Sustaining an Innovative Environment

The cost of innovation is often the determining factor when predicting the likelihood of sustainability. In regards to expanding telehealth capabilities, Nebraska’s Senator Nicole Fox, and many others, state that it is the cost saving capabilities of telehealth that should make it a priority in our government and healthcare organizations.2

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In my discussions with Sen. Fox, her passion for promoting the use of telehealth was apparent; so, I felt obliged to ask her what was stopping bills that promote things like parity pay from passing in the legislature. Sen. Fox advised anyone who hopes to create sustainable change to first create awareness. She informed me that while she is a healthcare provider herself (hospital nutritionist) and has a basic understanding of reimbursement processes, many legislators do not have that personal experience or even knowledge of the ins and outs of healthcare reimbursement. She suspects that some people in leadership (i.e. decision-making) roles may not always understand the consequences of what they are turning down.2 Sen. Fox affirms that government leaders such as herself rely on advocates and experts to provide awareness and information regarding issues that need to be brought to their attention.2

Payers have long disputed the forecasted financial savings telehealth could offer them. The lack of firm data to support the savings made commitment to up-and-coming technology difficult. However, with time and experience, many payers are beginning to recognize the financial benefit for themselves, their rural members as well as the city-dwelling “Netflix generation, who expect on-demand services.”1  This financial benefit comes from reduced ED visits, hospitalizations, complications, and improved efficiency of care.

I argue that private payers must provide parity pay for telehealth services; however, it is certainly of mention that many healthcare organizations will remain slow to adopt telehealth capabilities until Medicare expands their coverage (only $17.6 million of their $634 billion was paid towards telehealth services).1 Medicare has expressed concern that telehealth services will only become an add-on to the current standard of care (rather than replacing irresponsible use of resources) thus costing them significantly more money rather than resulting in cost-savings.1

In addition to mandating private payer parity, making telehealth sustainable will require a more open line of communication between the payers, providers, and patients. Many healthcare providers who do not utilize telehealth services state that they have no idea which payers reimburse for telehealth services or at what rate so they avoid it all together.1 Similarly, many patients who pay for plans that provide telehealth services are not aware that telehealth is an option for them.1 It is thought that as more consumers experience telehealth, they will soon be demanding these services leading to quicker action.

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It seems anytime government policy is discussed, the question arises of whose interest policymakers have at heart. Private payers (or CMS for that matter) have historically had a difficult time envisioning the savings this initial investment can offer. Unfortunately, their loud voices and deep pockets often stifle the concerns of the consumer (time away from work and family, travel costs, lost productivity, traffic, air pollution, etc.). As Senator Fox advised, we must speak up, advocate, and make our needs and desires known. As consumers or representatives of consumers, we must educate those in power of deciding what healthcare services we can receive.



  1. Herman, B. (2016). Virtual reality: More insurers are embracing telehealth. Modern Healthcare. Retrieved from
  1. Senator Nicole Fox, personal communication, February 9, 2016

Technological Innovations & Implications for Data & Privacy

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Anyone in the healthcare field is familiar with the Health Insurance Portability and Accountability Act or HIPAA, a federal law created to ensure individual privacy and protect personal health information.1,3 There have been concerns regarding telehealth’s ability to uphold this guarantee of privacy – concerns of increased vulnerabilities. Telehealth involves more than just the patient and provider. The companies who create the equipment, the vendors who work to transmit the data, and others are also held accountable for protection of patient information by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.2,3 While technological advancements alone cannot guarantee protection of personal health information, they can aid in the process with features such as software and network encryption, password protection, etc..1

Often included as a branch of telehealth is mHealth or mobile health where tools such as wearable devices and mobile applications transmit data intended to go to pre-approved parties like a healthcare provider or friends and family. However, there are limitations on the regulation of this information sharing – for example, financers and third party advertisers that sponsor mobile applications can access and use information collected by these devices.2 This information is often disclosed in small, lengthy, legal print that few people read and/or understand.2 The Fair Trade Commission Act and to some extent the Food and Drug Administration (FDA) are responsible for preventing and managing deceptive uses of this information; however, if the patient agrees to the terms and conditions (which we often do without reading just so we can use the product), that protection is somewhat minimized.2

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When telecommunication is taking place between two providers or two healthcare settings, networks are HIPAA-compliant making them more secure – privacy can be more easily ensured.2 However, as many states break down the barriers around eligible telehealth sites and use of mHealth equipment becomes more utilized, that same security cannot be as easily ensured on the patient’s end.2 These scenarios make breaching of confidentiality or unauthorized access to protected health information a greater risk.2

As mentioned above, data encryption makes great strides at protecting personal information. “End to end” encryption (meaning from provider to patient and vice versa) ensures that all information is only unencrypted if accessed at either of those two end-points. Data that is accessed between those two end points (i.e. during transmission or storage) is essentially meaningless to the hacker.2

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Authentication or other access control mechanisms are also useful tools in controlling who has access to the protected health information.2 Another data protection strategy involves limiting the distribution of telehealth software and devices to in-person visits to verify who is attaining this technology and who it is coming from.2 Requiring a face-to-face initial visit in order to get the telehealth system set-up can be seen as a nuisance to some, and possibly a relief to others.

The very foundation of telehealth is technological innovation. As with all technology, privacy is always a concern. However, the implications of misusing healthcare data carry a heavier weight to many people. Concerns over data security and patient privacy are at the very root of telehealth barriers. Much progress has been made as discussed above, but in no way is the struggle over.



Center for Connected Health Policy (CCHP). (2016). HIPAA. Retreived from

Hall, J.L. & McGraw, D. (2014). For telehealth to succeed, privacy and security risks must be identified and addressed. Health Affairs, 33(2), 216-221. doi: 10.1377/hlthaff.2013.0997.

Schweitzer, E.J. (2013). Reconciliation of the cloud computing model with US federal electronic health record regulations. Journal of American Medical Informatics Association, 19, 161-165. doi: 10.1136/amiajnl-2011-000162.

Private Sector Innovation & Policy Advancements

Alternative payment methods, such as those utilized in many Accountable Care Organizations (ACOs), are fitting for telehealth services. ACOs view telehealth as a means of increasing revenue by reaching more patients and keeping existing patients out of the hospital, engaging patients through ease of access to providers resulting in greater patient satisfaction, and saving costs by avoiding ER visits and hospital readmissions. (3)  Policy advancement, such as NE LB 556, and private sector innovations, like ACOs, are the driving force in making telehealth services available to a broader population.

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The passing of NE LB 556 in 2013 harnessed the support and efforts of the University of Nebraska Medical Center in expanding behavioral health teleservices. In addition, the bill amended managed care plans to add reimbursement rates that are comparable to in-person consultations for healthcare services delivered through telehealth technology (8). However, managed care plans are pertinent to only those with Medicaid coverage.

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ACOs are the joining of various healthcare stakeholders with a shared goal of meeting the Triple Aim. ACOs believe that the Triple Aim can best be met by veering away from fee-for-service payment models that are driven by volume and procedures and rather, focusing on rewarding outcomes, which stem from quality care and care coordination. (6)

In the early stages of ACOs, the concept was simultaneously trialed by both CMS and private sector entities. Both the public and private sector saw promise in this new concept and have gone on to form many ACOs in each state. (6)

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Private sector ACOs, whom are created and run by healthcare providers, hospital systems, physician groups, insurers, and/or community-based organizations, have more flexibility in the core concepts that they wish to employ (i.e. whether or not they want to model their ACO after Medicare’s Shared Savings Program, use bundled payments, pay-for-performance incentives, etc.). (6) The partners in an ACO are equally invested in meeting the Triple Aim goals and thus they are equally at risk if they do not. Having shared risk and cost makes investment in innovative systems like telehealth more attainable.

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An example of how the risk/benefit is shared among stakeholders.  Retrieved from

Quality benchmarking is a common requirement among public and private sector ACOs as an evaluation of the quality of care a provider or healthcare system provides and this equates to the level of reimbursement they receive. (6) Thus telehealth (and it’s reimbursement rate) has become a hot topic throughout these ACOs because of the efficiency of care and great outcomes it has shown to provide.

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The benefit (and purpose) of being a part of an ACO is the cost-sharing. Cost-sharing allows small, independently owned clinics to attain the benefits of offering telehealth services without the unreachable price tag that comes along with starting up the program. (4)  An example of this is the Midwest Health Coalition ACO, which is made up of more than 900 independent healthcare providers across Nebraska and Iowa (5).

Funding the start-up of telehealth programs may not be the primary barrier for larger organizations. Large organizations are often driven by other factors such as decreasing readmission rates and improving the outcomes of care. These, and other, driving forces led to Nebraska Medicine and Methodist Health Systems to join together forming the Nebraska Health Network, an accountable care alliance. (7)

While there are many other ACOs, I want to mention one last ACO partnership that represents shared risk, responsibility, and reward. The Aetna Whole Health – CHI Health Accountable Care Network is an example of a commercial, product-based ACO that offers business owners/employers in Nebraska and Iowa a healthcare model that creates a savings of up to 15% by improving the health outcomes of their employees. (1) This ACO focuses on creating and utilizing innovative products and services in order to improve the use of healthcare screenings, improve primary care services, and avoid hospitalizations – telehealth is an important tool in meeting these goals.

Private sector innovations are of great importance. While many view CMS as the leader in changing healthcare, they struggle to lead in an avenue that doesn’t have sufficient existing data that proves it’s success. Medicare relies on the private sector for trial and error from which they can then base their models of care on. (2)


  1. Aetna. (2015). Aetna and CHI health create Nebraska’s first product-based accountable care organization. Retrieved from
  2. Evans, M. (2015). Headed for risk: Health systems sign private-sector ACO deals that may lead to capitation. Modern Healthcare. Retrieved from
  3. Hyatt, A. (2014). Three ways telehealth drives revenue for ACOs. American Well. Retrieved from
  4. Lacktman, N. (2015). Telehealth reimbursement under the microscope. Retrieved from,1
  5. Midwest Independent Physicians Practice Association (MIPPA) ACO. (2016). Independent physicians working for you. Retrieved from
  6. Muhlestein, D. (2013). Continued growth of public and private accountable care organizations. Health Affairs Blog. Retrieved from
  7. Nebraska Health Network. (n.d.). Nebraska health network: Led by the physicians and health systems of your community. Retrieved from
  8. Nebraska Legislature. (2013). Legislative bill 556. Retrieved from

Public Sector Institutions and Public Policy

Public health policy and public sector institutions such as CMS may be the most critical factors in the viability of telehealth. Private payers and healthcare organizations are less likely to invest in telehealth if Medicare and Medicaid do not lay the groundwork for support and regulation.  Fortunately, Medicaid currently covers telehealth, to some extent, in 46 states. (4) While influential policy in favor of telehealth is slow to emerge, there are multiple motivating factors.

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As previously discussed, health system reform is motivated by the Triple Aim – improve quality, improve outcomes, and decrease cost. This triple aim was most recently and notably acted on by the signing of the Affordable Care Act (ACA) in 2010. (3)  The U.S. is particularly motivated by our exorbitant health care expenditure and poor health outcomes. Quality and cost control are addressed in the ACA through improvements in not only the quality, but also the efficiency, and effectiveness of the medical care we provide. (3)

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Making strides in a profession notorious for resistance to change is challenging. A movement towards global payment models (where providers/healthcare organizations are rewarded based on improvements in the quality, efficiency, and outcomes of care) and away from the fee-for-service system (where rewards come from volume and quantity of services) are inspiring the needed changes. (4)

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Barriers Related to Policy


  • While progress has been made with Medicaid coverage, this pertains to very little of the population.
    • In AZ, 25% of the population has Medicaid coverage (43% are employer covered, 14% Medicare, and 12% uninsured). (2)
    • In NE, only 14% of the population is covered by Medicaid (53% are covered by their employer, 14% Medicare, and 10% are uninsured). (2)
  • While CMS leads the way, policy changes are necessary to make telemedicine “attractive” to all payers not just one particular payer (Medicare, Medicaid, and Private/Commercial). (4)
  • It is imperative to push private payers to reimburse at the same rate as a face-to-face visit in order for the investment of telehealth to pay off. (1)
  • As the system continues to move more towards the global payment model, the fee-for-service reimbursement will become less meaningful. Providers will be more willing to utilize any tools that increase their outcomes and patient satisfaction rather than just tools they can get paid for. (4)

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Licensure Restrictions

  • Requiring special or dual licensure for cross-state telehealth services negatively impacts the likelihood of telehealth adoption due to the complexity, length of time, and added cost. (1)
    • As more states relax the policy requirements on cross-state licensure, evidence on safety concerns will present itself hopefully allowing more states to comfortably follow suit. (1)

Limited Diagnoses Available for Coverage

  • CMS is very slow to implement new approved billing codes that would expand the eligible services through telehealth. (5)
    • Medicare generally only increases a few codes per year – even these minor expansions require significant efforts and lobbying by organizations such as the American Telemedicine Association (ATA). (5)

So, if you glazed over, let me summarize…

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Something cute to refocus your attention

Take Home Points:

  • Adoption of telehealth is more likely when policy change promotes private payer reimbursement in addition to CMS. (1)
  • The majority of Americans have private health care insurance. Only 22 states have passed policy requiring some type of private coverage parity. (2; 4)
  • CMS must be more proactive in expanding covered diagnoses for telehealth services. (5)
  • State level policies that restrict telemedicine through special licensure requirements need to change in order to increase telemedicine adoption and utilization. (1; 4)
  • Many of our legislators have very little knowledge regarding telehealth – we must educate and advocate to create progress in policy change (Senator Nicole Fox, personal communication, February 9, 2016).
  • Without policy change, telehealth is less viable and without viable programs to provide data, policy will not change. (4)



  1. Adler-Milstein, J., Kvedar, J., & Bates, D.W. (2014). Telehealth among US hospitals: Several factors, including state reimbursement and licensure policies, influence adoption. Health Affairs, 33(2), 207-215.
  2. Kaiser Family Foundation. (2016). Health insurance coverage of the total population. Retrieved from
  3. McDonough, J.E. (2014). Health system reform in the United States. International Journal of Health Policy and Management, 2(x), 1-4.
  4. Neufeld, J.D., Doarn, C.R., & Aly, R. (2016). Brief communication: State policies influence medicare telemedicine utilization. Telemedicine and e-Health, 70-74. doi: 10.1089/tmj.2015.0044
  5. Weinstein, R.S., Lopez, A.M., Joseph, B.A., Erps, K.A., Holcomb, M, Barker, G.P., & Krupinski, E.A. (2014). Telemedicine, telehealth, and mobile health applications that work: Opportunities and barriers. The American Journal of Medicine, 127(3), 183-187. doi: 10.1016/j.amjmed.2013.09.032.

The Actors Involved & the Policy They Create

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As you likely know, we are in the middle of healthcare reform.  Our healthcare delivery is changing with three main goals as the driving force: improve quality, improve outcomes, and reduce cost — the Triple Aim (2).  Telehealth and mHealth have been embraced by many as potential solutions — innovative deviations from the traditional ideas of healthcare.  However, state and federal policy formation, implementation, and modification have been slow and ineffective inhibiting the full adoption of telehealth (2).  The inconsistent, unclear policy and regulation and insufficient resources have sparked action and advocacy from various players in the telehealth world.

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Solid evidence, consumer demand, leadership, commitment, and technology advancements are critical in optimizing telehealth services (2).  Large organizations such as Nebraska Medicine, Kaiser Permanente, or Mayo Clinic play a vital role in meeting these demands by designing, implementing, and evaluating telehealth projects.  It is pilot studies like those developed at these organizations that provide this solid evidence, demonstrate leadership, and make the consumer demands known.

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Special interest groups such as the American Telemedicine Association (ATA) and the International Society for Telemedicine & eHealth also play a fundamental role in challenging outdated ideas of healthcare delivery, advocating for change, and providing insight and recommendations to policymakers.

Another important supporter of telehealth is the Center for Connected Health Policy (CCHP); a nonprofit, nonpartisan organization that acts as a catalyst for change by bringing policymakers together with private health care sector, health plans, academic researchers, and consumer health advocates to gain ground in the Triple Aim objectives through telehealth (1).

These groups provide expert opinions to executive branches of government such as the Department of Health and Human Services (DHHS) where policy is designed, rules are made, the policy is put into operation, and subsequently evaluated (3).  In an interview with Senator Nicole Fox, a committee member of the DHHS, she discussed the reliance that committee members have on expert advocate groups to inform them of the current status of telehealth and the future needs.  Senator Fox provided examples of committee members not understanding the clinical pathways for many diagnoses, what services are appropriate for telehealth delivery, or what types of medical technology are available and how they can be useful to patients and providers.  It is often difficult for government representatives and stakeholders such as CMS to see beyond the upfront costs of telemedicine; it is because of this that solid evidence is so vital in order to make forward progress (Senator Nicole Fox, personal communication, February 9, 2016).

Regulatory Mechanisms

Some of the most commonly debated regulatory efforts include reimbursement rates, limited services, cross-state licensure, and distance between provider and patient among others.  Nebraska has been quite progressive in the expansion of telehealth.  LB 1076 – the Nebraska Telehealth Act addressed many of the issues other states continue to battle (4).  They have:

  • revised the definition of telehealth to include telemonitoring and medical information electronically exchanged from one site to another whether synchronously or asynchronously (i.e. store and forward messaging through secured email is reimbursable)
  • expanded the eligible telehealth providers to include all Medicaid enrolled providers
  • clarified that a relationship can be established between patient and provider without a face-to-face visit
  • required managed care contracts with managed care plans to include coverage of healthcare services delivered through telehealth.

There are plenty of regulatory mechanisms that continue to be debated — interstate licensure (expedited multi-state licensure), parity laws for private insurance coverage (see image below for U.S. report card), expansion of covered diagnoses, and more.  These issues will need to be addressed in a timely manner if telehealth is to be fully adopted and available to everyone in need of access to care.  Unfortunately, regulatory mechanisms need to be updated as frequently as the technology itself.  Thankfully, there are a lot of actors advocating for the cause.

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While changing public and private policy is important in advancing telehealth, it is “insufficient for achieving widespread adoption of telehealth care” (2).  Institutions and special interest groups are integral in creating partnerships in research, practice, technology, consumer support, policy, and financing.



Center for Connected Health Policy (CCHP). (2016). About CCHP. Retreived from

Gutierrez, M. (2014). The role of telehealth in the triple aim. Retrieved from

Longest, B.B. Jr. (2016). Health policymaking in the United States (6th ed.). Chicago, IL: Health Administration Press.

Nebraska Legislature. (2014). Legislative bill 1076. Retrieved from

Ethical Considerations in the Creation of Policy

ethics-v-complianceRetrieved from  

Public policy is a reflection of the government’s interests; however, the majority of resources for healthcare come from the private sector making for an interesting public-private intersection of opinions (4). Public policy has recently focused on reducing health and healthcare disparities (4). One of the most notable examples of acting on this goal is the Affordable Care Act’s call to increase access to care for all citizens (4). Telehealth has been praised as an opportunity to greatly expand access to care for those living in rural areas or unable to commute to a healthcare facility.

The Joint Commission and Centers for Medicare & Medicaid Services (CMS) have been major players in policy creation regarding the distribution and regulation of telehealth. They are a classic example of the public and private sector partnership creating ethically conscious, sustainable policy (3; 4).

Some argue that the technological advancements being made in an effort to increase access to care exclude the vital personal relationship between provider and patient. However, people who may otherwise not have access to care may be proponents of a virtual relationship with their provider over no relationship at all.

Redefining a patient-provider relationship.  Retrieved from 

Dr. Fleming (1) at the Center for Health Ethics at University of Missouri School of Medicine identifies some unique ethical concerns in telehealth to include privacy and confidentiality issues, depersonalization of healthcare (specifically with store and forward messaging), potential for exploitation, disproportionate distribution of services (i.e. the cost of telehealth may inhibit some from being able to access this type of care), and the potential burden that technology can place on the ill. Dr. Fleming also recommends focusing time and attention on the potential of virtual visits replacing face-to-face visits.

Similarly, the American Medical Association (AMA) urges policymakers to consider four possible pitfalls in making telemedicine ethical: “erosion of the patient-doctor relationship, threats to patient privacy, forcing one-size-fits-all implementations, and the temptation to assume that new technology must be effective” (5, p. 1014). Mehta acknowledges the common concern of privacy as more of an operational issue rather than ethical – something that requires close technological attention, but not a concern that should halt advancement. The primary ethical concern is understood to be that telemedicine (or many other healthcare technology innovations) can become a mindless checklist that assumes each patient fits into the same mold and has the same needs. The author cautions providers to approach telemedicine with the same foundation they have been trained to approach patients face-to-face — to maintain the same goals of best possible outcomes while promoting equity of care (5).

“It is important for the medical profession to…balance enthusiasm about telemedicine’s potential with acknowledgement of the need for clear-eyed evaluation.”  – Shivan J. Mehta (2014, p. 1015-1016)

It will be important for public and private sector policy makers to create new policy with these ethical considerations in mind while being conscientious not to allow the fear of change or the unknown to inhibit great expansion in access to healthcare. One such example would be the ethical concern of depersonalization of care, which was addressed with policy by requiring either a face-to-face visit or a live audio-video interaction prior to delivery of telemedicine services (2). This compromise/solution allowed for the ethical concern to be addressed by requiring a relationship be formed while still allowing for increased access to care.


  1. Fleming, D.A. (n.d.) Telehealth: The ethical challenges of a new technology. Retrieved from

2. (2014). Telehealth: Start-up and resource guide, version 1.1. Retrieved from

3. Joint Commission Perspectives. (2012). Accepted: Final revisions to telemedicine standards. Retrieved from

4. Longest, B.B. Jr. (2016). Health policymaking in the United States (6th ed.). Chicago, IL: Health Administration Press.

5. Mehta, S.J. (2014). Telemedicine’s potential ethical pitfalls. American Medical Association Journal of Ethics, 16(12), 1014-1017.

Intro: Expansion of Telehealth

“[Telehealth] will be the way health care is provided.  I don’t think we’ll call it anything.  It will just be health care.” 

Adam Darkins, VA chief consultant for telehealth services in reference to the future of telehealth (Calgary Scientific, n.d.)

I grew up in rural South Dakota. I couldn’t wait to move away, though ironically enough, I now find myself excited to return to my Midwestern roots. I will be moving to Nebraska this summer to work with a hospitalist team at Nebraska Medicine.

One of my passions is improving access to healthcare. In the Midwest, barriers to care include any of the common socioeconomical barriers, but can also include the mere distance to providers, battling weather conditions, or limited transportation options. Telehealth offers great promise in addressing many of these barriers. Much of healthcare involves conversation and education. These valuable discussions do not necessarily require a face-to-face visit to be effective.

“[Telehealth] has the same standards and the same outcomes as in person care delivery.”

Kyle Hall, Telehealth Coordinator at Nebraska Medicine (Calgary Scientific, n.d.)

Telehealth is defined as “the delivery of healthcare services at a distance using information and communication technology” (Calgary Scientific, n.d., p. 3). Telehealth and its necessary technology advancements are continually expanding across the nation, though many barriers still exist to its widespread and most effective use. Some of these barriers include widely varied regulation (currently different in all 50 states), reimbursement practices, eligible geographic locations, eligible services, and ability to practice across state lines (Calgary Scientific, n.d.).

However, telehealth, which was once just a subcategory of Health Information Technology (HIT), has beckoned attention from healthcare policy makers. The advisory board for Bloomberg Bureau of National Affairs (BNA) Health Law Reporter voted the topic as one of the Top Ten Health Law Issues for 2016 (Loughran, 2016).

In April 2014, Nebraska approved Legislation LB 1076 to expand the definition of telehealth to include synchronous and asynchronous, as well as remote patient telemonitoring (CCHP, 2014). The bill also declared that the reimbursement rate for telehealth is not dependent upon the distance between the healthcare provider and the patient (CCHP, 2014). These changes make Nebraska more progressive on the issue of telehealth expansion than many other states.

Later in 2014, Nebraska Medicine, formerly University of Nebraska Medical Center, received a $10 million telehealth grant from Centers for Medicare/Medicaid Innovation. This grant is being used to enroll patients in a remote patient monitoring program that will follow their care for 90 days post discharge and offer nurse coaching (Wilson, 2014). Remote patient monitoring allows a patient to use a mobile medical device to perform routine testing, such as check a blood glucose level, and send the results to a healthcare professional in real-time (Calgary Scientific, n.d.). The goal is to help patients stay healthy and out of the hospital rather than only treating them when they are sick (Wilson, 2014). Acting on these goals is necessary for quality, value-based, sustainable healthcare.

Over the coming months, this blog will explore many of the issues surrounding telehealth with consideration of existing health policy, technology advancements, impact of public and private sector institutions, ethics, and financing. A specific focus will lie on the advancements and future of telehealth at Nebraska Medicine.



Calgary Scientific. (n.d.). The road to telehealth 2.0 is mobile. Retrieved from

Center for Connected Health Policy (CCHP). (2014).NE approved legislation LB 1076. Retrieved from

Loughran, M. (2016). Telemedicine cracks top ten health law issue list for 2016. Bloomberg BNA. Retrieved from
Wilson, T. (2014). $10 million telehealth grant awarded to med center. Retrieved from