Crying for telehealth adoption – role of Policy in spurring innovation

Canadian telehealth has the potential to improve access to clinical care and save hundreds of thousands of patient travel miles. However, the scalability of the current model is in question, and physician adoption is slow. We propose a disruptive innovation of the present framework that could scale telehealth across Canada.

From Chile to Australia, across many fields of healthcare, patients can now be treated remotely, via telecommunications. All Canadian Provinces have some kind of a telehealth program. These are usually run by an independent not-for-profit organization, funded by the provincial government.

Telemedicine has many advantages. It improves access to medical services for people living in rural areas. It allows urban patients with restricted mobility to receive the care they need without leaving their homes. It also means that doctors in different locations can collaborate on a patient’s care – another plus.

The core business model of telemedicine in Canada is that all services must occur through the telehealth organization’s own telecommunications network. Health ministries don’t recognize billing codes that have gone through any other networks. This gives the telehealth organization a monopoly on services

Telehealth networks are rapidly expanding, but they still have a long way to go. Limited adoption is hindering telemedicine from achieving its full potential.

Two main reasons for telemedicine limited adoption:

  1. One reason is that the current model can be burdensome for healthcare providers. Doctors tend to find engagement with new technologies to be stressful: they don’t have time for the steep learning curve often involved. Signing on to a telehealth network means that participants have to install and learn yet another new software program, through which to connect with their patients.
  2. Another reason is that telehealth agencies have limited resources with which to develop and maintain networks, organize billing, and market themselves to healthcare providers. Increasing demand with resource constraints usually results in lower quality services.

So: How can a Policy change Canadian telemedicine increase adoption and fulfill its latent capacity?

What if, rather than having to adopt new telecommunications software, healthcare practitioners could choose instead to access one they are already familiar with: like Cisco video conferencing, for example, or Skype? What if, rather than providing access to their own networks, telehealth organizations acted instead as billing agents, contracting with established telecommunications networks for services?

An opportunity for startup companies in telehealth

Startup companies under this model can create alliances with consumer voice- and video- over-internet companies such as Skype, Lync, Samsung’s Sami, or google hangout to develop billing, privacy, and security application interface extensions (API). These would be made available to telehealth agencies. It’s a win-win situation: the software is being developed for a large and established market.

Provision of telemedicine services doesn’t necessarily mean provision of telecommunications networks

Telehealth agencies then would stop developing or buying voice or video over network applications and focus on integration and setting of specifications.

What does an open telehealth scenario look like?

Say that Dr. Gagnon in Victoria wants to give advice to Pierre Alison in northern BC about his diabetes. Once Dr. Gagnon has signed up with the telehealth agency, she can download the API as an add-on to her Skype software. Then, she can advise Pierre via her Skype connection. The enhanced software would allow Skype to track that Dr. Gagnon had conferenced with her patient for 24 minutes, and attach the appropriate billing code to the call. This encrypted data would be passed on to the telehealth agency, which would then bill the ministry of health on behalf of Dr. Gagnon.

Telehealth is about care delivery — three activities that will help agencies focus

It is important to remind ourselves that the principle purpose of telehealth is delivery of care.  The telehealth agency can expand its market by letting customers choose the communications technology they prefer. The agency can then focus its resources on billing, and on expanding its reach through marketing, rather than worrying about scalability and technical support.

As well as ensuring specific billing practices, telehealth agencies could also guarantee privacy and security requirements. Security requirements would define elements of encryption during transmission and storage, electronic identity certification, and availability. Privacy requirements would specify retention periods, recording of consent, access, auditing, and reporting.

The right kind of investment in telehealth is to focus the energy on clinical care by focusing on privacy, security, and billing

So far, it has proved challenging for provincial Canada’s telehealth programs to gain mass-market adoption and ability to provide quality support. These agencies are invited to consider our proposal. By focusing on billing, security, privacy, and technology integration requirements, and letting go their current role of telecommunications providers, Canadian telehealth could expand to meet its growing potential.