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THE ROLE OF
TELEHEALTH IN AN EVOLVING
HEALTH CARE ENVIRONMENT
Workshop Summary
Tracy A. Lustig, Rapporteur
Board on Health Care Services
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
NOTICE: The workshop that is the subject of this workshop summary was ap-
proved by the Governing Board of the National Research Council, whose members
are drawn from the councils of the National Academy of Sciences, the National
Academy of Engineering, and the Institute of Medicine.
This activity was supported by Contract/Grant No. HHSH250200976014I between
the National Academy of Sciences and the Department of Health and Human Ser-
vices. The views presented in this publication do not necessarily reflect the views of
the organizations or agencies that provided support for the activity.
International Standard Book Number-13: 978-0-309-26201-9
International Standard Book Number-10: 0-309-26201-1
Additional copies of this workshop summary are available for sale from the Na-
tional Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001;
(800) 624-6242 or (202) 334-3313; http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page
at: www.iom.edu.
Copyright 2012 by the National Academy of Sciences All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost
all cultures and religions since the beginning of recorded history. The serpent ad-
opted as a logotype by the Institute of Medicine is a relief carving from ancient
Greece, now held by the Staatliche Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2012. The role of telehealth in
an evolving health care environment: Workshop summary. Washington, DC: The
National Academies Press.
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"Knowing is not enough; we must apply.
Willing is not enough; we must do."
--Goethe
Advising the Nation. Improving Health.
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The National Academy of Sciences is a private, nonprofit, self-perpetuating society
of distinguished scholars engaged in scientific and engineering research, dedicated to
the furtherance of science and technology and to their use for the general welfare.
Upon the authority of the charter granted to it by the Congress in 1863, the Acad-
emy has a mandate that requires it to advise the federal government on scientific
and technical matters. Dr. Ralph J. Cicerone is president of the National Academy
of Sciences.
The National Academy of Engineering was established in 1964, under the charter
of the National Academy of Sciences, as a parallel organization of outstanding en-
gineers. It is autonomous in its administration and in the selection of its members,
sharing with the National Academy of Sciences the responsibility for advising the
federal government. The National Academy of Engineering also sponsors engineer-
ing programs aimed at meeting national needs, encourages education and research,
and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi-
dent of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of
Sciences to secure the services of eminent members of appropriate professions in
the examination of policy matters pertaining to the health of the public. The Insti-
tute acts under the responsibility given to the National Academy of Sciences by its
congressional charter to be an adviser to the federal government and, upon its own
initiative, to identify issues of medical care, research, and education. Dr. Harvey V.
Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sci-
ences in 1916 to associate the broad community of science and technology with the
Academy's purposes of furthering knowledge and advising the federal government.
Functioning in accordance with general policies determined by the Academy, the
Council has become the principal operating agency of both the National Academy
of Sciences and the National Academy of Engineering in providing services to
the government, the public, and the scientific and engineering communities. The
Council is administered jointly by both Academies and the Institute of Medicine.
Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively,
of the National Research Council.
www.national-academies.org
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PLANNING COMMITTEE FOR A WORKSHOP ON THE ROLE OF
TELEHEALTH IN AN EVOLVING HEALTH CARE ENVIRONMENT1
KAREN S. RHEUBAN (Chair), Professor of Pediatrics; Senior Associate
Dean for CME and External Affairs; and Director, University of
Virginia Center for Telehealth, University of Virginia Health System
NINA M. ANTONIOTTI, Director of TeleHealth, Marshfield Clinic
KAMAL JETHWANI, Corporate Manager--Research & Innovation,
Partners Healthcare Center for Connected Health; and Instructor in
Dermatology, Harvard Medical School
SPERO M. MANSON, Distinguished Professor and Director, Centers for
American Indian and Alaska Native Health, University of Colorado
Denver
THOMAS S. NESBITT, Associate Vice Chancellor, University of
California, Davis, Health System
SHERILYN Z. PRUITT, Director, Office for the Advancement of
Telehealth, Office of Rural Health Policy, Health Resources and
Services Administration
Project Staff
TRACY A. LUSTIG, Senior Program Officer
SAMANTHA ROBOTHAM, Senior Program Assistant
ROGER C. HERDMAN, Director, Board on Health Care Services
1Institute of Medicine planning committees are solely responsible for organizing the work-
shop, identifying topics, and choosing speakers. The responsibility for the published workshop
summary rests with the workshop rapporteur and the institution.
v
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Reviewers
This workshop summary has been reviewed in draft form by individu-
als chosen for their diverse perspectives and technical expertise, in accor-
dance with procedures approved by the National Research Council's Report
Review Committee. The purpose of this independent review is to provide
candid and critical comments that will assist the institution in making its
published workshop summary as sound as possible and to ensure that the
workshop summary meets institutional standards for objectivity, evidence,
and responsiveness to the study charge. The review comments and draft
manuscript remain confidential to protect the integrity of the process. We
wish to thank the following individuals for their review of this workshop
summary:
MARY DeVANY, Great Plains Telehealth Resource and Assistance
Center
STEPHANIE LAWS, Wabash Valley Rural Telehealth Network
DAVID LINDEMAN, Center for Aging and Technology
ROB SPRANG, Kentucky TeleCare
Although the reviewers listed above have provided many constructive
comments and suggestions, they did not see the final draft of the workshop
summary before its release The review of this workshop summary was
overseen by HUGH H. TILSON, University of North Carolina Gillings
School of Global Public Health. Appointed by the Institute of Medicine,
vii
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viiiREVIEWERS
he was responsible for making certain that an independent examination
of this workshop summary was carried out in accordance with institu-
tional procedures and that all review comments were carefully considered.
Responsibility for the final content of this workshop summary rests entirely
with the rapporteur and the institution.
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Contents
1INTRODUCTION 1
Workshop Statement of Task, 2
Definitions, 3
Organization of the Workshop Summary, 3
2 OPENING REMARKS 5
Welcome from IOM Planning Committee, 5
Welcome from Project Sponsor, 6
3 THE EVOLUTION OF TELEHEALTH: WHERE HAVE
WE BEEN AND WHERE ARE WE GOING? 11
Home- and Community-Based Care, 11
Office-Based Telemedicine, 12
Ancillary Telemedicine Services, 13
Hospital-Based Telemedicine, 14
Concluding Remarks, 15
4 CHALLENGES IN TELEHEALTH 17
Overview of Common Challenges, 17
Licensure, 20
Broadband Connectivity, 21
The Definition of Rural, 23
Reaction and Discussion, 26
ix
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xCONTENTS
5 TELEHEALTH AND PAYMENT 31
Medicare, 31
Traditional Payment Models and Regulation, 34
Private Payment, 36
Center for Medicare & Medicaid Innovation, 37
Reaction and Discussion, 38
6 THE HEALTH CARE CONTINUUM 43
Promoting Health, Preventing Disease, and Prompting
Population Progress, 43
Telehealth in an Acute Care Setting, 46
Chronic Disease Management, 50
Reaction and Discussion, 52
7 REMARKS AND DISCUSSION: DAY 1 55
Planning Committee Remarks, 55
Reaction and Discussion, 58
8 CURRENT EVIDENCE BASE 61
Current Research Base, 61
Using Data to Change Policies and Create New Standards of
Care: Telestroke, 66
Reaction and Discussion, 70
9 TECHNOLOGICAL DEVELOPMENTS 75
Patients' Provision of Data, 75
Remote Patient Monitoring, 77
Social Networking, 80
Wireless Health, 82
Reaction and Discussion, 85
10 STATE-BASED PERSPECTIVES 89
The Virginia Perspective, 89
The Maryland Perspective, 90
The Delaware Perspective, 92
State-Based Advocacy: NOBEL Women, 94
Reaction and Discussion, 96
11 EXPERIENCES OF THE VA AND IHS 99
U.S. Department of Veterans Affairs, 99
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CONTENTS xi
Indian Health Service, 104
Critical Relationships in Telehealth with American Indians and
Alaskan Natives, 108
Reaction and Discussion, 111
12 STAKEHOLDER PERSPECTIVES 115
National Rural Health Association, 115
American Telemedicine Association, 117
American Public Health Association, 119
Reaction and Discussion, 122
13 CONCLUDING REMARKS AND DISCUSSION 125
Planning Committee Remarks, 125
Reaction and Discussion, 129
REFERENCES131
APPENDIXES
A Definitions133
B Acronyms135
C Workshop Agenda 139
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