environment Workshop Summary (2012) / Chapter Skim
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4 Challenges in Telehealth
4 Challenges in Telehealth
Pages 17-30
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American Telemedicine Association When the ATA started in 1993, telemedicine largely consisted of hub and spoke networks based out of tertiary care or academic medical centers. Today it is a quite different picture.
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Practice regulations may be an even larger barrier than licensure, as many state medical boards require an in-person consultation before initiation of any telemedicine services. In fact, the American Medical Association recently proposed a resolution to the same effect, and federal legislation has also been proposed.
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Telemedicine networks are expanding ICUs and capabilities for stroke care, but many of these are independent networks, and isolated from the traditional telemedicine networks. Are they competing or are they a part of it?
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In the short term, we cannot dramatically affect the number of health care providers, but we can do something about the productivity of their time and resources. Increasingly, multistate plans deliver health care, whether it is a managed care plan or an ACO, in order to provide more care options.
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Major public health issues impact rural communities and their economic development, in part due to a lack of access to health care services. Telehealth technologies play a major role in helping individuals and their health care providers to better manage health.
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In July 2012, the FCC requested more input about how these programs might be improved. Rural Health Care Pilot Program The RHCPP was established by the FCC to help public and nonprofit health care providers deploy a state or regional dedicated broadband network, with the ultimate goal of creating a nationwide broadband network dedicated to health care.
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Urbanized areas have a core population of at least 50,000 people, and urban clusters have a core population of 2,500 to 50,000 people. Generally, urbanized areas need a population density of at least 500 people per square mile, or fewer than one person per acre.
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, population, and population density into account. A zip code approximation of these tracts was developed so that health care researchers can compare zip code data with its RUCA code to determine if that area is considered rural, micropolitan, or metropolitan.
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. TABLE 4-2 Urban Influence Codes Code Description Metropolitan Counties 1 In large metro area of more than 1 million residents 2 In small metro area of less than 1 million residents Non-Metropolitan Counties 3 Micropolitan area adjacent to large metro area 4 Non-core adjacent to large metro area 5 Micropolitan area adjacent to small metro area 6 Non-core adjacent to small metro area and contains a town of at least 2,500 residents 7 Non-core adjacent to small metro area and does not contain a town of at least 2,500 residents 8 Micropolitan area not adjacent to a metro area 9 Non-core adjacent to micro area and contains a town of at least 2,500 residents 10 Non-core adjacent to micro area and does not contain a town of at least 2,500 residents 11 Non-core not adjacent to metro or micro area and contains a town of at least 2,500 residents 12 Non-core not adjacent to metro or micro area and does not contain a town of at least 2,500 residents SOURCE: USDA (2012c)
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. Office of Rural Health Policy ORHP defines all nonmetropolitan counties in the United States as rural.
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Defining Rural One participant commented on the need to more accurately define ru ral, giving the example of San Bernardino County, which is 20,000 square miles and includes the Mojave Desert, yet is defined as metropolitan. Hirsch stated that rather than focusing on definitions of rural, more concentration should be placed on the broadband coverage necessary to serve all individuals.
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From page 28... ...
Another participant mentioned that a recent IOM study on geographic payment adjustment for Medicare payment called for changes in payment policy on telehealth. She added that the committee saw the availability of telehealth as a matter of equity of access to care, and also that the committee made recommendations on scope of practice, seeing that as a matter of efficiency and access for Medicare beneficiaries.
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Levels of Evidence One participant related the story of a study that aimed to look at both clinical and the financial benefits of home telemonitoring for elderly congestive heart failure patients. She noted that the randomized controlled trial (RCT)
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