Jonathan Linkous, Chief Executive Officer of the American Telemedicine Association (ATA), has shared seven market trends that will shape telemedicine and telehealth in the immediate future. These trends represent major changes from the existing norm, creating new challenges and opportunities for the industry, according to the ATA .
1. A Shift away from reimbursement models
Reimbursement has been the Holy Grail for telemedicine in America but the rapid growth of managed care, Accountable Care Organizations and medical homes are changing the way we pay for telemedicine services. One quarter of all Americans--73 million patients--are now covered under a managed care health insurance program. With this shift, the focus of decision-making is gradually turning to local and regional healthcare decision makers.
2. Telemedicine as a standard of care
Medical images, like x-rays and CT scans, have been viewed in digital form for forty years. "Teleradiology" is now so common that many hospitals don't recognize the name - outsourcing part or all of a radiology program is just the way things are now done in healthcare. Providing 24/7 services by a radiologist, using telehealth technologies, may be the first form of telemedicine that becomes a true standard of care; as such it would be included in state, federal and Joint Commission requirements and be a basis for court decisions on medical liability and hospital accountability. According to Linkous, it would not be surprising to see a legal case decided on this basis.
3. Emergence of remote clinical enterprises
Outsourcing the interpretation of medical images is now used by most hospitals in the United States. A relatively new and related market is the use of private firms of medical specialists to provide other remote clinical consultations. If a hospital can completely outsource its (non-interventional) radiological services, why not outsource neurology, psychiatry or a host of other clinical services? A series of small vendors have emerged to provide telehealth consults for stroke care, mental health, hospitalist services, and dermatology, says Linkous. Some of these firms may be considered competitors to hospital-based telemedicine programs. Look for mergers and expansions of such enterprises as the market grows.
4. The rise of virtual medical centers
In October, Mercy Hospitals announced that it would build a $90 million virtual care center near its headquarters in Chesterfield, Missouri. This center will host an array of clinical specialists who will serve patients in outlying centers across the four states in which Mercy operates. On a smaller scale, intensivists at Inova  Health System in Virginia are based at corporate office building and provide remote ICU services to 122 ICU beds throughout northern Virginia. Other health systems are looking closely at these developments and, if proven successful, will start on their own versions.
Mobile Health (mHealth) is a hot topic and an important addition to the mix of technologies changing the way healthcare is delivered. However, as many people have acknowledged, the mHealth sphere is full of yet-unproven promises and uncertainty about how to pay for these technologies. As an industry, we need to address these shortcomings because, undoubtedly, wireless technologies will continue to redefine what we mean by telemedicine, says Linkous.
6. Programs vs. networks
Federal grants  have helped to establish about 200 telemedicine programs linking multiple health centers throughout the country. Almost all these programs are hub-and-spoke models, where a large central hospital unidirectionally provides services to connected sites. An alternative approach, connecting multiple centers using a true network design, is starting to gain favor. This new model is based on paid memberships, with services delivered from any point on the network to any other point. Both the Arizona Telemedicine Program and the Ontario Telehealth Network epitomize this new approach.
Once confined to international charities and a few remote image-reading centers, telemedicine is now poised to become a major source of international trade. Global investments in high-speed networks and emerging practice guidelines are providing the infrastructure. Issues such as licensure, payment mechanisms, trade protectionism and cultural biases remain; however, the potential revenue from such services could have a significant effect on worldwide trade balances.