Outdated regulations, insufficient payment mechanisms, and established clinical paradigms are the top tier barriers to more widespread use of telemedicine according to study results published in the Jan/Feb issue of Telemedicine and e-Health.
The study, lead by Dr. Herb Rogove, president and CEO of C3O Telemedicine, was conducted in conjunction with researchers from the Mayo Clinic, Arizona and UCLA Medical Center, Los Angeles. “Our goal was to try to understand barriers to adoption of robotic telemedicine (RTM) when we are facing an impending shortage of acute care physicians, such as intensivists” said Dr. Herb Rogove. “Surprisingly and fortunately, administrative and nursing leaders were very welcoming of telemedicine.”
In the study, Barriers to Telemedicine: Survey of Current Users in Acute Care Units, emergency and critical care robotic telemedicine users were asked to identify the factors that motivate and the barriers that impede the acceptance and maintenance of remote presence telemedicine. It revealed three major human principals that create barriers to adoption, with the first two being more likely to hamper program success: regulatory, financial, and cultural.
The major regulatory barriers are the difficulty and cost of obtaining licensure across multiple states, malpractice protection and privileges at multiple facilities. Lack of acceptance and reimbursement by government payers and some commercial insurance carriers has created a major financial barrier, which places the investment burden squarely upon the hospital or healthcare system -- even though the former benefit from more timely access to specialists and their expertise. And finally, cultural barriers occur from the lack of desire, or unwillingness, of some physicians to adapt clinical paradigms for telemedicine applications.
An email to users of robotic remote presence telemedicine and web-based survey resulted in a 60.3% response rate. More than two-thirds of the respondents were physicians and the remainder were nurses and administrators from facilities located in the United States, Canada and Ireland -- representing academic, community and rural facilities.
Their top motivating factor for implementation of remote presence technologies is the immediacy of patient access (69.5%). The top motivating factor for their institution is providing quality care (87.6%) Given the importance of both patient access and quality care, it’s no surprise that the primary utilization of RTM is emergency response and consultation in both the ED and the ICU.
Dr. Rogove stated “my hope is that the results of this survey will trigger additional momentum for the push toward regulatory reform of state medical licensing and that third party payers will see the value of encouraging the adoption of telemedicine as an integral part in healthcare delivery systems”. He suggests the following actions will go a long way toward resolving the barriers:
- A much needed national medical license and expansion of credentialing by proxy.
- A payment mechanism from both CMS and private payers in all states for reimbursement that recognizes the significant provider investments being made to improve access and reduce costs.
- Outreach and educational programs that help healthcare professionals and policy makers explore the body of existing medical literature and published data on the safety, efficacy, and outcome benefits of telemedicine.
Rogove believes that “In a time when this country faces a growing shortage of physicians, telemedicine offers the opportunity to fill this gap and allow all hospitals to have access to the needed care that their patients require”.
About C3O Telemedicine
C3O Telemedicine is an innovative provider of virtual presence clinical coverage solutions to metropolitan and rural health facilities. With renowned physicians board certified in the specialties of neurology/neurocritical care, psychiatry, pulmonary/critical care and other high-demand, scarce specialties, C3O Telemedicine delivers flexible, responsive and highly supported telemedicine services with exceptional clinical quality. This virtual medical group is lead by Herb Rogove, DO, FCCM, FACP, President and CEO, who has developed multiple ICU, Hospitalist, and Emergency Medicine programs.