Telemedicine, or the provision of medical services at a distance, has been envisioned for decades.

The promise of telemedicine is slowly becoming reality in the US.

Now the technology and connectivity necessary to support it are available. Adoption of telemedicine services is growing in the United States, but the pace has been slower than many people imagined. Consumer technology has taken off since the introduction of smartphones, and most ordinary consumers are decidedly tech savvy – including consumers who happen to be physicians.

So why has expansion of telemedicine been slow in the United States, particularly when it has been growing rapidly in many European countries, in Israel, and in China? A number of barriers to telemedicine expansion exist in the US in the form of state and federal laws, insurance regulations, and concerns about privacy and security. Here are some of the barriers that must be surmounted before telemedicine flourishes in the US.

State Physicians’ Licensing and Telemedicine in the US

Physicians in the US are licensed by individual states, and jurisdiction applies to the patient’s rather than the doctor’s location. Therefore, if a doctor in Illinois wants to treat patients just across the state line in Wisconsin, she must be licensed to practice in Wisconsin. Additionally, care standards from state to state are complex and can be difficult for even highly educated physicians to understand. Currently, state licensing requirements apply to telemedicine visits as well as in-person visits. Therefore if a doctor in one state wants to treat via telemedicine a patient in another state, he must be licensed in the state where the patient is located.

One possible solution is a concept called license reciprocity. Nurses have already had success with a multi-state licensing compact. In this program, a nurse with permanent residency in one Nursing License Compact (NLC) state is eligible to work in other states that are parties to the compact. Currently there are 24 nursing NLC states. Some policy experts believe the solution ultimately would be similar to state recognition of other states’ driver’s license recognition, where your state driver’s license allows you to drive in all 50 states.

Compensation Issues in the US

Currently, 21 states require that telemedicine be compensated at the same cost as in-person care. Federal programs have mixed histories with embracing telemedicine. For example, the Veterans Administration has expanded telemedicine more willingly than Medicare has. In the private insurance sector, employers and insurers are increasingly willing to pay for telemedicine services, and insurers have in many cases shifted to paying doctors for “packages†of services rather than per-service costs.

Medicare currently doesn’t cover telemedicine services except in underserved remote or rural areas, and doesn’t cover remote monitoring of people with chronic medical conditions. Therefore, even if a physician and patient believe telemedicine monitoring to be appropriate, if that patient is on Medicare, he or she would not be eligible for coverage of costs.

On the other hand, Medicaid is run by states and does not have the same level of restriction that Medicare does. This has prompted Medicaid to embrace telemedicine a bit more enthusiastically than Medicare. However, the issue of physician reimbursement rates for telemedicine services under Medicaid remains unresolved, and doctors currently cannot count on predictable levels of compensation for telemedicine services provided under Medicaid.

Patient Privacy and Telemedicine in the US

Many people use video calling applications like Skype and FaceTime because they make it easy to stay in touch with friends and family. Though telemedicine operates on similar technology, requirements for privacy and security are much greater. In fact, this year, the FBI warned healthcare providers in the US that their cyber security needed to be more robust. Electronic documents, such as doctors’ notes and radiology images, must be as secure as their hard copy versions, and this requires advanced encryption technology and secure practices on the part of telemedicine providers.

As important as security is with most remote interactions, it is even more critical with telemedicine services.

To adequately maintain security, healthcare professionals that provide telemedicine services must also insure that the workspaces from which they provide these services are private and secure, and should take steps to ensure discussions with patients cannot be overheard. Furthermore, if other people are in the room with either the patient or provider, both parties must be aware of the situation and agree to the other party’s presence. The American Telemedicine Association (ATA) outlines a number of guidelines for privacy in its 2014 Core Operational Guidelines.

Patient and Physician Attitudes Toward Telemedicine

Finally, for telemedicine to widely embraced in the US, both physicians and patients will have to adjust their attitudes toward the practice. Some doctors, for example, feel that telemedicine can dilute their authority by making it too easy for patients to seek alternative advice. At the same time patients may feel that telemedicine is “second best†even though patient outcomes with telemedicine have been shown to be equal to outcomes with face-to-face care.

Perceptions and attitudes are, however, evolving, as both doctors and patients see the benefits of telemedicine firsthand. Doctors who can remotely monitor patients can prevent readmission to hospitals, a costly problem that many insurers want to curtail. Patients who can avoid long drives to specialists, or who can have routine problems like respiratory illnesses treated without having to spend a morning in a crowded waiting room quickly realize the benefits of telemedicine as well.

Conclusion

Telemedicine adoption in the US has lagged somewhat behind adoption of telemedicine in other parts of the world. Reasons for this include the restrictions of state licensure of physicians, a lack of data and experience in determining and collecting compensation for telemedicine care, concerns about privacy under laws like HIPAA, and some skepticism on the part of both physicians and patients. However, states, the federal government, and telemedicine advocates are working to overcome these barriers so that patients and doctors can enjoy the many benefits that telemedicine offers.

AccessRx.com is watching the evolution of telemedicine in the US with great interest, and has already had experience with the benefits involved in providing prescription medications to patients quickly, securely, and at competitive prices. AccessRx.com is also at the forefront of the technology involved in ensuring patient safety and privacy, and in ensuring that all online transactions adhere to strict online security processes.