Telemedicine's value is clear, but future growth needs clarity around standards and practices

Telemedicine is not new—every time a healthcare provider (HCP) picks up a phone to contact a patient, that’s telemedicine—but it is still only gradually moving into standard practice in healthcare. Meanwhile, a Silicon Valley ethos has infused into the industry under the moniker “mHealth,” offering a growing variety of whizzy patient-monitoring devices, social-media channels and patient interactions.

Taking a look at what has happened so far, Altarum Institute (Ann Arbor, MI), a public-policy nonprofit, finds that the value of telemedicine is fairly well documented, but that its applicability across HCPs and payers is unevenly regulated or practiced. In the report, Telemedicine Today: the State of Affairs, senior policy analyst Anne Montgomery concludes: “This review suggests that telemedicine is also well-suited for further development of ‘person-centered care’ models, in which informed consumers engage in shared decisionmaking with their doctors based on the best available evidence.”

At this point, telemedicine is defined in four categories, notes Altarum:

• Phone-only consultation
• Interactive videoconferencing
• Store-and-forward technology (e.g., exchanging X-rays during consultations)
• Remote monitoring

Among examples that Altarum found in its literature survey of over 1,600 papers, one from Kaiser Permanente Northern California showed that 10-15-minute telephone visits from physicians had increased from 640,000 in 2008 to over 2.3 million in 2013—demonstrating high acceptance by patients. The federal government has been actively supporting telemedicine, especially for rural populations and for care of veterans through the VA system. Last April, the Federation of State Medical Boards approved nonbinding guidelines, while specifying that “telemedicine” should be more than voice-only phone calls and include such capabilities as videoconferencing.

Pharma marketers typically do not interact directly with patients; however, there are growing number of hired intermediaries, especially surrounding the hub services offered for specialty drugs. In the literature survey, Altarum found some commentary among HCPs in the telemedicine field for the risks of “overprescribing” certain drugs. However, telephone- or Internet-prescribing is barely understood, both among HCPs and state medical and pharmacy boards. Some states prohibit it outright; others allow it provided that varying conditions for establishing a “prior patient-physician relationship” have been met.