Last week’s Connected Health Symposium was once again an event about a sector just waiting to break-out of perpetual pilot stage. This was my 4th Connected for Health Symposium (it holds a special place in my heart as this was the very first HIT-related conference I ever attended) but in each and everyone, a dominant, pervasive topic is the pending market break-thru for telehealth and the devices, sensors, software and services that will see rapid market growth and acceptance.

Four years on and we are still waiting.

Despite that wait there was a palpable feeling in the air at this year’s event that the long-awaited break-thru pulling the telehealth sector out of pilot and into wide-spread adoption was imminent. Many are putting their hopes, dreams and money on pending healthcare reform, specifically payment reform. Others see the coming shortage of clinicians as forcing the issue. And one can not help but think that if 1 in 3 Americans will have diabetes by 2050, then certainly telehealth will have to play a role in their care.

Indeed, it does seem inevitable that at some point in time telehealth will take hold as the current system of care continues to spiral in a chaotic unsustainable trajectory. Something has to change, something will change and the technologies discuss at this event will be a part of that future equation. The multi-million if not billion-dollar question is when. Yet again, no one seems to have, at least at this conference, a clear answer. But as the CTO and co-founder of start-up ZEO stated (my recollection & may not be the direct quote, but it’s close):

The healthcare system is completely broken, therefore we have chosen to bypass the system completely and go direct to the consumer.

And he does make a good point. The telehealth sector has done just that; waited patiently for the healthcare system to adopt this model of care delivery. They are still waiting. That’s not to say the Zeo go-to-market strategy will fare any better.  As has been stated many times before on this site, the direct to consumer model is extremely challenging and very, very few companies have seen any real success.

The dominant hurdles to wide-spread telehealth adoption can be broken down into five key points, many of them discussed ad nauseum at this event.

1) Show me the money. Reimbursement models for telehealth services are still immature with payers, especially CMS, still reluctant to pay for telehealth services.  This will likely continue for the foreseeable future until the 800lb gorilla in the market, CMS, begins reimbursing for such services.

2) Integrate it seamlessly into my day. Telehealth remains a novelty of sorts as beyond a pilot here or there, there are few examples of how a physician practice, clinic or large hospital would integrate data flows from telehealth systems into existing, or modified workflow and minimize impact to clinician productivity. Payment reform may help here as we move from pay per visit to pay per healthy (or in compliance) consumer. The consumer also plays an important role here in that telehealth devices and services must also fit into their lives and to date, we have seen mixed success outside the Quantified-Self zealots.

3) Why should I bother? Consumers remain an apathetic bunch. Despite big box retailer attempts to jump start telehealth, to date there is no one, at least at this event, crowing about the big jump in consumer sales that they are seeing. As BCBS-MA CEO Andrew Dreyfus put it:

We need a fundamental rethink on how we educate consumers on health and how to maintain it.

Hey Andrew, I have an idea…

How about we start with our kids bringing back recess and getting kids back on bikes.

4) Too many products, not enough solutions. One thing that was painfully evident at this event (also saw it at Health 2.0) is the plethora of products but very few turnkey solutions. Whether your a clinician or a consumer, jumping on the telehealth bandwagon still requires a level of intestinal fortitude and patience to pull all the disparate pieces together to enable some form of telehealth capability. We’ve yet to see the Geek Squad of telehealth arrive.

5) Where’s the value? There have been a number of pilot studies conducted to measure the value that telehealth delivers. Yet when I sit and listen to the various presentations, the discussions in the halls and reflect on what I may have come across in secondary research, I’m left with that uneasy feeling that a consistent and robust value proposition, be it for consumer, provider, payer or employer remains elusive.

While each of these five points are critical to the future growth of telehealth, the last two are arguably the most significant. Until the stakeholders in this industry address these two issues, we will continue to come to conferences such as this rehashing what has become an increasingly monotonous set of topics related to telehealth adoption. Frankly, I’m tiring of the conversation.