A new law in Connecticut, effective July 1, 2018, will allow healthcare providers to prescribe controlled substances for mental health and substance abuse treatment via telemedicine. S.B. 302 essentially reverses the state’s restrictions on the prescription of Schedule 1, 2, and 3 controlled substance via telemedicine tech, though opioids don’t seem to be included.
With this new bill, Connecticut joins a select group of states looking to utilize digital health tools and technology in a more meaningful way. This represents the beginning of a rising tide, and while it’s looking good on the state level, federal law still has to catch up. At least, according to some, there’s still hope.
“The nation’s ongoing opioid abuse crisis is creating a groundswell of support for changes in federal law to make telemedicine and telehealth a more prominent feature in treatment,” writes Eric Wicklund for mHealth Intelligence. “Congress is currently considering several bills that would, if passed, create a special registration through the U.S. Drug Enforcement Agency to enable healthcare providers to prescribe controlled substances through telemedicine.”
This support for telemedicine has been growing steadily as it’s proven itself to be one of the major emerging technologies in healthcare — but before we get too far, let’s back up for a moment. What exactly is telemedicine, what other obstacles does telemedicine face, and why is it that experts are calling it “the future of healthcare”?
What Is Telemedicine?
Penn Medicine associate CIO John Donohue, writing for Healthcare IT News in 2016, asks, since telemedicine has been around now for “almost twenty years … why is it not as common as sliced bread?” The answers to that are many, but perhaps one is that the public isn’t entirely sure just what “telemedicine” is — but that’s changing quickly.
USC’s Keck School of Medicine lists mobile health (or mHealth) as one of the three fastest-growing public health technologies in today’s age.
“People too ill to attend a clinic, without adequate transportation, or without time to spare can turn to their mobile device and video conference with a trained health care practitioner through apps such as Doctor on Demand and NowClinic,” they write.
This description of “mHealth” matches the definition of telemedicine. If we were to take the cut-and-dry, no-funny-business definition offered by Community Impact News, then “telemedicine is the provision of healthcare services to a patient by a doctor in a remote location using technology.”
The first serious portrayal of telemedicine came from Hugo Gernsback, according to Smithsonian Magazine, in 1925 via a device called a ‘teledactyl’ which would “allow doctors to not only see their patients through a viewscreen but also touch them from miles away with spindly robot arms.”
Since then, fiction and fantasy have become fact and reality. Many modern societies now operate with bandwidth and infrastructure that support telecommunication technology on a day-to-day basis. Apps like FaceTime and Skype, in conjunction with the prevalence of the modern day phone, of course, have made remote face-to-face interactions not only possible but commonplace and expected.
This has fueled the recent growth in telemedicine and mHealth. George Washington University actually predicts that the global homecare diagnostics and monitoring market will grow 8.71 percent between 2016 and 2020. This growth is not based solely on expectations and convenience — there are concrete benefits to the deployment of telemedicine.
Benefits of Telemedicine
The good news is that both the benefits and applications of telemedicine are many. Multiple sources, including the American Telemedicine Association (ATA), have listed the four fundamental benefits of telemedicine as:
— Healthcare cost savings: “Reducing or containing the cost of healthcare is one of the most important reasons for funding and adopting telehealth technologies,” writes the ATA. Telemedicine can help to save money in healthcare by increasing efficiency via reduced travel times, fewer or shorter hospital stays, and by further automating administrative roles and responsibilities, which make up 31 percent of employees in the average physician’s office.
— -Better quality care: Telemedicine improves quality of care by making it easier to for providers to follow-up with patients, as well as to monitor patients remotely, and respond to queries when called upon. “In some specialties, particularly in mental health and ICU care, telemedicine delivers a superior product, with greater outcomes and patient satisfaction,” the ATA writes.
— -Better access, more consistent engagement: The eVisit website makes brilliant points about access to niche medical specialists, stating that telemedicine “makes it easy for primary care doctors to consult medical specialists on a patient case, and for patients to see a needed specialist on a rare form of cancer, no matter their location.” Ease of access will inevitably lead to more consistent engagement, meaning more “more questions asked and answered, a stronger doctor-patient relationship, and patients who feel empowered to manage their care,” they write
— -Patient demand and satisfaction: You can’t discount patient demand, and a world without telemedicine is becoming a world of the past. “Over the past 15 years, study after study has documented patient satisfaction and support for telemedical services. Such services offer patients the access to providers that might not be available otherwise, as well as medical services without the need to travel long distances,” writes the ATA.
Other benefits include the ability to employ school-based telehealth, as well as prison-based telehealth, creating a safer environment for students, prisoners, and healthcare professionals alike. Telemedicine is even changing up pet healthcare.
Unfortunately, for all the benefits and applications of telemedicine, the technology isn’t perfect yet.
The Cons of Telemedicine
When asked, “what are the major limitations and barriers to a full-blown rollout of telemedicine across the country?,” CIO John Donahue responded to Healthcare IT News:
“A fistful of issues prevents us from fully realizing the potential of telemedicine. The largest, of course, is reimbursement. Bending the cost curve in healthcare is going to require the reduced costs typically associated with telemedicine programs. Limited reimbursement in today’s market has been a constraint. This is improving over time and as the value associated with telemedicine becomes more tangible, the constraint should be less of an issue. Clinical and legal concerns are also potential issues, but healthcare organizations have been working with the appropriate local, state and federal agencies to develop workable solutions to alleviate these concerns.”
While the cost may be a huge issue, it’s one that even Donahue admits is improving. His analysis that legal concerns are issues is one that’s shared by the experts at Vsee.
“Because technology is growing at such a fast pace, it’s been difficult for policymakers to keep up with the industry,” they write. “There is great uncertainty regarding matters like reimbursement policies, privacy protection, and healthcare laws. In addition, telemedicine laws are different in every state.”
Still, even larger than any other concern has to be cybersecurity and, in effect, HIPAA compliance. This doesn’t refer to just the legislation surrounding HIPAA compliance but the actual problem of poor cybersecurity and data breaches.
“As information has increasingly been stored on digital platforms it has increased in volume as well … a shift has occurred because criminals have access to more data, data that can be taken in essentially a single sweep,” writes Chloe Moore with Fiscal Tiger. “The scope of data breaches almost can’t be overstated. There is no entity that has escaped the reach of cyber-criminals. From credit reporting bureaus to the government, and from phone numbers to social security numbers, hackers seem to be able to infiltrate and steal it all.”
The more connections that pop up, tying the internet of things (IoT) to the field of healthcare, the more opportunities cybercriminals will have to steal personal and private information. In turn, this means the potential for massively debilitating HIPAA violations that, at this point, there currently are no existing solutions to.
The Future of Healthcare
The good news is that, even though the state of cybersecurity in healthcare (and in most professional fields, honestly) is dismal, an international effort is being expended to solve the problem. The recent GDPR measures that were released to help combat data breaches lay down specific measures for international companies, including:
- Pseudonymization and encryption of personal data
- The ability to ensure the confidentiality, integrity, availability, and resilience of the systems and services related to the processing on a permanent basis
- The ability to rapidly restore the availability of and access to personal data in the event of a physical or technical incident
- A process for periodically reviewing and evaluating the effectiveness of technical and organizational measures to ensure the safety of processing
While HIPAA measures include protections, procedures, and processes that protect against data breaches, a globe that is more attuned to the issues represented by cybercrime will be better able to protect itself from them.
As time goes on, cybersecurity, policy, reimbursement, and HIPAA concerns will all be sorted out. Telemedicine isn’t ushering in these problems — they’re running rampant in our system already. It would take an astounding lack of care to create a telemedicine system that would actually exacerbate the problem to a large degree.
As such, the future of healthcare is telemedicine. The obstacles are large, but we’ll soon be over them. The benefits are too great, and the public expects it. As with every other field on the planet, technological disruption will leave its mark and rule the day.