Report: Cultural, reimbursement barriers thwart robotic telemed adoption

Licensing, costs for technology and reimbursement for robotic telemedicine (RTM) continue to impede progress, according to an article published in the January/February edition of Telemedicine and e-Health.

Herbert J. Rogove, DO, from the C₃0 Medical Group in Ojai, Calif., and colleagues conducted a study of current telemedicine users to understand the barriers and motivational factors related to telemedicine’s utilization. With the majority of survey respondents in the emergency department or in the intensive care unit setting, 106 web-based surveys were completed, equaling a response rate of 21.9 percent for individuals.

The researchers found emergency response and consultation (47.2 percent) to be the leading applications of RTM and that patients, physicians, nurses and hospital executives were not barriers to implementation.

Other primary uses included critical care patient follow-up and evening rounds (13.7 percent), critical care routine rounds (10.4 percent), critical care education (7.5 percent), critical care non-urgent consults (9.4 percent) and critical care family and patient communication (0.9 percent). “The most popular combination of primary and secondary tasks was emergency response/consults along with patient follow-up/evening rounds,” the authors added.

Patients seen using RTM were primarily stroke (49.1 percent) and intensive care unit (35.8 percent) patients.

“Achieving immediate patient access (69.5 percent), overcoming service gaps (60 percent), improving quality (59 percent), providing clinical support (83.8 percent), and maintaining patient satisfaction (80 percent) were viewed as significant motives for RTM implementation,” wrote Rogove et al.

The researchers found regulatory barriers, financial barriers and cultural barriers as the top three barriers to adoption of telemedicine in emergency and critical care medicine. For example, 61 percent agreed or strongly agreed that inability to bill services rendered was a barrier to implementation of RTM. In addition, 61 percent agreed or strongly agreed that out-of-state licensing was a barrier to implementation and 73.3 percent agreed or strongly agreed that government reimbursement was a barrier to RTM implementation.

About 43 percent agreed or strongly agreed that RTM’s success is hampered by both a lack of understanding and a lack of exposure.

Rogove and company concluded that the action items necessary to resolve these barriers include development of the following:

• Regulatory models that permit physicians to obtain credentialing and interstate licensing for telemedicine;
• Payment mechanisms for telemedicine that go beyond currently restrictive practices; and
• Ongoing educational programs to introduce the concepts of telemedicine to all physicians, including discussion of pertinent literature that outlines safety, efficacy and outcome benefits of telemedicine.