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1
Introduction
In 1996, the Institute of Medicine (IOM) released its report Tele
medicine: A Guide to Assessing Telecommunications for Health Care
(IOM, 1996). In that report, the IOM Committee on Evaluating Clinical
Applications of Telemedicine found
Telemedicine is similar in most respects to other technologies for which
better evidence of effectiveness is also being demanded. Telemedicine,
however, has some special characteristics--shared with information tech-
nologies generally--that warrant particular notice from evaluators and
decision makers. Most notably, telemedicine is not a single technology or
a discrete set of related technologies; it is, rather, a large and very hetero-
geneous collection of clinical practices, technologies, and organizational
arrangements. In addition, widespread adoption of effective telemedicine
applications depends on a complex, broadly distributed technical and
human infrastructure that is only partly in place and is being profoundly
affected by rapid changes in health care, information, and communications
system. (IOM, 1996, p. 208)
Since that time, attention to telehealth1 has continued to grow in both
the public and private sectors. Peer-reviewed journals and professional
societies are devoted to telehealth, the federal government provides grant
funding to promote the use of telehealth, and the private technology indus-
try continues to develop new applications for telehealth. However, barriers
1Seelater in this chapter as well as Appendix A for more on definitions of telehealth, tele-
medicine, and other relevant terms.
1
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2 THE ROLE OF TELEHEALTH
remain to the use of telehealth modalities, including issues related to reim-
bursement, licensure, workforce, and costs. Also, some areas of telehealth
have developed a stronger evidence base than others.
WORKSHOP STATEMENT OF TASK
The Health Resources and Services Administration (HRSA) sponsored
the IOM in holding a workshop in Washington, DC, on August 8-9, 2012,
to examine how the use of telehealth technology can fit into the U.S. health
care system. HRSA asked the IOM to focus on the potential for telehealth
to serve geographically isolated individuals and extend the reach of scarce
resources while also emphasizing the quality and value in the delivery of
health care services. Specifically, the charge to the planning committee
was to
· discuss the evolution of telehealth since 1996, including the increas-
ing role of the private sector, policies that have promoted or de-
layed the use of telehealth, and consumer acceptance of telehealth;
· discuss the current evidence base for telehealth, including available
data and gaps in data;
· discuss how technological developments, including mobile tele-
health (mHealth), electronic intensive care units, remote monitor-
ing, social networking, and wearable devices, in conjunction with
the push for electronic health records, is changing the delivery of
health care in rural and urban environments; and
· discuss actions that the U.S. Department of Health and Human
Services (HHS) can undertake to further the use of telehealth to
improve health care outcomes while controlling costs in the current
health care environment.
Overall, the workshop speakers were asked to meet the following
workshop objectives:
· delineate the evidence base for telehealth;
· highlight special implications for rural populations;
· discuss the actions HHS can undertake; and
· identify what in particular warrants further study.
The planning committee's role was limited to planning the workshop,
and the workshop summary has been prepared by the workshop rapporteur
as a factual summary of what occurred at the workshop. Statements, rec-
ommendations, and opinions expressed are those of individual presenters
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INTRODUCTION 3
and participants, and are not necessarily endorsed or verified by the IOM,
and they should not be construed as reflecting any group consensus.
DEFINITIONS
In 1996, the IOM defined telemedicine as "the use of electronic infor-
mation and communications technologies to provide and support health
care when distance separates participants" (IOM, 1996, p. 1). (See Ap-
pendix A for more definitions related to telehealth and telemedicine.) In his
keynote address at this workshop (see Chapter 3), Dr. Thomas S. Nesbitt
of the University of California, Davis, Health System noted that while the
terms telehealth and telemedicine both describe the use of technology to
exchange information to improve a patient's health status, they are often
interchanged. He stated that telemedicine has typically been used more to
describe direct clinical services, whereas telehealth has been used to define
a broader scope of health-related services (e.g., patient education, remote
monitoring). Similarly, the American Telemedicine Association (ATA) states,
Telemedicine and telehealth both describe the use of medical informa-
tion exchanged from one site to another via electronic communications
to improve the patients' health status. Although evolving, telemedicine is
sometimes associated with direct patient clinical services and telehealth
is sometimes associated with a broader definition of remote health care
services. (ATA, 2012a)
Many of the presenters at the workshop itself interchanged the use of
the terms, and this summary does not attempt to regularize the usage of
either term. Appendix A defines some telehealth-relevant terminology, as
defined by the ATA.
ORGANIZATION OF THE WORKSHOP SUMMARY
In this summary, the presentations at the workshop have been orga-
nized into 13 chapters. Following this introduction, Chapter 2 presents
the opening remarks of the planning committee chair and the workshop
sponsor. Chapter 3 provides an overview of the past, present, and future
of telehealth. Chapter 4 considers some of the overarching challenges in
telehealth, especially for rural communities. Chapter 5 delves into the issues
surrounding the challenges of payment for telehealth. Chapter 6 examines
the use of telehealth by a variety of providers in different settings across the
health care continuum. Chapter 7 reviews the observations and discussions
of the planning committee members as well as other workshop participants
at the end of the first day of the workshop.
Chapter 8 discusses the evidence base of telehealth, including challenges
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4 THE ROLE OF TELEHEALTH
with research design and how evidence can help change policy. Chapter
9 explores the development of newer telehealth technologies. Chapter 10
examines how telehealth is being embraced at the state level. Chapter 11
considers the experiences of the federal government in providing telehealth
care. Chapter 12 presents perspectives from the representatives of several
stakeholder organizations. Finally, Chapter 13 provides final observations
made by planning committee members and workshop participants at the
conclusion of the workshop.
Appendix A offers some key definitions for telehealth. Appendix B
includes a list of acronyms. Appendix C provides the workshop agenda.
