Overview

By Julia Adler-Milstein, Joseph Kvedar, and David W. Bates

doi: 10.1377/hlthaff.2013.1054

Telehealth Among US Hospitals:

HEALTH AFFAIRS 33,
NO. 2 (2014): 207–215
©2014 Project HOPE—
The People-to-People Health

Several Factors, Including State Foundation, Inc.

Reimbursement And Licensure

Policies, Influence Adoption
Julia Adler-Milstein (juliaam@
ABSTRACT Telehealth is widely believed to hold great potential to improve umich.edu) is an assistant
professor at the School of
access to, and increase the value of, health care. Gaining a better Information and the School of
understanding of why some hospitals adopt telehealth technologies while Public Health, University of
Michigan, in Ann Arbor.
others do not is critically important. We examined factors associated with
telehealth adoption among US hospitals. Data from the Information Joseph Kvedar is director of
the Center for Connected
Technology Supplement to the American Hospital Association’s 2012 Health, Partners Healthcare
annual survey of acute care hospitals show that 42 percent of US System, in Boston,
Massachusetts.
hospitals have telehealth capabilities. Hospitals more likely to have
telehealth capabilities are teaching hospitals, those equipped with David W. Bates is chief of the
Division of General Medicine,
additional advanced medical technology, those that are members of a senior vice president for
larger system, and those that are nonprofit institutions. Rates of hospital quality and safety, and chief
quality officer, all at Brigham
telehealth adoption by state vary substantially and are associated with and Women’s Hospital, in
differences in state policy. Policies that promote private payer Boston.

reimbursement for telehealth are associated with greater likelihood of

telehealth adoption, while policies that require out-of-state providers to
have a special license to provide telehealth services reduce the likelihood
of adoption. Our findings suggest steps that policy makers can take to
achieve greater adoption of telehealth by hospitals.

T
he rapid development of new com-
munications technologies, coupled
with growing pressure to develop
more-efficient health care delivery
models, has focused renewed atten-
tion on telehealth.1 Telehealth encompasses a
wide array of applications—for example, remote
patient monitoring, electronic intensive care
units (eICUs), and video visits—all of which
are designed to take advantage of communica-
tion technologies to support care from a
distance.
The evidence is still emerging on whether or
not telehealth consistently leads to better care at
lower cost.2–4 In addition, the degree to which
telehealth technologies have been adopted and
the factors that influence whether or not insti-
tutions adopt them are not well understood.5–8
A hospital’s decision about whether to invest
in telehealth is likely shaped by a range of fac-
tors. These include specific features of the hos-
pital, such as its teaching mission, its affiliations
with other institutions, and its technological ca-
pabilities. Market factors, including rurality and
degree of competitiveness, may also shape hos-
pitals’ decisions about investing in telehealth.
For example, hospitals in more rural areas have
access to federal funds to improve care accessi-
bility, and as a result they may be more likely to
provide telehealth than hospitals in more urban
areas.9 Hospitals in more competitive markets
may see telehealth as a way to distinguish them-
selves. Finally, and perhaps most importantly,
state policies affecting reimbursement and reg-
ulation likely affect how interested hospitals are
in offering telehealth services.

F eb r u a ry 2 0 1 4 33:2 H e a lt h A f fai r s 207

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Overview
Gaining a better understanding of why some
hospitals choose to adopt telehealth while others
do not is critically important. If certain types of
hospitals, such as those that are not part of a
larger system, find it particularly difficult to en-
gage in telehealth, concerted, targeted efforts
may be useful once evidence for the benefits of
telehealth is more robust. And if certain state
policies facilitate or hinder telehealth uptake,
policy makers could catalyze adoption through
new legislation. Empirical evidence here would
be very helpful.
In this study we sought to identify the hospi-
tal-, market-, and state-level factors associated
with telehealth adoption among US hospitals.
We specifically sought to answer the following
questions: What percentage of US hospitals cur-
rently have telehealth capability? Which charac-
teristics of hospitals and markets are associated
with hospital telehealth adoption? Is there sub-
stantial variation in adoption of telehealth
across states? And are certain state policies as-
sociated with the greater likelihood of telehealth
adoption among hospitals?
To address the rapidly changing environment
of health care delivery, we complement our as-
sessment of current telehealth adoption among
US hospitals with a discussion of the most prom-
ising and innovative applications of telehealth,
focusing on those that target the priorities set
out in the Affordable Care Act, such as reductions
in thirty-day readmissions to hospitals. These
results provide a timely picture of the factors that
appear to be shaping hospitals’ decisions to in-
vest in telehealth, and they suggest potential
strategies to help policy makers increase tele-
health adoption.
Study Data And Methods
We used national data from the Information
Technology (IT) Supplement to the American
Hospital Association (AHA) 2012 Annual Survey
of Hospitals,10 which was sent at the end of 2012
to all acute care hospitals in the United States
and its territories. The IT Supplement was de-
signed to capture key functions for which hospi-
tals used health information and communica-
tions technologies. The survey was sent to
each hospital’s CEO, who was asked to assign
the most knowledgeable person in the institu-
tion (typically the chief information officer or an
equivalent person) to complete it. The survey
achieved a 63 percent response rate.11
Our analytic sample was limited to the 2,891
acute care, nonfederal hospitals in the fifty states
and the District of Columbia that responded to
the IT Supplement. Federal hospitals were ex-
cluded because they are not subject to state reg-
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ulations. Hospitals in Guam, Puerto Rico, and
other US territories were excluded because they
are subject to different rules and regulations.
We merged the IT Supplement data with re-
sults from the AHA annual survey to develop
measures at the market level and to capture ad-
ditional hospital characteristics. We defined a
market as a Hospital Referral Region,12 a desig-
nation developed for the Dartmouth Atlas of
Health Care to identify health care delivery mar-
kets based on Medicare beneficiaries’ travel pat-
terns for tertiary hospital care. The Area Re-
source File, Medicare inpatient claims, the
Health Resources and Services Administration’s
Health Professional Shortage Area files, and the
Dartmouth Atlas were all used for additional mar-
ket-level measures.
Telehealth Adoption The IT Supplement
asks hospitals to report the extent to which they
have implemented a set of health information
and communication technology functions, one
of which is telehealth (the survey question can be
found in the online Appendix).13 We considered a
hospital to have telehealth capability if tele-
health was fully implemented in at least one unit.
Hospital Characteristics We assessed
whether hospital telehealth adoption was asso-
ciated with the presence of a cardiac ICU (indi-
cating a certain level of technological capability)
and IT resources (at least a basic electronic
health record),14 because telehealth can comple-
ment these technologies and because it may re-
flect a broader strategy of investment in ad-
vanced technology. We also assessed whether
hospitals that were affiliated with a larger system
would be more likely than others to have imple-
mented telehealth, because the technology of-
fers a way to deliver a full range of services to
patients from any location, increasing access as
well as revenue.
In addition to these three focal hospital char-
acteristics, we examined size, teaching status,
ownership (for-profit, nonprofit private, or pub-
lic), and proportion of Medicaid admissions, be-
cause these might also be directly related to tele-
health adoption or confound the relationship
between the focal characteristics and telehealth
adoption.
Market Characteristics At the market level
we focused on the following four dimensions of
the environment that might promote hospital
investment in telehealth: rurality, population
density, designation as a Health Professional
Shortage Area, and the competitiveness of the
hospital market. Rurality was measured using
rural-urban commuting area categories (urban,
suburban, large rural, or small town). Popula-
tion density was measured based on population
per square mile. We considered a market to be a
primary care Health Professional Shortage Area
if one or more counties within the market were
currently designated as such by the Health
Resources and Services Administration.15 The
competitiveness of the hospital market was mea-
sured using the Herfindahl-Hirschman Index.
Additional market-level measures were frag-
mentation (measured as the proportion of dis-
charged patients subsequently readmitted to a
nonaffiliated hospital within the same market);
mean annual Medicare inpatient expenditures;
percentage of population uninsured; and per
capita income. These variables were chosen be-
cause each might be directly related to the im-
plementation of telehealth or might confound
the relationship between the focal market char-
acteristics and telehealth adoption.
State Policy Characteristics We used a re-
cent compilation of state telehealth laws16 to cap-
ture a variety of dimensions of state policies that
might affect telehealth adoption.We created sev-
en measures of reimbursement policies for tele-
health services. Reimbursement policies may
promote telehealth adoption because they clarify
the regulations for, and in some cases explicitly
require, reimbursement for telehealth services.
Our first measure captured whether the state
had policies in place to reimburse for some form
of live video, including regulations on which
specialties or conditions were covered for treat-
ment. The second captured whether the state had
policies in place to reimburse for “store and for-
ward” services, often meaning that the state had
passed legislation specifying that the definition
of telehealth must include this form of informa-
tion sharing and that it could be reimbursed like
other telehealth services. The third captured pol-
icies that specified reimbursement for remote
patient monitoring. This measure considered
only states with direct reimbursement for remote
patient monitoring, not states that might reim-
burse for remote monitoring through other
mechanisms such as home health services.
The fourth measure captured whether the state
had policies in place specifying reimbursement
to the telehealth provider for transmission, a
facility fee, or both. The fifth measure captured
policies that restricted reimbursable services by
location, either to rural or underserved areas or
by specific types of facilities, primarily hospitals
and physician practices. The sixth measure cap-
tured state policies that require private payers to
reimburse telehealth services to the same extent
as face-to-face services. Some policies specify
that private payers must reimburse for telehealth
in certain situations, such as for rural popula-
tions or mental health services.
In addition to reimbursement-related policies,
we examined two other types of policies—patient
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consent and licensure—that could inhibit hospi-
tals’ adoption of telehealth. A state with consent
policies requires some type of informed consent
by patients before they can receive telehealth
services. A state with licensure policies regulates
cross-state use of telehealth—that is, it issues
special licenses to out-of-state providers to deliv-
er telehealth services to patients in a state they
are not located in, in some cases only if certain
conditions are met (for example, the provider
agrees not to open an office in that state). We
divided such policies into licensure require-
ments for Medicaid patients and those for the
state as a whole.
Analysis We calculated a national telehealth
adoption rate among all hospitals in our sample
and then calculated participation rates by state.
We next assessed whether the characteristics we
examined independently predicted hospitals’
adoption of telehealth. To do this, we used a
multivariable logistic regression model with hos-
pital, market, and state characteristics.
Our model included robust standard errors
that were adjusted for clustering at the market
level. It also included hospital-level sampling
weights to adjust for potential nonresponse bias,
based on known differences between respon-
dents and nonrespondents to the IT Supple-
ment.11 In addition, we adjusted for the number
of respondents to the IT Supplement in
each state.
Robustness Assessment The IT Supplement
asked a single question about adoption of tele-
health that could have been interpreted by
respondents to include different types of tech-
nologies. Therefore, we assessed whether our
findings persisted when we used data on tele-
health adoption from HIMSS Analytics.17 This
is the only other comprehensive source of data
on US hospital adoption of health information
and communication technologies that we iden-
tified.
Using the most recent available HIMSS Ana-
lytics data (from 2011), we considered a hospital
◀
42
to have adopted telemedicine if it reported one or
more telemedicine applications to be “live and
operational” in at least one department.13 Ninety- %
seven percent of the hospitals in our analytic
Of hospitals
sample were represented in the HIMSS Analytics
We found that 42 percent
data. of hospitals across the
Limitations Our work has important limita- country had adopted
tions. First, the IT Supplement survey asked telehealth as of late 2012.
about telehealth only as a single category. Be-
cause the survey did not ask about the extent
of use or about different types of telehealth (such
as remote patient monitoring), our ability to
assess specific telehealth applications was limit-
ed. In addition, some respondents may have in-
terpreted the question to include a wide array of
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Overview

applications, while others may have interpreted hospitals with greater technological capabili-
it more narrowly. This prompted us to conduct ties—as measured by the presence of a cardiac
our robustness assessment using an indepen- ICU—were more likely than others to have
dent source of data on telehealth adoption (dis- adopted telehealth. Hospitals that were part of
cussed above). a larger system were also more likely to have
Second, we attempted to include a comprehen- adopted telehealth, as were teaching hospitals.
sive set of variables, but we were unable to mea- Finally, for-profit hospitals were much less likely
sure some that could have affected our key re- than their nonprofit counterparts to have
sults. For example, we were unable to capture adopted telehealth.
data on the financial position of hospitals. More Market-level factors also appeared to shape
broadly, there are many factors that likely affect a hospitals’ decisions about whether or not to
hospital’s decision to invest in telehealth, and we adopt telehealth. Rurality was significantly asso-
were not able to examine all of them. ciated with telehealth adoption overall—an asso-
Finally, we were not able to assess causality ciation that was driven by the greater likelihood
and could assess only associations. However, of adoption among hospitals in large rural areas
many other studies have qualitatively described compared to those in urban areas (Exhibit 2).
how policy barriers limit the adoption of tele- Population density also appeared to be indepen-
health and similar technologies.18–20 dently associated with the odds of telehealth
adoption, with the odds decreasing as density
increased. However, that association was only
Study Results marginally significant.
We found that 42 percent (1,208 of the 2,891 We did not find a significant difference in tele-
hospitals in our sample) of hospitals across health adoption based on whether the hospital
the country had adopted telehealth as of late was in a market that included a designated pri-
2012. When we examined telehealth adoption mary care Health Professional Shortage Area
based on key hospital and market characteris- (Exhibit 2). Finally, the competitiveness of the
tics, we found several differences. market appeared to shape telehealth adoption.
We failed to find a significant association be- Hospitals in the least competitive markets (those
tween telehealth and the adoption of an electron- in the top quartile of the Herfindahl-Hirschman
ic health record system (Exhibit 1). However, Index) were slightly more than half as likely to

Exhibit 1

Hospital Characteristics And Their Relationship To Hospitals’ Participation In Telehealth, 2012

Participates in telehealth
Hospital characteristic Odds ratio 95% CI p value
Has cardiac ICU 1.23 1.02, 1.50 0.036
Has at least basic EHR system 0.87 0.72, 1.05 0.153
Affiliated with a hospital system 1.62 1.35, 1.96 <0.001
Size
Small Ref —a —a
Medium 1.28 1.00, 1.63
Large 1.31 0.92, 1.87 0.131 (across categories)
Teaching status
Nonteaching Ref —a —a
Minor teaching 1.70 1.14, 2.52
Major teaching 1.26 0.97, 1.63 0.022 (across categories)
Ownership
Private, nonprofit Ref —a —a
For-profit 0.39 0.28, 0.54
Public 0.89 0.68, 1.15 <0.001 (across categories)
Quartile of Medicaid admissions
1 (smallest) Ref —a —a
2 1.14 0.92, 1.41
3 1.11 0.87, 1.40
4 (largest) 0.91 0.71, 1.18 0.305 (across categories)

SOURCE Authors’ analysis. NOTES CI is confidence interval. ICU is intensive care unit. EHR is electronic health record. Ref is reference
category. aNot applicable.

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 Exhibit 2

Market Characteristics And Their Relationship To Hospitals’ Participation In Telehealth, 2012

Participates in telehealth
Odds ratio 95% CI p value
Primary care HPSA in market 0.84 0.61, 1.17 0.295
Commuting area
Urban Ref —a —a
Suburban 1.45 0.99, 2.12
Large rural 1.41 1.09, 1.82
Small town 1.15 0.84, 1.57 0.043 (across categories)
Quartile of market population density
1 (least dense) Ref —a —a
2 0.94 0.69, 1.27
3 0.79 0.57, 1.11
4 (most dense) 0.58 0.38, 0.88 0.074 (across categories)
Quartile of market competitionb
1 (most competitive) Ref —a —a
2 0.83 0.63, 1.10
3 0.75 0.56, 1.00
4 (least competitive) 0.59 0.39, 0.89 0.030 (across categories)
Quartile of market fragmentationc
1 (least fragmented) Ref —a —a
2 1.00 0.81, 1.24
3 1.06 0.83, 1.34
4 (most fragmented) 0.90 0.68, 1.18 0.644 (across categories)
Quartile of Medicare market spending
1 (least spending) Ref —a —a
2 0.90 0.67, 1.20
3 0.95 0.66, 1.37
4 (most spending) 0.60 0.40, 0.89 0.072 (across categories)
Quartile of uninsured market population
1 (smallest % uninsured) Ref —a —a
2 0.78 0.58, 1.05
3 1.00 0.70, 1.44
4 (largest % uninsured) 1.05 0.74, 1.50 0.240 (across categories)
Quartile of market per capita income
1 (lowest income) Ref —a —a
2 0.90 0.65, 1.25
3 1.00 0.70, 1.42
4 (highest income) 1.30 0.86, 1.96 0.289 (across categories)

SOURCE Authors’ analysis. NOTES CI is confidence interval. HPSA is Health Professional Shortage Area. Ref is reference category. aNot
applicable. bBased on the Herfindahl-Hirschman Index. cThe proportion of discharged patients readmitted to a nonaffiliated hospital in
the same market.

have adopted telehealth as hospitals in the most
competitive markets.
When we examined the rates of hospital tele-
health adoption across states, we found substan-
tial variation (Exhibit 3). The states with the
broadest adoption were Alaska, where 75 percent
of the hospitals had telehealth; Arkansas (71 per-
cent); South Dakota (70 percent); and Maine
(69 percent). In contrast, Rhode Island had 0 per-
cent of its hospitals participating in telehealth,
and Utah had only 13 percent.
The highest- and lowest-adopting states all had
fairly small populations, and each had fewer
than fifty hospitals responding to the IT Supple-
ment survey. These facts suggest that factors be-
yond the number of hospitals in the state, such as
state policies, affect the proportion of hospitals
that offer telehealth.
In fact, we found significant associations be-
tween state policies and hospitals’ adoption of
telehealth. Specifically, state policies that re-
quired private payers to reimburse for telehealth
services to the same extent as face-to-face ser-
vices made hospitals more likely to adopt tele-
health (Exhibit 4). In contrast, state policies that
required out-of-state providers to have special
licenses when delivering telehealth services to
Medicaid patients made hospitals less likely to

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Overview

Exhibit 3

Hospitals’ Telehealth Participation, By State, 2012

AK
AR Without telehealth
SD With telehealth
ME
VA
NH
HI
NE
SC
NJ
WA
CO
OR
ID
MA
GA
MT
WI
NM
IA
DE
MN
MI
PA
NC
MO
AZ
IN
KY
OH
MD
ND
CA
FL
NV
LA
OK
WY
CT
KS
WV
TN
VT
DC
NY
TX
IL
MS
AL
UT
RI

Number of hospitals

SOURCE Authors’ analysis. NOTES Limited to hospitals that responded to the Information Technology Supplement to the 2012 Ameri-
can Hospital Association Annual Survey of Hospitals (see Note 10 in text). States are arrayed in order of highest proportion (Alaska) to
lowest proportion (Rhode Island) of telehealth adoption.

adopt telehealth. of telehealth adoption (30 percent of the hospi-

When we replicated our analyses using HIMSS tals in our sample, instead of 42 percent). How-
Analytics data,17 we found a somewhat lower rate ever, the associations we found between key hos-

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pital and market characteristics and telehealth Exhibit 4
adoption persisted.13 For our state-level policy
State Policy Characteristics And Their Relationship To Hospitals’ Participation In Telehealth,
measures, we continued to find that state poli- 2012
cies requiring a special license to provide tele-
health reduced hospitals’ rate of adoption. Participates in telehealth
We also continued to find that state policies State policy characteristic Odds ratio 95% CI p value
requiring private payer reimbursement led to Reimbursement
greater adoption of telehealth. Although the as- For live video 1.01 0.64, 1.60 0.952
sociation was not significant (p ¼ 0:15), the ef- For store and forward 0.78 0.56, 1.10 0.148
fect size and direction were comparable with For remote monitoring 1.04 0.77, 1.40 0.798
findings of our primary analysis. For transmission and facility fees 1.00 0.77, 1.30 0.986
Based on locationa 1.33 1.02, 1.75 0.052
From private payers 1.54 1.19, 2.00 0.002
Patient consent
Discussion
Required 0.77 0.59, 1.00 0.062
About four in ten US hospitals have adopted tele-
Cross-state licensureb
health. Hospitals’ decisions to do so appear to be
For Medicaid 0.63 0.44, 0.89 0.014
shaped by a combination of hospital-, market-,
For rest of state 0.87 0.65, 1.16 0.337
and state-level factors. Our findings suggest that
telehealth adoption is driven in part by the need
to improve access, with hospitals in more rural SOURCE Authors’ analysis. NOTES For details about the characteristics, see “State Policy
areas more likely to offer telehealth than those in Characteristics” in the text. CI is confidence interval. aPayment allowed only for specific
locations, such as rural or underserved areas, or for types of health care facilities, such as
more urban areas.
hospitals and medical practices. bSpecial license required.
However, adoption also appears to be shaped
by the perceived strategic advantages that tele-
health offers hospitals: Technologically ad-
vanced teaching hospitals in competitive telehealth to pursue and make it more likely that
markets are more likely to have adopted tele- any type of investment in telehealth will pay off
health, compared to hospitals without advanced for them.
technology that do not have residents and are in Telehealth has also challenged the predomi-
less competitive markets. We suspect that a key nant model of face-to-face care and raised ques-
advantage of telehealth is the ability to support tions regarding the appropriate safeguards to
the delivery of more-complex care as well as ensure care quality when treating patients re-
more-efficient care. The former is likely of par- motely. States vary in how conservatively they
ticular value to teaching hospitals that may con- have approached these questions. Some states
sult on the treatment of patients with complex require providers to have a special license to
conditions located in areas with limited access to deliver telehealth services from out of state.
specialists. The latter may be of particular value Our results suggest that these policies decrease
to hospitals in more competitive markets that the uptake of telehealth technology, probably
seek technologies to help lower the cost of care because they make it more costly and difficult
delivery, such as teleradiology and eICUs. for hospitals to participate in telehealth services.
We also found that telehealth adoption varied If states wish to further expand the use of tele-
greatly across states. In some states the majority health, one strategy may be to relax such poli-
of hospitals offered telehealth services, while in cies. Many states do not require that out-of-state
other states adoption was minimal. State policies providers have a special license. Thus, there
related to reimbursement and licensure seem to should be sufficient cumulative experience
have important effects on the adoption of this across states to assess whether or not the con-
technology. cerns associated with care quality are founded.
Our results suggest that states seeking to pro- States with more conservative policies may want
mote telehealth through reimbursement should to examine what has been learned in other states
focus on broad legislation instead of on paying and then consider revising their policies.
for individual telehealth approaches, such as live As policy makers weigh changes to state poli-
video or store and forward. Paving the way for cies to foster greater hospital adoption of tele-
the reimbursement of specific types of telehealth health, they should also consider other specific
may not be enough to entice hospitals to invest in drivers that are creating incentives for hospitals
telehealth. In contrast, broader reimbursement to use telehealth to improve quality and efficien-
policies—in particular, those that require private cy. For example, provisions in the Affordable
payers to reimburse telehealth services to the Care Act require the Centers for Medicare and
same extent as face-to-face services—may give Medicaid Services to penalize hospitals for read-
hospitals more latitude to choose the type of missions that occur within thirty days of dis-

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Overview
charge. In addition, new value-based payment
models (such as shared savings, accountable
care organizations, and bundled payments) cre-
ate incentives for keeping patients healthy and
out of the hospital; for improving patients’ loy-
alty to their providers, so that care is more easily
coordinated; and for bringing more value to re-
ferring providers, so that primary care providers
are better informed about the care their patients
receive. This changing landscape is conducive
for the growth of telehealth services.
In particular, a number of studies21 have ad-
dressed the impact of home telemonitoring on
the health outcomes of patients with congestive
heart failure and have demonstrated a decrease
in both hospital readmissions and mortality. In a
program at Partners Healthcare, for example,
more than 3,000 patients with congestive heart
failure received care using home monitoring of
weight, blood pressure, heart rate, and pulse
oximetry (blood oxygenation levels). Patients
uploaded these data daily, and decision support
software identified patients who were in need of
attention. Three to four nurses were able to care
for a panel of 250 patients. Hospital readmis-
sions dropped by 44 percent, and the program
generated savings of more than $10 million over
six years.22
Another strategy for extending hospital ser-
vices across a wider geographic region relies
on care delivery based on videoconferencing.
Typically, providers in settings that lack access
to high-quality specialty services use video tech-
nologies to access those services remotely. The
most successful examples include stroke triage23
and eICUs. In the latter case, the technology of-
fers a way to have intensivists (physicians who
specialize in the care and treatment of patients in
intensive care) cover more ICU beds by providing
direct consultation and management of ICU pa-
tients in a distant site through remote two-way
audio, visual, and physiologic monitoring.24
The economic rationale is simple: Instead of
paying a stroke neurologist or intensivist to be
on call although there may be little or no actual
clinical need, eICUs widen the reach of these
specialists, increasing the likelihood that their
advanced knowledge and judgment will be need-
ed. Several studies have shown that this ap-
proach to ICU care can also decrease mortality
by more than 20 percent, decrease ICU length-of-
stay by up to 30 percent, and reduce the cost of
care.25
Nonetheless, only 13 percent of ICU beds in the
The Dorenfest Institute for Health
Information of the HiMSS Foundation
(see Note 17 in text) provided data for
this study. Joseph Kvedar is a consultant
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Our results suggest
that telehealth is
perceived as a way to
increase patients’
access to care and to
give hospitals a
competitive
advantage.
United States are supported by eICU technolo-
gies,25 which suggests a substantial opportunity
to increase value from the broader adoption of
this model. More-systematic evidence is likely
needed to establish the effectiveness and cost-
effectiveness of these technologies and to con-
vince hospitals as well as policy makers to pursue
them.26–28
Conclusion
Telehealth is a promising way to use communi-
cations technologies to improve health care val-
ue.3 We examined current national data on hos-
pitals’ adoption of telehealth and found key
differences in the types of hospitals that have
adopted it. Our results suggest that telehealth
is perceived as a way to increase patients’ access
to care and to give hospitals a competitive advan-
tage. Our data also reveal substantial variation in
telehealth adoption by hospitals across states.
The findings suggest that states may want to
consider implementing policies to promote pri-
vate payer reimbursement of telehealth and re-
laxing policies that require providers to have a
special license to engage in telehealth across
state boundaries.
As implementation of the Affordable Care Act
progresses and hospitals seek new strategies for
improving the quality and efficiency of care,
these findings should help guide policy makers
in paving the way for the use of hospital tele-
health as such a strategy. ▪
and equity holder in Healthrageous and
an advisory board member at Qualcomm
Life.
NOTES
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February 2014 33:2 Health A ffairs 215