Why not MU for telemedicine?

ATA speaker calls for meaningful use, national coordinator, standards, quality measures
By Bernie Monegain
09:33 AM

Imagine if telemedicine had the same government support that EHRs have garnered. That’s the steep and thorny path on which Ryan Spaulding took his audience during a public policy discussion May 8 at the American Telemedicine Association’s annual meeting.

Spaulding, director of telemedicine and telehealth at the University of Kansas Medical Center titled his talk Telehealth and Meaningful Use: Can It Be Done? He posed the question, and answered, “Of course it can be done. I think the question might have been. "How can it be done?"

"How can we take a little more of a structured approach to not just adding current telehealth into meaningful use, but how can we create almost our own meaningful use for telehealth," he asked, and he recommended that the ATA take a proposal to Health and Human Services Secretary Kathleen Sebelius to create a telemedicine national coordinator, who might work in tandem with the ONC chief, who oversees health IT.

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Spaulding pointed out that there is no formal authority at the national level like there is for meaningful use of electronic medical records. Nor is there a roadmap or strategic plan.

"So we would like to suggest a plan to address that issue because there is no plan."

He said telehealth was on the healthcare scene just a bit earlier than electronic health records. Many of the programs started in the ’80s and ’90s – at least one as early as the '60s. And yet meaningful use and EHRs have "kind of leapfrogged ahead" in the national priority via the HITECH piece of the American Reinvestment and Recovery Act, he said.

His proposal to adapt the meaningful use program for telemedicine is not “groundbreaking,” he told the audience. It’s just copying or adapting the program, which has been instrumental in spurring EHR uptake, to telehealth.

Health IT has had four national coordinators, he noted. The first David Brailer, MD, was appointed by George W. Bush, who had also established the Office of the National Coordinator for Healthcare Information Technology.

"Sometimes people forget there was a lot of work done in 2004 and 2005 before meaningful use came along," Spaulding said.

"We’ve had four national coordinators for meaningful use, but we don’t have one for telehealth," he said. "We’ve got some people in the shadows, I think, that could do this kind of work and drive this kind of program, but we just haven’t really taken that idea to the next step to get somebody in place."

Spaulding suggested telehealth also might benefit from something akin to the Regional Extension Centers that the government established in all the states across the country to provide doctors with help selecting an EHR system, implementing it and then using it in a meaningful way, all of which leads to CMS incentive payments that turn into penalties in 2015.

The centers might be operated by the Telehealth Resource Centers scattered around the country, he suggested, though it would not be exactly the same, since there are only 12 centers.

"But, it’s something we could build on," he said. "And, they’re already funded. So, they’re already in place."

Other policies mirroring health IT – a federal standards panel and a policy panel for telemedicine as there are for health IT, Spaulding would champion. He acknowledged that as complicated as standards are for EHRs, they would be even more so for telemedicine.

There are standards for video and other equipment that makes telehealth possible, but no standards for how people are doing telehealth, Spaulding said.

"We don’t really have at the national level a strategic plan that was designed in a way that this plan (for health IT) was designed," he said. "It would be nice if we could pursue something like that."

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