Telemedicine: Stuck in the waiting room

A long-touted health-care revolution may at last be about to arrive

THE idea of telemedicine—health care provided using telecommunications equipment—has a lengthy history. Radio News, an American magazine, devoted its cover to a patient at home consulting a doctor in his surgery via a television link as long ago as 1924. When NASA began monitoring astronauts in space in the 1960s, fantasy became reality. It has been touted as health care’s future ever since.

But even smartphones and tablets have failed to usher in the telemedicine revolution: most health care still happens face to face. Now, enthusiasts think the wait is nearly over. Governments have been slow to embrace an approach that could improve coverage and outcomes, as well as saving money. But they are under increasing pressure from ageing populations and a surge in chronic diseases, just as public budgets are being squeezed.

At an industry conference in Rome on October 7-8th, participants discussed the problems that must be solved if telemedicine’s day is to come. They include redesigning laws and payment systems set up for face-to-face care, and finding ways to keep patients’ data secure and private.

In America, the world’s largest health-care market, states license doctors. Jurisdiction depends on the patient’s location, not the doctor’s—so doctors must be licensed in all states where they have patients, and meet care standards that René Quashie, a health-care lawyer, says are “complicated, incoherent and sometimes contradictory”.

The situation in the European Union is simpler: countries may not pass laws that would stop doctors practising telemedicine, and doctors need only be licensed in one country to practise in all. But member states do not agree on whether to pay for care that is administered remotely; some, including Germany, rarely pay for it at all.

In America only 21 states mandate that telemedicine be compensated at the same rate as face-to-face care. At the federal level, the Veterans Administration has embraced telemedicine whereas Medicare, the public-health programme for the elderly, largely ignores it. But private employers and insurers are increasingly paying for telemedicine, encouraged by a shift to paying doctors for packages of care rather than per service. This has “opened the door” to remote care, says Jonathan Linkous of the American Telemedicine Association.

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