In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. 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 technologies generally-that warrant particular notice from evaluators and decision makers.

Since that time, attention to telehealth 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 industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others.

The Health Resources and Service 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. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, 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. This report also summarizes 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.

Contents

• THE NATIONAL ACADEMIES
• PLANNING COMMITTEE FOR A WORKSHOP ON THE ROLE OF TELEHEALTH IN AN EVOLVING HEALTH CARE ENVIRONMENT
• Reviewers
• 1. Introduction
  • WORKSHOP STATEMENT OF TASK
  • DEFINITIONS
  • ORGANIZATION OF THE WORKSHOP SUMMARY
• 2. Opening Remarks
  • WELCOME FROM IOM PLANNING COMMITTEE
  • WELCOME FROM PROJECT SPONSOR
• 3. The Evolution of Telehealth: Where Have We Been and Where Are We Going?
  • HOME- AND COMMUNITY-BASED CARE
  • OFFICE-BASED TELEMEDICINE
  • ANCILLARY TELEMEDICINE SERVICES
  • HOSPITAL-BASED TELEMEDICINE
  • CONCLUDING REMARKS
• 4. Challenges in Telehealth
  • OVERVIEW OF COMMON CHALLENGES
  • LICENSURE
  • BROADBAND CONNECTIVITY
  • THE DEFINITION OF RURAL
  • REACTION AND DISCUSSION
• 5. Telehealth and Payment
  • MEDICARE
  • TRADITIONAL PAYMENT MODELS AND REGULATION
  • PRIVATE PAYMENT
  • CENTER FOR MEDICARE & MEDICAID INNOVATION
  • REACTION AND DISCUSSION
• 6. The Health Care Continuum
  • PROMOTING HEALTH, PREVENTING DISEASE, AND PROMPTING POPULATION PROGRESS
  • TELEHEALTH IN AN ACUTE CARE SETTING
  • CHRONIC DISEASE MANAGEMENT
  • REACTION AND DISCUSSION
• 7. Remarks and Discussion: Day 1
  • PLANNING COMMITTEE REMARKS
  • REACTION AND DISCUSSION
• 8. Current Evidence Base
  • CURRENT RESEARCH BASE
  • USING DATA TO CHANGE POLICIES AND CREATE NEW STANDARDS OF CARE: TELESTROKE
  • REACTION AND DISCUSSION
• 9. Technological Developments
  • PATIENTS’ PROVISION OF DATA
  • REMOTE PATIENT MONITORING
  • SOCIAL NETWORKING
  • WIRELESS HEALTH
  • REACTION AND DISCUSSION
• 10. State-Based Perspectives
  • THE VIRGINIA PERSPECTIVE
  • THE MARYLAND PERSPECTIVE
  • THE DELAWARE PERSPECTIVE
  • STATE-BASED ADVOCACY: NOBEL WOMEN
  • REACTION AND DISCUSSION
• 11. Experiences of the VA and IHS
  • U.S. DEPARTMENT OF VETERANS AFFAIRS
  • INDIAN HEALTH SERVICE
  • CRITICAL RELATIONSHIPS IN TELEHEALTH WITH AMERICAN INDIANS AND ALASKAN NATIVES
  • REACTION AND DISCUSSION
• 12. Stakeholder Perspectives
  • NATIONAL RURAL HEALTH ASSOCIATION
  • AMERICAN TELEMEDICINE ASSOCIATION
  • AMERICAN PUBLIC HEALTH ASSOCIATION
  • REACTION AND DISCUSSION
• 13. Concluding Remarks and Discussion
  • PLANNING COMMITTEE REMARKS
  • REACTION AND DISCUSSION
• References
• Appendix A Definitions
• Appendix B Acronyms
• Appendix C Workshop Agenda

Rapporteur: A. Lustig Tracy.

This activity was supported by Contract/Grant No. HHSH250200976014I between the National Academy of Sciences and the Department of Health and Human Services. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity.

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.

NOTICE: The workshop that is the subject of this workshop summary was approved 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.