Health Information Technology   Telehealth    Implementation: Challenges Considerations

Detailed below is information compiled by the Maryland Health Care Commission (MHCC) regarding factors impacting the adoption of telehealth in Maryland.

Telehealth uses medical information shared through two-way audio/video and other forms of telecommunication technologies, including mobile communication devices and remote monitoring devices, to improve patients’ health status.[1] [2] , There are many benefits to providing telehealth services. Telehealth has the potential to reduce health care costs by enabling more timely interventions in care delivery, reducing overhead costs associated with office visits, and allowing for consultations without the need for a separate appointment with a specialty provider[3]. There are several barriers that may impact the adoption of telehealth.

Physician licensing

Regulations governing the provision of telehealth services vary by state. In Maryland, a physician must be licensed in the State if either or both the individual practicing medicine or if the patient is physically located in Maryland[4] .In other states, the physician can pay a fee to practice across state lines. The lack of standardized telehealth licensing requirements impacts providers’ willingness to offer telehealth services.[5]

Credentialing

The credentialing process for telehealth services can be complicated and costly. If a multi-site hospital credentials physicians specifically for the site at which they are located, then every physician within the hospital system would need to be credentialed at all hospital sites in order to provide telehealth services. This requires more time to complete credentialing paperwork and a high cost for administrative processing, which can be difficult for hospitals and health care practices to initiate.[6] [7]

Liability

There are inconsistent guidelines among carriers offering liability and malpractice insurance for telehealth services. Each carrier defines their own standards/criteria that must be met to receive coverage of telehealth services[8]. A physician must work with their insurance carrier to determine if telehealth coverage is available and if so, the extent of coverage allowed under their policy.

Financial

When telehealth services are being provided from a physician to a patient at their home, the financial benefits are clear with respect to reduced travel time for the physician and patient and reduced overhead by elimination of the office setting[9]. However, the financial benefits for providing telehealth services are much less clear when looking at a reduction in utilization of higher cost medical care, such as emergency department visits and inpatient hospital stays. This makes justification for the up-front costs associated with purchasing and maintaining equipment difficult from an economic benefits perspective[10].

Technology

Providing care via telehealth may require a provider to access a patient’s electronic health information remotely and from a variety of sources. Some technologies used to provide telehealth are limited in their ability to exchange health information electronically. This can result in silos that make it difficult for providers to gain access to medical data necessary to make informed decisions regarding a patient’s health care, including during a telehealth encounter[11]. In addition, lack of broadband access in some areas can impede on the ability to deliver telehealth services, such as video streaming and storage and transmission of vital health information. Additionally, the integration and connectivity of health information required to provide telehealth services requires defined standards for data confidentiality and integrity when providing telehealth services[12].

Organizational Structure

Traditionally, health care organizational processes are set up to support face-to-face encounters. Telehealth services can be viewed as an ancillary or secondary service and not integrated into the standard of care. In addition, an organization must have the staff to support telehealth delivery. Access to providers that are able and willing to provide telehealth services and support the needs of the organization as they implement and grow their telehealth services is a necessary resource for organizations looking to provide telehealth services.[13]


 
 
 1. Maryland Telemedicine Task Force Final Report, October 2014?
 2. American Telemedicine Association. About Telemedicine? 2012?
 3. American Telemedicine Association. About Telemedicine? 2012
 4. COMAR 10.32.05.03
 5. eVisit: Barriers to Telemedicine and How to Solve Them.
 6. eVisit: Barriers to Telemedicine and How to Solve Them.
 7. LeRouge, Cynthia and Garfield, Monica J. Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced? Int. J. Environ. Res. Public Health 2013, 10, 6472-6484; doi:10.3390/ijerph10126472.
 8. LeRouge, Cynthia and Garfield, Monica J. Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced? Int. J. Environ. Res. Public Health 2013, 10, 6472-6484; doi:10.3390/ijerph10126472.
 9. LeRouge, Cynthia and Garfield, Monica J. Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced? Int. J. Environ. Res. Public Health 2013, 10, 6472-6484; doi:10.3390/ijerph10126472.
 10. LeRouge, Cynthia and Garfield, Monica J. Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced? Int. J. Environ. Res. Public Health 2013, 10, 6472-6484; doi:10.3390/ijerph10126472.
 11. MHealth News: The top three barriers to telehealth adoption
 12. LeRouge, Cynthia and Garfield, Monica J. Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced? Int. J. Environ. Res. Public Health 2013, 10, 6472-6484; doi:10.3390/ijerph10126472.
 13. LeRouge, Cynthia and Garfield, Monica J. Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced? Int. J. Environ. Res. Public Health 2013, 10, 6472-6484; doi:10.3390/ijerph10126472.

Last Updated: 2/1/2017