30 August 2013

The Challenges for Telemedicine

The challenges for the future of telemedicine are going to be complex and require cooperation of government agencies (FAA, FDA, HHS, CMS,) added to some state government departments and state medical boards. This will be a complex web that may prevent some forms of telemedicine from getting off to a good start.

The medical establishment is buzzing about the concepts of telemedicine, telehealth, telecare, and mHealth. The question on everyone's mind is how long will we need to wait before they become a standard way of care and have reasonable guidelines for use. Another and maybe more important question is; how long will telemedicine benefit from the presently low barriers of entry before the regulatory machine limits what telemedicine can accomplish. Even the question should be raised about what impact the Affordable Care Act will have.

Next, we have the emerging mHealth (mobile health) industry, which is presently an undefined area in a fast developing technology climate. This is still waiting for FDA and other regulators to arrive at standards for the approval, market access, and reimbursement of those devices, applications and other healthcare software. Will the FDA, HHS, CMS, and other federal bureaucracies be able to step forward in a timely manner to prevent stifling innovation? Or will they threaten small business and new entrepreneurs that feed the market and delay important technology? To me there is little middle ground and action is needed now.

Here are some of the key issues:

#1. Technology Platform. Currently we do not have a network system that can accept images from CT scanners and MRI devices and transmit them straight to the doctor's smart phones. I have seen a secure computer network in the VA hospital that makes this possible, so I know it can be done on computer networks.

#2. Data Volume and Speed. Since I have seen this accomplished on secure computer networks and done in about one hour, from scan to viewing on the doctor's computer screen, I know it is possible. However, with mobile applications, there are some key points. The volume of data and the priority of moving this data will be huge and software developers need to be aware that the network infrastructure is aligned with the needs. In the diabetic platform similar to the recently launched Cellnovo in the UK (and hopefully shortly in the US), when a patient is hypoglycemic, the cellular bandwidth at which the device sends signals to the mobile phone needs to be somehow prioritized. Moreover, when similar devices come into the market, cellular urgency becomes an issue.

#3. Data Security. Data security is the last concern as it affects all of telemedicine. As more devices come to market, and the public or patient sector considers them, the assurance of privacy and protection of the data will need to be answered. Will HIPAA be able to cover this in advancing technology market? There are some real doubts at present as slowly as Congress is acting.

Yes, in the ever-expanding chronic disease arena and projected physician shortage, mHealth and telemedicine may have a role to play. This will be tested by state medical boards trying to prevent new technologies and there will be many other challenges along to way to a more productive and lasting improvement in medical care. Will efficiency win the day? We can only hope!

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