This technology is expected to affect health care providers, payers, and consumers in both the public and private sectors. Telemedicine is also expected to impact how medical care is delivered, who delivers it, and who pays for it. Although many players throughout the federal government and the private sector are involved in telemedicine, the Department of Defense (DOD) is considered a leader in research related to telemedicine efforts. What Is Telemedicine? As a result, HHS organized the Joint Working Group on Telemedicine (JWGT). Objectives, Scope, and Methodology

As a result of congressional concerns about the federal government’s role in advancing telemedicine, the Chairman and Ranking Minority Member, Subcommittee on Research and Development, House National Security Committee, asked us to help determine the steps that DOD and the federal government need to take to realize the full potential of telemedicine and achieve cooperation with the private sector. Specifically, this report addresses the (1) scope of public and private telemedicine investments; (2) telemedicine strategies among DOD, other federal agencies, and the private sector; (3) potential benefits that the public and private sectors may yield from telemedicine initiatives; and (4) barriers facing telemedicine implementation. Estimates of telemedicine and related technology investments in the private sector have not been quantified because telemedicine costs are difficult to separate from health care delivery costs and most cost data is proprietary. However, as table 2.1 shows, the federal government invested at least $646 million for fiscal years 1994-96. Other Federal Agencies Invest in a Range of Telemedicine Activities

Eight civilian federal departments or independent agencies with various roles in providing or supporting health care delivery invested $384 million in telemedicine from fiscal years 1994 to 1996. Federal Government Does Not Have a Strategy to Maximize Value of Telemedicine Investments

No overarching, governmentwide strategy exists to ensure that the most is gained from numerous federal telemedicine efforts. However, we did not evaluate the program, since it was beyond the scope of our review. No comprehensive studies have been completed to prove that telemedicine delivers cost-effective, quality care. However, it is impossible to determine the full scope of these initiatives. DOD is currently the largest federal investor with $262 million. Successful expansion and sustainment of telemedicine will require resolution of many legal and regulatory, financial, technical, and cultural barriers. Some of the more critical barriers, such as licensure, privacy, and infrastructure costs, are too broad and have implications too far-reaching for any single sector to address. In addition, the proposed strategy should include approaches and actions needed to establish a means to formally exchange information or technology among the federal government, state organizations, and private sector; foster collaborative partnerships to take advantage of other telemedicine investments; identify needed technologies that are not being developed by the public or private sector; promote interoperable system designs that would enable telemedicine technologies to be compatible, regardless of where they are developed; encourage adoption of appropriate standardized medical records and data systems so that information may be exchanged among sectors; overcome barriers so that investments can lead to better health care; and encourage federal agencies and departments to develop and implement individual strategic plans to support national goals and objectives.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the steps that the federal government needs to take to realize the full potential of telemedicine and achieve cooperation with the private sector, focusing on: (1) the scope of public and private telemedicine investments; (2) telemedicine strategies among the Department of Defense (DOD), other federal agencies, and the private sector; (3) potential benefits that the public and private sectors may yield from telemedicine initiatives; and (4) barriers facing telemedicine implementation.

What GAO Found

GAO found that: (1) collectively, the public and private sectors have funded hundreds of telemedicine projects that could improve, and perhaps change significantly, how health care is provided in the future; (2) however, the amount of the total investment is unknown; (3) 9 federal departments and independent agencies invested at least $646 million in telemedicine projects from fiscal years 1994 to 1996; (4) DOD is the largest federal investor with $262 million and considered a leader in developing this technology; (5) state-supported telemedicine initiatives are growing; (6) estimates of private sector involvement are impossible to quantify because most cost data are proprietary and difficult to separate from health care delivery costs; (7) opportunities exist for federal agencies to share lessons learned and exchange technology, but no governmentwide strategy exists to ensure that the maximum benefits are gained from the numerous federal telemedicine efforts; (8) the Joint Working Group on Telemedicine (JWGT) is the first mechanism structured to help coordinate federal programs; (9) however, its efforts to develop a federal inventory, a critical starting point for coordination, have been hampered by definitional issues and inconsistent data; (10) in addition, DOD and other federal departments do not have strategic plans to help guide their telemedicine investments, assess benefits, and foster partnerships; (11) telemedicine is an area in which public and private benefits converge; (12) many anecdotal examples demonstrate how telemedicine could improve access and quality to medical care and reduce health care costs; (13) however, comprehensive, scientific evaluations have not been completed to demonstrate the cost benefits of telemedicine; (14) the expansion of telemedicine is hampered by legal and regulatory, financial, technical, and cultural barriers facing health care providers; (15) some barriers are too broad and have implications too far-reaching for any single sector to address; (16) telemedicine technology today is not only better than it was decades ago, it is becoming cheaper; (17) consequently, the questions facing telemedicine today involve not so much whether it can be done but rather where investments should be made and who should make them; (18) the solution lies in the public and private sectors' ability to jointly devise a means to share information and overcome barriers; and (19) the goal is to ensure that an affordable telecommunications infrastructure is in place and that the true merits and cost benefits of telemedicine are attained in the most appropriate manner.