U.S. Healthcare Goals Require More Use of Telemedicine, Federal CTO Says

Chopra cited statistics showing the telemedicine significantly reduces readmission rates. Payment reform alone “will essentially create the market conditions where it’s in the economic interests of our hospitals to stay connected,” he said. Chopra also said better use of data is critical to improving medical research. Companies in the retail sector like Best Buy have figured out how to use data to make decisions on the best approach to sell big-screen TVs and other electronics to consumers, he said. The medical community must have the same access to data.

“I spend a great deal of time in the R&D world, cancer care being amongst the most important in my mind to get right,” Chopra said. “Despite the fact that we spend record billions in research, less than 3-1/2 percent of the nation’s cancer patients have data captured in any meaningful repository. … There is no Best Buy television promotion analogy in the cancer care community today because that data is not stored in an environment that would allow us to make meaningful judgments.”

Chopra said his job as federal CTO is to help identify technologies that can meet the president’s goals in other policy areas and to help stimulate the technology economy. Chopra said he will focus in part on standards. “I'm going to be working like a dog on making sure standards drive innovation, not stifle it.” The government also has a $150 billion research and development fund, he said. “I'm going to make sure that we have the right mix in that portfolio to spur innovation through pushing as much as I can on the applied R&D fund where appropriate,” Chopra said. “Rest assured healthcare IT will include telemedicine.” Chopra said the federal government will also buy technology that is cutting edge. “We are going to apply all levers to drive innovation in this space,” he said. “If I'm missing something, tell me.”

“In much of this country, we have incredible gaps in broadband, there are huge digital divides,” said Dale Alverson, professor of pediatrics at the University of New Mexico School of Medicine. “It’s going to be really important in the broadband plan to look how do we get affordable connectivity to every American that needs it and desires it.” He cited the case of Ruidoso, N.M., where broadband costs the hospital $12,000 a month to meet its telemedicine needs, which is expected to rise shortly to $18,000 per month. “There is absolutely no way that I believe we as American citizens can afford that or tolerate it,” he said.

But to make broadband affordable, the focus must be on meeting the needs of various sectors and not just building unique networks for healthcare, Alverson said. “It’s not just healthcare, it’s education, distance learning, connecting libraries, the schools and colleges and universities, but also business and government,” he said. “By aggregating … services I believe we can come up with a much better price point that provides a return on investment for industry.”

Internet2 CEO Douglas Van Houweling said major medical centers in the U.S. are already well connected. “Our problem is as we move out of those medical centers,” Van Houweling said. “In many community medical centers they cannot conduct a video conference … which means they can’t consult effectively with major medical centers.” Another hole is that most emergency medical technicians don’t have wireless connections to hospitals, he said.

FiberUtilities CEO Scot Eberle said some connectivity speeds that pass for broadband are so low they're not really broadband. “Create something that incents the right kind of broadband at the right price points,” Eberle advised. “Some of the incentives and reimbursements today don’t incent new broadband. They pay for old broadband.” Eberle said the need for faster speeds will rise quickly. “As we build networks, one of the examples is the Iowa network, we said a [gigabyte] to a hospital is going to be perfect,” he said. “Before we installed it we were at two and now we're at 10.”

Wireless will play a big role, panelists agreed. Chairman John Clarey of the National Medical Wireless Broadband Alliance, representing 100 hospitals, said wireless can fit many hospitals needs, such as access to experts in teaching hospitals or data and large file transfer. The group proposes a solution built around distributed antennas within medical facilities. “The problem with bringing fiber to the hospital is it doesn’t stop there,” Clarey said. “You need a network infrastructure inside the hospital to deliver the actual broadband to the point of care.”

“In rural America, when we look at New Mexico, part of the solution is going to be looking at wireless,” Alverson said. “Putting fiber in the ground is not going to be a realistic option.” He cited the example of Ruidoso: “They're in the mountains. They're not going to put adequate landlines in at this point.”

On a second panel, medical officials spoke about the many benefits of telehealth. “We are about enhancing access to care,” said Karen Rheuban, a pediatrician and president of the American Telemedicine Association. “Remote medical clinics are all over the country and every time that they are set up, thousands and thousands of unserved patients show up.”

Telemedicine means access to experts only available in another hospital, better triage of patients prior to transfer to another facility, reduced admission for the same diagnosis, improved chronic disease management and reduced travel for those seeking care, Rheuban said. Medical professionals can use broadband connections to earn continuing medical education credits, she said. Telemedicine also reduces the sense of isolation felt by doctors in rural communities. “That’s a continual problem that we hear,” she said.

Telemedicine also helps rural communities remain economically viable, Rheuban said. “More than 85 percent of patients remain in the local community environment when they're served by telehealth,” she said. “That has tremendous advantages. Care in the community is at lower costs … and if a patient stays in a hospital that keeps the hospital viable and the hospital is often the major employer in any community.”