The Opportunity Awaits to Lead Orthopaedic Telehealth Innovation: AOA Critical Issues.

Telehealth is a way to provide health-care services to a patient from a provider who is at another location. The most common methods include a live interactive visit with the patient, interpretation of imaging, and monitoring of patient progress. Principally, telehealth is a way of providing a service rather than a type of service. It is about patient care, not data care.Examples of orthopaedic applications include conducting patient examinations, interpreting imaging studies, and providing postoperative care. Teleconsultation has been shown to be cost-effective. Other examples in orthopaedic research include the application of telemedicine when measuring patient-reported outcomes. Especially in cases when the patient lives far away from the provider, telehealth reduces time, produces good patient satisfaction, and costs less than hands-on care. As in everyday life, consumers have learned to demand convenience, ease of use, choice, control, and direct access. The ubiquity of telecommunications, combined with consumer technology savviness, drives the demand for telehealth. Unfortunately, the nation's largest payer for health services is one of the most restrictive for telehealth coverage. Medicare's restrictions are mostly the work of the U.S. Congress under Part B law. Video visits are very narrowly covered. Another major policy barrier is that interstate telehealth requires multiple state licenses for the physician, who must be licensed in the jurisdiction of each patient as well as the provider's physical locations. As Medicare shifts toward capitated payment and other value-based methods, there are opportunities to remove such restrictions.Despite these challenges, some states have been proactive in implementing telehealth systems. Arkansas is one of these states, and being a rural state with 2 main population centers, specialty care is relatively sparse. Implemented in 2014, the hand trauma program has been a partnership between the University of Arkansas for Medical Sciences (UAMS) and the Arkansas Trauma Communications Center (ATCC). This program has been very successful in decreasing the rate of hand trauma transfer, allowing patients to be treated closer to home while having coordinated access to fellowship-trained hand surgeons when necessary.More widespread innovation of orthopaedic applications for telehealth requires physician buy-in and health-systems partnerships. The regulatory environment will need streamlining. Ultimately, consumer demand will drive the implementation of technology to make care more accessible, convenient, and cost-effective.

An Emergent Research and Policy Framework for Telehealth.

CONTEXT: Telehealth is a fast-growing sector in health care, using a variety of technologies to exchange information across locations and to improve access, quality, and outcomes across the continuum of care. Thousands of studies and hundreds of systematic reviews have been done, but their variability leaves many questions about telehealth's effectiveness, implementation priorities, and return on investment. OBJECTIVES: There is an urgent need for a systematic, policy-relevant framework to integrate regulatory, operational, and clinical factors and to guide future investments in telehealth research and practice. METHODS: An invited multidisciplinary group of 21 experts from AcademyHealth, the American Telemedicine Association (ATA), Kaiser Permanente Institute for Health Policy (KP), and the Physician Insurers Association of America (PIAA) met to review and discuss the components of a draft framework for policy-relevant telehealth research. The framework was revised and presented in a challenge workshop at Concordium 2016, and some additional refinements were made. The current framework encompasses the regulatory and payment policy context for telehealth, delivery system factors, and outcomes of telehealth interventions. FINDINGS: Based on the feedback at Concordium 2016, the framework seems to have potential to help educate policymakers, payers, and health systems about the value of telehealth and to frame discussions about implementation barriers, including risk management concerns, technology costs, and organizational culture. However, questions remain about how to disseminate and use the framework to help coordinate policy, research, and implementation efforts in the delivery system.