"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 earlier this week. The discussion, titled EHRs and Telemedicine, also included Yael Harris, director of the Office of Health IT and Quality at Health Resources and Services Administration (HRSA), and Christina Thielst, a hospital administrator and independent IT consultant from California.
The question at hand was the intersection of telehealth tools with and EHRs and HIEs. Neuberger said the ONC should take a much more definitive role in helping increase and solidify those technologies' symbiosis.
[See also: Telehealth boon expected for chronic care patients.]
As of now, there's "no real inclusion for telemedicine and telehealth" as a direct component of the three stages of meaningful use, Neuberger 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, he said – especially in the rural and underserved areas that need it the most.
Neuberger pointed out that telehealth-intensive programs like "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 left out, he said, 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," Neuberger said, "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 currently being drafted.
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 HRSA programs for increasing access.
Especially important, he said, "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.
[See also: CCHIT poll shows Stage 2 and 3 qualms.]
After all, said Harris, her work with HRSA – 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 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?"