Nationwide Telemedicine Networks Essential for Successful Health Care Reform

According to a new white paper from the American Telemedicine Association to be published in the peer-reviewed journal, Telemedicine and e-Health, telemedicine, or information technology enhanced healthcare, must be a core component of any viable healthcare reform strategy.

The white paper, entitled "National Telemedicine Initiatives: Essential to Healthcare Reform," presents a consensus perspective developed by a diverse group of healthcare providers, researchers, academicians, and industry representatives from across the U.S. Lead authors Rashid L. Bashshur, PhD from the University of Michigan (Ann Arbor) and Gary W. Shannon, PhD from the University of Kentucky (Lexington), clearly state that, "While not a panacea, telemedicine offers significant opportunities to address the issues of inequities in access to care, cost containment, and quality enhancement."

The study argues that well-designed telemedicine systems have proven value for improving access to quality healthcare, providing effective clinical decision support and medication prescribing, promoting patient-centered care through community- and home-based resources. Additionally telemedicine can enhancing chronic disease management, promote adoption of healthy lifestyle choices and self-care and containing cost inflation. As a result, telemedicine offers substantial benefits that greatly exceed its cost.

The authors encourage the continuing effort to make electronic health records (EHRs) universally available, but caution that an exclusive focus on EHRs would result in increased cost without addressing the necessary changes for effective and sustainable healthcare reform. On a broader scale, telemedicine systems will incorporate EHRs as well as a host of other technologies that enable the electronic acquisition, storage, retrieval, and exchange of information "for the purpose of promoting health, preventing disease, treating the sick, managing chronic illness, rehabilitating the disabled, and protecting public health and safety.

"Most medical centers are currently facing a perilous financial situation from declining revenues," the white paper notes. "Some have found it expedient to reduce their investment in ICT. Moreover, the prospect of providing additional services via telemedicine is not inherently attractive to them because of significant limitations and restrictions on reimbursement for these services. As supported by scientific evidence, a fair reimbursement policy would equate services delivered electronically to those delivered in person."

The report adds that an inability to recoup costs currently has hampered the diffusion of telemedicine nationwide since no medical practice can be sustained without reliable recurring revenue. "In the current economic environment, it would be futile to propose

solutions in healthcare that simply add expenditures without having a clear and explicit expectation of significant returns on investment," the report says.

The authors encourage the continuing effort to make electronic health records (EHRs) universally available, but caution that an exclusive focus on EHRs would result in increased cost without addressing the necessary changes for effective and sustainable healthcare reform. On a broader scale, telemedicine systems will incorporate EHRs as well as a host of other technologies that enable the electronic acquisition, storage, retrieval, and exchange of information "for the purpose of promoting health, preventing disease, treating the sick, managing chronic illness, rehabilitating the disabled, and protecting public health and safety.

"Telemedicine is the common element to make reform succeed," said Journal co-editor-in-chief Ronald Merrell, MD, Professor of Surgery, Virginia Commonwealth University in Richmond in a news statement. "Telemedicine involves stunning new technologies that go well beyond just using electronic health records, which can ensure both quality care and cost savings if this technology is widely applied throughout health systems. Telemedicine applications have been tested and proven through years of research and are ready for scalable expansion to serve the entire country and make healthcare reform a reality and a success."

The white paper concludes that telemedicine not only provides the potential to address structural issues of the health system, but it also promotes transparency and evaluation to drive further improvement. Telemedicine that connections between primary care providers and specialists would lend greater economic benefits. Patients would be less likely to get "lost" in the complexities of fragmented and unconnected medical providers and health systems. Instead, their care would be facilitated through an integrated and electronically connected medical care landscape across the entire country.

The full white paper is available online at http://www.liebertonline.com/doi/pdfplus/10.1089/tmj.2009.9960

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