TAMPA, FL – "Historically, telehealth hasn't received the attention that it's deserved from the federal government," says Neal Neuberger, executive director of the Institute for e-Health Policy and president of Health Tech Strategies. A case in point is the government's meaningful use program.
Neuberger spoke with Healthcare IT News after participating in a panel discussion at the American Telemedicine Association's annual conference in Tampa, Fla. in May.
As providers and vendors explore the ways in which telehealth tools can integrate with EHRs and HIEs, Neuberger said, the ONC should take a much more definitive role in helping increase and solidify those technologies' symbiosis.
As of now, there's "no real inclusion for telemedicine and telehealth" as a direct component of the three stages of meaningful use, he said. And, for all the great strides forward since ARRA, there are still a lot of "disconnects and coordination flaws" in putting comprehensive health IT to work – especially in the rural and underserved areas that need it the most.
Neuberger pointed out that telehealth-intensive programs, such as "long-term care, nursing homes and home care are largely left out of the incentive programs under HITECH."
Behavioral healthcare and EMS services are likewise not included, as well as "most other allied health professionals beyond a defined set of primary care clinicians."
And so, despite the fact that HITECH "requires a commitment to rural, underserved, minority and disparate populations," said Neuberger, "there were no monies attached" to the areas that could most benefit them.
"I think that those communities have been left as sort of an afterthought," he said. "There's just not enough bandwidth, not enough funding. And so we just have to work around the edges on some of those efforts."
Neuberger called on the new national coordinator, Farzad Mostashari, MD, to help "get all those other efforts up and running."
"I think we need a grand vision," he said, "that takes the long view as far as transforming healthcare as far as outcomes, quality, efficiency, cost, and" – crucially for telehealth – "access."
At the moment, said Neuberger, "we don't necessarily see that vision" in the strategic plan.
He called on the ONC to better align the mandates of the HITECH program with the "many disparate efforts that are under way" – from the broader mandates of the Affordable Care Act to smaller telehealth initiatives to Health Resources and Services Administration (HRSA) programs for increasing access.
Especially important, said Neuberger, "we need to know about the role of telehealth as it relates to certification efforts of CCHIT, EHNAC and others. If we can start to get the policy and standards committees of the ONC to focus on mandatory objectives for telehealth in Stages 2 and 3 of meaningful use … that will give vendors the impetus to build modules for telehealth" into EMR and HIE technologies.
An ONC spokesperson responds that “the meaningful use criteria recognize the importance of telehealth for patient care by ensuring that meaningful use of EHRs lays the groundwork for future advances in telehealth. Stage 1 Meaningful Use criteria set the foundation for remote access to data via the objectives in the patient-family engagement health outcome priority. This priority relates to ensuring remote access to clinical data. In Stage 2, the Health Information Technology Policy Committee has proposed secure patient-provider messaging, which would represent another step towards long-distance communication.”
Additionally, “the Health Information Technology Standards Committee is also considering radiology/imaging standards, which could provide more of a foundation for tele-radiology. These are important foundational elements of telemedicine.”
As those foundations get put into place, Yael Harris, director of the Office of Health IT and Quality at HRSA, who also spoke on the panel, said her work with the agency – whose mandate is to improve access to healthcare services for people who are "uninsured, isolated, or medically vulnerable" – has shown that underserved populations are most in need of IT-enabled care.
The rates of obesity, diabetes, poor neonatal care and child abuse are often much higher in the very same communities that have next to no resources to help deal with those issues. Telehealth can help – as she showed, running down a list of promising individual initiatives nationwide.
Improving quality and safety while lowering costs are crucial, of course. But increasing access to care is every bit as important, said Harris. "How can technology be used to reach people wherever they are?"
More to the point, she asked, "how do we get" agencies like the ONC and CMS "to recognize the value of this?"
