Telemedicine: Stuck in the waiting room

[eridani]

http://www.economist.com/news/international/21623710-long-touted-health-care-revolution-may-last-be-about-arrive-stuck-waiting?fsrc=nlw|hig|9-10-2014|NA

In America only 21 states mandate that telemedicine be compensated at the same rate as face-to-face care. At the federal level, the Veterans Administration has embraced telemedicine whereas Medicare, the public-health programme for the elderly, largely ignores it. But private employers and insurers are increasingly paying for telemedicine, encouraged by a shift to paying doctors for packages of care rather than per service. This has “opened the door” to remote care, says Jonathan Linkous of the American Telemedicine Association.

Telemedicine is more than a Skype chat between doctor and patient, says Michael Young, who works on remote care for the University of North Carolina. The technology can look similar but the need for security and privacy is greater. Earlier this year the FBI warned American health-care providers that their cyber-security systems were not up to snuff. Electronic versions of sensitive documents such as X-rays or doctors’ notes must be as secure as paper ones. That is hard when they are flying through the ether. In August one of America’s biggest hospital groups said Chinese hackers had stolen data on 4.5m patients.

Some small countries are in the vanguard. Israel’s health-care system is fully digitised: all doctors use electronic medical records, and patients have access to their data. Doctors can write repeat prescriptions and refer patients to specialists over the internet. The health ministry noticed an uptick in telemedicine in 2010 and introduced relatively lax guidelines in 2012.

China is spending billions on health-care reform, with a focus on telemedicine. But keen interest is no guarantee of success in any country. “If you have a chaotic system and add technology, you get a chaotic system with technology,” says Peteris Zilgalvis, a health official at the European Commission. Telemedicine may even increase costs if it is added to old routines rather than replacing them. There is little evidence of its cost-effectiveness, says Marc Lange of the European Health Telematics Association,