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The possibilities, challenges and opportunities for telehealth

Kaveh Safavi, vice president and global leader for Cisco's healthcare business, talks about the possibilities, challenges and opportunities for greater telehealth adoption in the United States and abroad.  

When you look at the topic of telehealth, how would you describe its role today in delivering care services?
Telehealth has historically focused on solving a healthcare delivery challenge associated with geographic distance by connecting a doctor or patient in one location with a doctor in another location to provide some basic forms of care. Telehealth is typically perceived as an alternative to no care – primarily for people who live in rural areas with limited access to physicians. However, we are beginning to understand that telehealth may be a means for better care even for those already served by physicians.

What role would you say information technology can play in aiding in this connection between doctor and patient?
There are several benefits that information technology can play in advancing telehealth. For example, there are three levels of opportunity:
    1)    Replacing what you can do today. This is about how telehelath can serve as a healthcare resource for aiding the unmet needs of citizens who don't have any access to care. This could include people living in rural or inner city locations with little or no available health services.
    2)    Doing more of what you can do today. This includes things like how telehealth services can connect patients with specialists as well as primary care physicians in order to have greater access to specialty care.  
    3)    Doing things you can't even think of. This is an unbroached area that involves using information technology to permit a consultation between patient and several doctors simultaneously via patient group visits. It might also involve augmenting the typical patient visits with information that helps them better understand their condition such as what a surgical procedure may look like.
What is the bigger promise or opportunity for telehealth?
The real promise for telehealth is in its ability to be an alternative for existing one doctor at a time in-person care. For example, today's advancements in telehealth technology allow for a patient to experience the opportunity to remotely view his or her eardrum or listen to a heartbeat at the same time a doctor is providing a remote exam/diagnosis. Digital otoscope and stethoscopes when applied to the patient, now share information with the patient that isn't part of a traditional medical exam. When the telehealth experience is as good if not better than an in-person exam, then possibilities for mainstream adoption of telehealth become greater. The same goes for the ability to see a primary doctor and a specialist at the same time. If patients experience a decidedly superior clinical experience they will demand it and that will drive adoption.

Where can telehealth make the most immediate impact?
The greatest immediate promise for telehealth is in its ability to remotely connect clinicians to each other in order to better collaborate and problem solve.  We recently conducted a global health leader survey with 96 world health leaders to better understand their desire to embrace new care delivery options such as telehealth. We found that real long-term and lasting health transformation is expected to come from improved clinician collaboration. Connecting doctors with patients was then the follow-up objective/opportunity.

Why hasn't telehealth been more widely adopted in the United States and abroad?
The economic model in American healthcare is built around reimbursement for a face-to-face visit. In addition, we haven't had public health financing model for widespread care at-a-distance. So adoption of technologies that advance patient care are often held back by reimbursement models. In addition, lack of broadband access, practice of medicine regulation and lack of familiarity with telehealth practice models have all held adoption back.

Do you see the economic and reimbursement models for enabling telehealth changing in the future?
Some private health insurers are already taking steps to reimburse health providers for remote care services. At the same time, technology is advancing to a stage where an in-person consult can be replicated remotely to provide an equal or better patient experience. These are all positive steps toward evolving the future for telehealth.

What is the role of government and the private sector in bringing a telehealth delivery model to reality?
The private sector role is to lead in the innovation of technology and in the development of care delivery systems. The public sector is responsible for creating an economic framework that is sustainable and for having a regulatory framework that allows for telehealth to have equal footing for in-person care. Ultimately the public sector would play a key role in making sure that telehealth is seen as a viable alternative to face-to-face care.

What advice would you give to those who are considering telehealth as a care delivery model?
    1)    Keep an eye on the long-term idea that telehealth could provide a superior experience to face-to-face care and build a program around this objective.
    2)    For telehealth to be successful it has to fit into the way people work. It can't be too disruptive or it won't be adopted.
    3)    There has to be an economic model that is sustainable for the support of telehealth. It has to fit into a long-term financing model.

How would you finish this sentence: In the next five years, telehealth will…
… be an increasingly important part of the public policy discussion and will rise to the same level of discussion and importance as the electronic health records. As patients and providers realize that telehealth offers a superior experience to face-to-face care, the interest and adoption will accelerate.

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