One participant noted that telehealth is a broad and encompassing term, so precision is needed in language. Schwamm agreed, adding that precision of language is also needed when talking about affordability and costs. He noted that costs are incurred by patients, by third-party payers, and by the provider institutions, and so clarity is needed about who saves money. He said some interventions may save the patient money that is not accounted for in health care dollars (e.g., patient transportation, time lost from work), which is not the dollars that most legislators or payors are focused on saving. He added that telehealth can reduce usage, such as by using each health care provider to his or her highest capacity (e.g., a nurse practitioner providing care with telehealth support from a physician, a physician providing care with support from a more senior physician). He summarized that precision is needed about the true costs and where real savings occur. Krupinski agreed, stating that definition of terms in a cost analysis is a form of standardization. She stated that differing interpretations of cost makes comparison of cost analysis studies difficult. Krupinski further added that cost of care cannot be separated from quality of care.
Incentives of Health Care Reform
One participant asked if the Health Information Technology for Economic and Clinical Health (HITECH) Act of 20092 and the ACA might motivate the adoption of telehealth. Schwamm stated that the contingencies, costs, and efficiencies associated with the HITECH Act created incentives for his own organization to adopt a single, unified medical record on the platform of an integrated delivery system. He noted, however, that discussions of the medical record have lacked consideration for the integration of telehealth as one of the key priorities in selecting a vendor. He argued that as organizations start to embrace and adopt electronic medical records, vendors will need to ensure the links will be there to incorporate telehealth in all modalities as another domain of the medical record.
One participant asked whether there might be a public push for tele-health technologies and how that might be leveraged. Schwamm agreed that the public is very engaged in access to health care information, and frustrated by the lack of access to providers, especially through modalities
2 The HITECH Act was enacted as part of the American Recovery and Reinvestment Act, P.L. 5, 111th Cong., 1st sess. (February 17, 2009).