The Economist Intelligence Unit Outlines Key Conditions for Viable Telemedicine Implementation

The Intelligence Unit of The Economist magazine in the United Kingdom recently released a research report. What conditions are required to achieve telemedicine? What kind of environmental support is needed? The report provides an in-depth analysis, offering a comprehensive interpretation focusing on policy, infrastructure, implementation techniques, and organizational structures. The findings are primarily based on desk research and expert interviews, with case studies drawn from regions including North America, Europe, Australia, and New Zealand. This study was commissioned by Philips, and the original author is Frieda Klotz.



Telemedicine is advancing rapidly, characterized by the provision of real-time connectivity tools—such as CT scanning, video-based diagnosis, and remote monitoring—that enable comprehensive and closer engagement between patients and physicians.

The primary advantage of telemedicine can be distilled into one key point: it provides patients with access to physicians. Regardless of their location, patients can conveniently receive diagnoses, consultations, and monitoring. However, the success of telemedicine depends not only on technological advancements but also requires modernized policy frameworks, improved communication infrastructure—such as broader broadband and mobile network coverage—and a progressive shift in the mindsets of both physicians and patients.

This briefing outlines three factors reshaping the landscape of telehealth access: policy enablement (such as legal and regulatory deregulation, particularly across state and national borders), communications infrastructure, and technical proficiency.

Key Points:
1. The implementation of telemedicine requires support beyond technology; healthcare policies must first evolve in tandem with technical capabilities, and communication infrastructure must reach vulnerable populations in remote areas.
2. If patients can consult with doctors in different states remotely, how should state governments efficiently authorize and allow cross-state medical practice by physicians?
3. Telemedicine personnel should coordinate with the deployment of internet infrastructure, taking into account that users with disabilities and elderly individuals may be less responsive to new technologies.
4. Focusing on system integration, telemedicine fosters closer collaboration among physicians, social workers, and nurses, while prioritizing security and privacy.
5. Physicians require support when adopting new technologies, such as the establishment of training programs to ensure that telemedicine and in-person care adhere to the same standards.

Chapter 1: New Policies on Remote Connectivity

From the perspective of U.S. investors, the American healthcare market is highly attractive, with many sectors already privatized. Among these, virtual care stands out as one of the most promising areas, having drawn hundreds of millions of dollars in investment toward telehealth technology and service providers.

For instance, Teladoc offers on-demand medical consultation services, which are undoubtedly a benefit for individuals enrolled in the lowest-tier plans under the Affordable Care Act (Obamacare). However, these services are not free and require out-of-pocket payment. In reality, the Centers for Medicare & Medicaid Services (CMS) has indicated that relevant healthcare policies have failed to keep pace, with policy-making seemingly stuck in the 1970s.

In the healthcare sector, technology advances far more rapidly than policy reform. The fragmented regulatory landscape creates a complex environment for stakeholders, particularly for companies seeking to operate across multiple states simultaneously. In 2015, 42 U.S. states enacted more than 200 pieces of legislation related to telemedicine; however, most of these policies have proven largely ineffective in practice.

It is evident that incentive policies are particularly crucial. The current fee-for-service model hinders healthcare professionals, clinics, and hospitals from adopting efficient telemedicine technologies, as these innovations tend to reduce medical billing revenues. A superior approach is exemplified by institutions such as the Mayo Clinic and Kaiser Permanente, which prioritize health outcomes as the standard of care, provide fixed salaries to medical staff, and emphasize a value-based service model.

Is the Time Ripe for Introducing Mobile Licenses?

Recently, several states have enacted the Interstate Medical Licensure Compact, easing the requirements for physicians to obtain medical licenses. One of the key drivers behind this initiative is the adoption of telemedicine. Proponents of telemedicine firmly believe that varying state-level licensing regulations for cross-state medical practice are the primary obstacle hindering the flourishing development of telemedicine. Physicians should be granted licensure to practice across different states, enabling them to reach more patients and fully leverage healthcare resources as medical demand continues to grow.

In fact, Europe has already begun to implement regulations abolishing the requirement for separate medical licenses across states. The European Union has been working for years to unify regulatory oversight, which is beneficial not only for neighboring countries but also for the world at large. Given the uneven development among nations, implementing unified management will facilitate collaboration in telemedicine.

Hub-and-Spoke Effect: Europe’s Telehealth Pathways

As one of the world’s most advanced regional economies, the European Union (EU) offers valuable references for the coordinated regulation of telemedicine. Although the EU’s telemedicine framework is primarily led by individual member states, the European Commission has also played a significant role. The Commission has identified telemedicine as a key component of its “Digital Agenda for Europe 2020,” demonstrating through concrete actions its commitment to Europeans by ensuring the security of online health data and promoting the widespread deployment of telemedicine technologies. The Commission has drafted a Green Paper that establishes regulatory provisions for telemedicine, aiming to enhance public trust in the rapidly evolving mobile app industry.

The theme encompasses privacy and security, aiming to enhance data protection awareness among EU developers. It has also funded projects such as the European Patients’ Smart Open Services (epSOS), enabling interoperability of electronic patient data across 25 countries and allowing physicians to practice diligently across different jurisdictions.

Other OECD countries. For instance, Australia launched its electronic health record system in 2012, providing access to summary health information for all citizens. The Australian government has also funded telemedicine pilot projects across multiple areas to reduce hospitalization rates and improve communication efficiency between healthcare providers and patients.

According to a research report published by Canada Health Infoway, a government-funded think tank, Canada has invested heavily in telemedicine due to its vast rural areas. Since 2001, the Canadian government has injected $2.1 billion into more than 400 interprovincial and territorial projects. By March 2015, the adoption rate of electronic health records in Canada had reached 91%, and in 2014, over 500,000 clinicians conducted online consultations for patients.

Chapter 2: Communication Infrastructure

For telemedicine, communication infrastructure, particularly broadband and mobile network coverage, plays a crucial role in the effective delivery of healthcare services. The development of communication infrastructure remains a significant challenge even in developed countries. Currently, although some countries possess superior infrastructure, telemedicine remains unfeasible in certain regions with poor conditions.

Due to the poor broadband services in rural areas, most patients living in these regions cannot benefit from the innovations and advancements of internet-based products. Even in developed countries such as the United Kingdom, there is insufficient nationwide bandwidth infrastructure. The UK government has invested $1 billion in mobile and broadband infrastructure, committing to accelerate national network speeds by 2018.

Other economic cooperation organizations have also increased their investment in telemedicine communication infrastructure. New Zealand established a National Telehealth Forum, supported by the IT Committee of the National Health Board and integrated into the Ministry of Health’s national plan, running in parallel with government-funded broadband enhancement initiatives. Some government officials believe that prioritizing healthcare needs can accelerate the improvement of broadband service speeds.

Regional disparities in information infrastructure also exist in the United States, where some individuals still rely on dial-up internet. Nevertheless, rural health centers using dial-up connections can still benefit from similar services. Leveraging mobile connectivity rather than broadband may offer an alternative pathway, as seen in rural Spain, where broadband penetration is low but mobile phone usage is widespread. Moreover, surveys indicate that SMS text messaging continues to meet the requirements of telemedicine. In fact, it is not necessary to blanket every corner with network coverage; Africa serves as a prime example.

The Balance Between Data Security and Interoperability

Infrastructure development cannot rely solely on government efforts. Hospitals should also carefully plan which telehealth service providers to partner with and build information networks accordingly. Each healthcare system is unique, varying in areas of expertise and scale. New tools must integrate seamlessly with existing ones; it is unrealistic to expect any single device to offer universal, all-encompassing functionality. Since investments typically target projects outside the hospital, establishing connections between internal and external operations is essential. For instance, if Mayo Clinic collaborates with smaller hospitals to provide remote stroke treatment, staff must be trained on how to use the relevant hardware and software, while ensuring data security remains a top priority.

If systems are highly complex, achieving interoperability among healthcare institutions is also essential. The U.S. Affordable Care Act promoted the adoption of electronic health records, but connectivity between different systems remained limited. In August 2015, CVS partnered with several online physician service providers, including American Well, Doctor on Demand, and Teladoc, signaling a significant step forward for telemedicine.

However, if healthcare providers cannot access the medical records of patients seeking care, it may lead to potential treatment errors. Moreover, as medical personnel will need to communicate with dietitians, social workers, and health counselors in the future, the influx of service providers enabled by telemedicine is certainly welcome, but it also raises a critical question: how can information be freely transmitted and easily shared among different individuals? This issue will undoubtedly be resolved within our lifetime. With the passage of time and societal progress—much like how Microsoft systems were once incompatible with Apple products, whereas now Microsoft systems can be installed on any mobile device with seamless compatibility—the integration of medical informatics will inevitably be achieved.


Chapter 3: Skill Enhancement

Leveraging communication technologies to deliver healthcare services seems quite intuitive. After all, many people are accustomed to using time and online tools to manage important information, such as personal banking. The Center for Internet Health Policy has provided training for physicians on how to conduct telemedicine consultations with patients. Telemedicine has transformed doctor-patient interactions, and physicians may require training to effectively adapt to the changes brought about by remote care delivery.

The second key point is the shift in physicians’ own mindset. They need to adjust their attitudes, as many doctors remain accustomed to face-to-face consultations. Some physicians may perceive that large hospitals offering telemedicine services will threaten their practice and affect their business. For instance, the Texas Medical Board imposed restrictions on the use of telemedicine, but Teladoc filed a lawsuit alleging that the Board had restrained competition, ultimately prevailing in the case.

Changes in skills and behaviors affect not only physicians but also patients and healthcare providers. Participating in remote video consultations entails certain minimum requirements, such as digital literacy or IT support. In Bulgaria, 40% of households lack internet access. Eurostat data indicate that the majority of individuals who do not use the internet are older adults and people with disabilities.

This situation affects the confidence of healthcare professionals; however, as telemedicine becomes increasingly important, relevant training has been prioritized in the professional development agenda for healthcare workers. For instance, Skills for Care, a UK organization dedicated to workforce development and adult social care and health, offers modules on digital working and digital learning as part of its overarching strategy.

Distribution Map of International Telemedicine Organizations and User Groups:

Note:
American Telemedicine Association (ATA): The American Telemedicine Association (ATA) is a non-profit organization driven by a sense of mission. Membership is open and jointly led by industry and academia.
European Health Telematics Association (EHTEL): EHTEL is a European forum organization that provides a platform for telehealth practitioners, including enterprises, institutions, and individuals.
National Telehealth-Related Organizations: Distributed across Algeria, Brazil, Finland, Germany, Ghana, India, Indonesia, Iran, Japan, Morocco, Nigeria, Poland, Russia, South Africa, Tunisia, Uganda, Ukraine, the United Kingdom, the United Arab Emirates, Saudi Arabia, Qatar, and other countries.
International Society for Telemedicine and eHealth (an international organization for telemedicine): A non-governmental organization in official relations with the World Health Organization, dedicated to promoting telemedicine and advancing its global development. It comprises 31 national telemedicine member institutions and organizational members.
HIMSS is a global, non-profit organization dedicated to improving health through information technology.
Australasian Telehealth Society (ATS) was established in 2008 to provide a platform for healthcare professionals, clinics, and industry partners in Australia and New Zealand to exchange ideas.