Teleheath, eHealth, and Outsourcing: Where are we going?

When the number of articles coming through my inbox converge on a topic, I usually decide it is time to write about it. Three articles about telehealth and e-health appeared today. Another dropped into my inbox at the beginning of July. What is this about and what does it have to do with behavioral health organizations and practices?

As you are undoubtedly aware, what happens in the broader healthcare community often follows in the behavioral health world. Sometimes behavioral health leads the way with innovations; at other times it merely follows. Telehealth is one arena where I think behavioral health has been in the vanguard.

I would like to start with three simple definitions:

  1. Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. (from
  2. eHealth (also written e-health) is a relatively recent term for healthcare practice supported by electronic processes and communication, dating back to at least 1999.[1] Usage of the term varies: some would argue it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health[2] while others use it in the narrower sense of healthcare practice using the Internet. (from Wikipedia)
  3. In business, outsourcing is the contracting out of a business process to a third-party. The term “outsourcing” became popular in the United States near the turn of the 21st century. . . Outsourcing includes both foreign and domestic contracting,[3] and sometimes includes offshoring or relocating a business function to another country.[4] Financial savings from lower international labor rates is a big motivation for outsourcing/offshoring. (from Wikipedia)


I have included these three terms together because outsourcing often goes with the capability of using electronic devices and various telecommunications methods. Certainly, most of us have some experience of receiving customer service assistance from somewhere half way around the world from our homes. I am wondering if the same will be true as we move toward increasing the use of telehealth and ehealth methods in our healthcare system.

Two of the three articles I saw today related to general healthcare. FierceHealthIT newsletter contained two articles about the potential benefits of electronic doctor visits and telemedicine. With pressure on insurance payers and employers to provide healthcare services at lower cost than currently, we can expect all sorts of innovations. The capability of ‘seeing’ patients remotely is one of those possible innovations.

But what about behavioral health? And what does outsourcing have to do with any of this?

In yesterday’s Open Minds daily briefing, Monica Oss discussed telehealth and how it is beginning to spread in the behavioral health world. With Medicare now willing to pay for telehealth services that meet certain criteria, this possibility has become more likely. In behavioral health, telephone contact with clients has been a long-time staple in helping clients remain stable. Now that Skype and other visual telecommunications capabilities exist, a whole new industry has developed . . . and many existing organizations have added ways to include remote psychotherapy and follow-up sessions in the repertoire of their organizations. SAMHSA and HRSA have pioneered projects and pilot programs to foster such development, especially into rural communities.

Where there is remote capability to provide services, outsourcing is not far behind. If it can be done more cheaply by using resources outside the U.S., businesses will find ways to do it. While licensing and practice laws may currently stand in the way of too much outsourcing, you can be sure that it will come.

How does any of this affect your behavioral health organization? Our experience with our customers suggests that change occurs very slowly within their organizations.

As those of us who are more senior slow down our participation and eventually retire, resistance to paradigmatic change reduces. As younger people who are perfectly comfortable with all things electronic move into the professional arena, newer technologies are successfully introduced. Where is your organization in this process? Do you see groundbreaking changes ready to happen? Or is your organization one of those holding onto the older ways at all costs?

Please share your opinions and experience with telehealth services and where you see it going. And what about outsourcing? Just click in the Comment box below to share your thinking.

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