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FCW : February 2014
February 2014 FCW.COM 23 Ferguson imagines that in the not- too-distant future, an EHR system will be the platform on which telemedicine services run. Practitioners would have multimedia access to X-rays, stetho- scope recordings and other patient information. The problem now is that doctors in the Alaska tribal health system have about 28 EHR systems in place, and they don t all talk to one another. The Health IT Act that was passed in 2009 as part of the broader economic stimulus package provides grants and other incentives to encourage medical practices to adopt EHR systems that adhere to federal standards. There s also a rather big penalty: Practices that have not done so by January 2015 face lower Medicare reimbursement rates. EHRs that have some degree of interoperability with regard to patient records and communication among care providers will push industry in the direction of creating telemedicine standards across the board. "Our goal is to make telemedicine and EHRs look like one system to the clinician," Ferguson said. Congress gets into the act Despite a range of technological and industry issues, the biggest impedi- ments to telehealth are regulatory. State licensing requirements restrict treatment by out-of-state doctors even via telemedicine. One big reason VA has such an outsized in uence on the development of telehealth is because its network of physicians are able to treat veterans throughout the system without regard to state licensing rules. A few bills introduced in the House Energy and Commerce Committee are trying to simplify the delivery of tele- medicine services across state lines. The Tele-Med Act, backed by Reps. Devin Nunes (R-Calif.) and Frank Pal- lone (D-N.J.), would allow Medicare recipients to seek telemedicine care from participating providers across state lines. For example, an elderly New Yorker who winters in Florida or Arizona would be able to receive care online from his or her regular physician. The Telehealth Modernization Act, a companion bill backed by Reps. Bill Johnson (R-Ohio) and Doris Matsui (D-Calif.), would create a single, fed- eral standard for telemedicine for use in national health care programs. And the Telehealth Enhancement Act from Reps. Gregg Harper (R-Miss.) and Peter Welch (D-Vt.) would expand reimbursement for telemedicine serv- ices under Medicare and Medicaid, mostly through pilot programs and narrowly de ned circumstances. It would also amend the Communica- tions Act to support health care pro- viders under the universal service requirement. It s not clear if any of those bills will pass, but the bipartisan focus on expanding telemedicine on that pow- erful committee indicates an interest in establishing some federal rules to make the patchwork of state laws more manageable for providers and insurance carriers. The Affordable Care Act has already established a number of key markers for the study of telemedicine as a care model, with the goal of evaluating effectiveness of treatment, cost savings, reduction in hospital readmissions and other factors. In addition, the latest National Defense Authorization Act includes a provision that grants those leaving the military service and transitioning into civilian life an additional 180 days of telemedicine services on top of the 180 days of health coverage already issued under the Transitional Assis- tance Management Program. The push for broadband access Much of the infrastructure required to support telemedicine is in place. Although research and development predates fax machines and dial-up Internet, the growth of robust, high- speed broadband and the ubiquity of high-de nition video technology have made access to telemedicine services a reality for millions of Americans. Tapan Mehta, global health care lead at Cisco Systems, told FCW that even relatively low broadband speeds of 1 to 2 megabits/sec are suf cient to handle videoconferencing and data transfers for teleradiology. The Federal Communications Com- mission s Universal Service Fund has helped bring telecommunications connectivity to rural communities throughout America, and Ferguson said just about every village in Alaska takes advantage of the fund. The state has shifted from doing about 95 per- cent of its telemedicine via satellite to building a combination of ber and microwave links, which means better bandwidth without the latency of sat- ellite, he added. Yet Whitson said there are still gaps in broadband services, and advocates at VA are pushing the FCC, the Agri- culture Department s Rural Broadband Loan Program and other government programs to continue to ll out the national broadband map. Even with high-speed broadband, network latency issues can limit per- formance. "It s just physics you re bound by," Whitson said, adding that VA s IT staff is focused on manag- ing network congestion and making applications work at an optimal level. "Performance is something that we collectively focus on in a very signi - cant way," he said. Ferguson said providing tech sup- port to rural areas is an added logisti- cal challenge. In a remote Alaska vil- lage, a service call might begin with a $900 plane ticket, which makes sending an IT specialist an expensive proposition. "It s not unusual for us to work with a health aide to help us do basic trou- bleshooting and do basic xing on the network," Ferguson said. "If something is hard to use, we try to redesign it. Simplicity and reliability are the two main technical concerns for us." ■
March 15, 2014