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Keeping California in Front of the Telehealth Curve

For a couple decades, California has been a leader in exploring ways to use telecommunication technology in health care. In 1996, the California Legislature passed the Telemedicine Development Act to lay policy groundwork for developing technology. The law has been updated a few times in an effort to keep up with new tools and new ways of doing things.

The time has come not only for more updates — including changing terms like “telemedicine” to the more broadly interpreted “telehealth” — but also for removing barriers in the health care system so telehealth can flourish, according to a new report from the Center for Connected Health Policy.

The report, titled “Advancing California’s Leadership in Telehealth Policy: A Telehealth Model Statute & Other Policy Recommendations,” is directed at legislators and policymakers. Although it’s aimed at creating a welcoming policy environment for telehealth in California specifically, officials at the Center for Connected Health Policy hope other states follow similar paths.

“Our state has been a leader in this area but as is often the case, technology is moving and developing faster than government can keep up with it,” said Pat Powers, interim CEO of the Center for Connected Health Policy. “This report and the model statute are aimed at making sure the policy environment supports new technology. Things are moving quickly and we have to make sure that we’re in a position to make the best use of innovations when they become available.”

The Center for Connected Health Policy, a program of the Public Health Institute, was created by and still receives funding from California HealthCare Foundation. CHCF publishes California Healthline.


About a year ago, the Center for Connected Health Policy gathered a group of 25 health care and policy professionals to form a work group on telehealth policy. Last week’s report is the product of their work.

“Telehealth is this very powerful tool,” said Sandra Shewry, president and CEO of the Center for Connected Health Policy. “So why, if it is such a great tool, is it not utilized in more settings across the health care continuum? We believe there are barriers to fully implementing telehealth practices.”

One of the report’s main goals is to remove those barriers, Shewry said.

The model statute report makes 13 recommendations in four categories:

  • Revisions to the Telemedicine Development Act, focusing primarily on financial incentives and informed consent;
  • Incorporating telehealth into state work force law;
  • Statutory changes to promote interoperability of technology and consumer education; and
  • Increasing research and education efforts in telehealth technologies.

Some of the report’s recommendations:

  • Update the term “telemedicine” used in current law to “telehealth” to reflect changes in technologies, settings, and applications, for medical and other purposes;
  • Require private health care payers and Medi-Cal — California’s Medicaid program — to cover encounters between licensed health practitioners and enrollees irrespective of the setting of the enrollee and health care provider(s);
  • Require the Office of Statewide Health Planning and Development to develop and implement a plan to provide greater visibility for the State Health Workforce Pilot Project, and require that OSHPD prioritize projects that utilize telehealth;
  • Require state activities related to health information technology and health information exchange to explicitly include telehealth advocate representation;
  • Require practitioners providing volunteer health services via telehealth to be included in any legislation that allows for malpractice coverage to volunteers providing health services; and
  • Require malpractice insurance vendors and professional societies to educate practitioners regarding their options for malpractice coverage for telehealth services.

Broad Range of Telehealth Benefits

Telehealth applications have the potential to spread to many corners of the health care world. Dental care and oral health, especially for underserved populations, as well as pediatric care and rural health care all can benefit from telehealth, according to members of the model statute work group.

“Removing barriers to use of telehealth would have impacts far beyond the basics of specialists consulting,” said Paul Glassman, professor of dentistry and director of Community Oral Health at the University of the Pacific.

Glassman said telehealth technology offers opportunities for underserved people all over California — many of whom have never seen a dentist — to get dental care.

“As a society, we can’t afford not to take advantage of every opportunity,” Glassman said, adding, “We have to think about different ways of reaching the underserved population. We think the use of telehealth will allow us to serve many more people who otherwise might not have access to oral health.”

UOP’s Community Oral Health program launched a telehealth demonstration project, called the virtual dental home, that involves nine sites across the state and serves dental patients of all ages.

“We have schools, nursing homes, head start centers, residential treatment centers. We’re using telehealth technology to get dentists involved. We have dental hygienists and dental assistants at the sites and dentists connected through technology,” Glassman said

Access to dental care, perhaps more than access to medical care, separates the haves from the have-nots in our culture, Glassman said, noting that telehealth can help bridge that gap.

“We expect many millions of people to gain access to oral health care through telehealth,” Glassman said.

When Telephones Were New Technology

Herrmann Spetzler — CEO of the Open Door Community Health Centers in rural Northern California — likens the growing pains of telehealth to those of another technology when it was new.

“There was resistance to using telephones in communicating in the field of medicine when that technology first arrived,” Spetzler said. “I think we’re seeing the same kind of process now. Telehealth is another tool. And in our current situation this tool is way ahead of our system’s ability to make the best use of it.”

Spetzler’s 10 health centers in Del Norte and Humboldt counties have been early and consistent users of telehealth. He said health care is vastly improved for the widespread population in the two-county region about the same size as Connecticut.

“We’re connected to specialists all over the state and beyond,” Spetzler said.

Importance for Underserved Children

Jenny Kattlove, director of Strategic Health Initiatives for The Children’s Partnership, said telehealth has particularly important implications for underserved children.

“There is a significant shortage of pediatric subspecialists in California and across the nation,” Kattlove said. She added, “The majority of pediatric subspecialists practice within academic medical systems and regional pediatric tertiary centers, which are usually not in remote areas. Children who live in rural and other underserved areas can greatly benefit from telehealth’s ability to connect them to pediatric subspecialists.”

Kattlove said some of the policy recommendations in the model statute report are especially important for underserved children’s access to care.

“If telehealth applications are not reimbursed by Medi-Cal and other payers, children will not be able to reap the benefits of telehealth. The other barriers that the report’s recommendations address will facilitate increased access to health care via telehealth for children, especially underserved children.”

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