Telemedicine: What’s the problem and how to increase adoption?

Every U.S. citizen has a vested interest and an opinion about the quality and effectiveness of healthcare delivery, a $3.8 trillion industry with rapidly escalating costs.

The fastest-growing industry in healthcare is telemedicine, which is now used in over 50% of the hospitals in the U.S. to promote remote access to healthcare. Examples range from tele-surgery to tele-emergency care to tele-psychiatry. The reasons for telemedicine abound. It allows specialized care to be distributed from a central hub to a rural location or an underserved population, efficiently and at lower costs.  For instance, in 2012, the Veterans Administration (VA) documented over 1.5 million telehealth sessions, for over 35% of veterans.

Problem statement and opportunity

The primary problem with telemedicine is low user adoption rates because many people resist organizational change. The result is massive waste that can be reduced.   Telemedicine technology and processes exist. However, organizational readiness for telemedicine results from two variables: 1) ability to change, and 2) motivation to change. The innovation diffusion curve (see Figure 1) demonstrates an immediate opportunity for telemedicine initiatives to move from the early adopter phase to the majorities.

Organizational readiness for telemedicine can be measured.   The key variables for organizational readiness include 1) executive sponsors who champion the ability and need to change, 2) buying agents convinced by case studies or ROI data of the economic value for the change, and 3) consumers driven by a compelling need for effective, inexpensive health care outcomes. The need for organizational leadership innovations in telemedicine programs is immediate.

DOI curve

Figure 1: The innovation diffusion curve (in Rogers (2003) Diffusions of Innovation)

Unique opportunity:  Tennessee

Although resistance to telemedicine is a global problem, we have a unique opportunity to provide a solution from Tennessee. Described as the “Global Center of Healthcare,” Nashville, TN has over 400 healthcare companies, spawned from Healthcare Corporation of America (HCA). On January 1, 2015, Tennessee became the 21st state to enact “telemedicine parity” legislation requiring that insurers reimburse licensed health care providers for services delivered remotely just as they would for in-person visits. On February 15, 2015 Tennessee added law stating that telehealth providers will be held to the same level of care as direct care providers (SB 1223). That law “opened the door” for telemedicine services to be delivered remotely, at lower cost, to rural minorities in Tennessee. We are in the right time at the right place to lead innovation in telemedicine.

Sadly, there is resistance to telemedicine from consumers and administrators who do not trust the government, or the technology, or the financial benefits. A telemedicine visit may cost $50 and take 10 minutes (e.g. MD Live, Teladoc); an ER visit may cost $150 and take 3 hours; a hospital visit may cost $15,000 and take 3 days. Telemedicine has demonstrated a 10X cost savings. Unless, of course, there is organizational resistance to change, in which case telemedicine is a waste of time and resources.

One administrator said, “We have 3 telemedicine kiosks sitting in a storage room, hidden by sheets. The vendor who provided them no longer exists.   The technology may be extraordinary, but I cannot get my physicians and nurses to use it.” His experience represents hundreds of wasteful healthcare initiatives.

What can you do to increase adoption of telemedicine?