States possess varying regulatory protocol and in regional healthcare systems that stretch across numerous states, interstate licensing can inhibit some physicians from providing remote care


Syracuse University

- limitations to clinician-to-clinician communications
- limitations of remote patient monitoring
- limitations of video visits
- limitations to telephone visits
- limitations to patient initiated communication
- limitations to training clinicians in using telemedicine devices
- geographic region (in the U.S.)
- payment and reimbursement
- Interstate/ intrastate regulatory protocol and telehealth
- social barriers to telehealth implementation

Limitations of telehealth infrastructure 

Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic. (2020, June 10). 
https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html

Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic

- It can shift extra work to front-line medical providers
- Lack of a direct physical exam on patients
- Communication is through a platform rather than being face-to-face

Limitations to clinician-to-clinician communications

- devalued by insurance coverage 
- medical health providers cannot conduct a physical exam
- the patient's assessment is conducted solely on verbal cues


Limitations to telephone visits

- Technology requirements include the following: broadband internet/smart device, digital peripherals
- most complex conditions may be the least able to access medical attention


Limitations of video visits

- Requires staffing infrastructure
- There needs to be a method of integrating patient data into the electronic health record

Limitations of remote patient monitoring

- Commercial and Medicaid reimbursement is states’ decision
- 20% of states require payment parity between telemedicine and in-person services
- Medicare grants payment parity between telehealth and in-person clinical care. 
- Center for Medicare and Medicaid Services (CMS) issued waivers during pandemic.
- CMS and some local commercial payers have modified their payment policy during the COVID-19 pandemic.

Payment and reimbursement for telehealth services

- Telemedicine usage is limited within the scope of medical, nursing, and allied health field training
- Sudden integration of telemedicine say be seen as "disruptive" or "complex" by clinicians

Limitations to training clinicians in using telemedicine devices

- Patient discomfort or privacy concerns in addressing sensitive topics
- Cultural disapproval of employing telehealth services in place of traditional in-person care visits
- Healthcare providers and patients with limited access to stable connectivity or technological devices needed for telehealth services

Social barriers to telehealth implementation

- States in the southern and midwestern regions of the U.S. had a lower percentage of hospitals with telemedicine intensive care units (Tele-ICU) 
- Lack of funding for teleservices in metropolitan areas/cities, where people are especially vulnerable due to high population density
- Although ~20% of the American population lives in a rural area, only 9% of physicians actively practice in rural areas 

Geographic region (in the U.S.) related telemedicine limitations

- Requires staff and a thorough infrastructure to optimize workflow

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