Research & Commentary: States Should Not Block the Growth of Optical Telemedicine

Published April 7, 2016

Telemedicine, which is the use of information technology in the diagnosis, treatment, or monitoring of patients’ conditions, can dramatically lower health care costs while increasing access for patients, especially those in underserved areas. Telemedicine has existed for years at a basic level, but the technology has now advanced to the point where the full process of diagnosis, analysis, and prescribed treatment can often be done remotely. Unfortunately, some governments are working to prevent this breakthrough technology from being utilized by doctors and patients. One example of government obstruction is the efforts currently being made to block online eye exams.  

In several states, including Indiana, Nebraska, Oklahoma, and South Carolina, legislators are considering new laws that would ban the use of new telemedicine technologies that would enable patients to receive a prescription for glasses or contact lenses using a vision test they administer themselves using laptops or smartphones. These apps, which have been approved in 45 states and are currently available in 33, provide an affordable refractive eye exam that is verified by a doctor licensed in a patient’s state of residence. These apps give customers a physician-issued prescription for glasses or contact lenses within 24 hours, streamlining the process of obtaining eyewear for a fraction of the cost.

Supporters of banning this technology stand to lose business from the app and have argued the tests are not reliable and should not replace in-office care. Manufacturers have agreed these apps should not replace in-office exams entirely, and they were never designed to do so. The exams the apps provide, which are reviewed by a licensed doctor, are merely a supplement to annual eye exams. Opternative, one company promoting an eye exam app, notes its app limits users to four consecutive times before requiring proof of an in-office eye exam. It also limits the app to healthy adults who are 18 years old to 40 years old.

In addition to crony opposition to new competitors, the main barriers preventing telemedicine from expanding further are government regulations and the inability of the current system to properly reimburse doctors providing telemedicine services. Strict licensing standards have become a significant barrier to entry in the health care industry. In many instances, states control licensing standards, professional discipline, and the various costs associated with the licenses.

Adam C. Powell, president of Payer+Provider Syndicate, a health services consulting firm, outlined several ways telemedicine could help decrease healthcare spending in a 2012 Healthcare IT News article. Powell notes the use of remote analysis services, remote monitoring technologies, and mobile health monitoring enable health care professionals to pool resources and prevent unnecessary and expensive inpatient stays and emergency room visits. He also notes telemedicine helps reduce hospital readmissions after treatment, which cost patients and the industry more than $16 billion each year, according to a 2011 study by National Institute for Health Care Reform.

Telemedicine can provide health care services to more people who need it at a lower cost. It is hampered by government regulations, not by inadequate technology or a lack of demand. Allowing one industry’s lobby to block technology that could benefit thousands of patients is unfair and unjustifiable. The government should not be in the business of choosing winners and losers. Instead of enabling blatant cronyism, state legislators should work to encourage telemedicine by reforming licensing standards to allow physicians to treat patients across state lines and to work to streamline credentialing.

The following documents examine telemedicine and various barriers blocking its expansion.

Opternative’s Online Eye Exam Gets You a Glasses Prescription From Home
Josh Constine of TechCrunch examines the Opternative online eye exam, how it works, and the uphill battle it faces against new government-imposed regulations. 

Ten Principles of Health Care Policy
This pamphlet in The Heartland Institute’s Legislative Principles series describes the proper role of government in financing and delivering health care and provides reform suggestions to remedy current health care policy problems.

Research & Commentary: Medical Licensing and the Doctor Shortage
Heartland Institute Senior Policy Analyst Matthew Glans argues although a complete repeal of medical licensing may not be practical, allowing physicians to treat patients across state lines and expanding the scope of practice for nurse practitioners are two steps states can take to address the shortage of doctors.

Telemedicine: Changing the Landscape of Rural Physician Practice
Writing in the New England Journal of Medicine, Bonnie Darves argues new applications of telemedicine have enabled rural physicians to manage a wide range of acutely ill patients, improve accessibility to specialists, and reduce barriers to care in underserved regions: “With advances in technology, plummeting costs, and governmental health care system partnerships, telemedicine is now used by more than half of U.S. hospitals and has reduced rural practice isolation. Be sure that health plan and hospital credentialing, privileging, licensure, and malpractice issues are addressed before practicing telemedicine.”

5 Ways Telemedicine is Driving Down Healthcare Costs
Steff Deschenes of Healthcare IT News examines telemedicine and mHealth, arguing they can help the healthcare system meet the Institute of Healthcare Improvement’s triple aim to increase the quality of care, improve the health of populations, and reduce the per capita cost of care.

Physician Care and Telemedicine
Devon Herrick of National Center for Policy Analysis examines the benefits of telemedicine in providing health care at a lower cost and outlines the current barriers to expansion: “Entrepreneurs are using the telephone, the Internet and personal computers for innovative solutions to traditional problems of health care delivery. These advances are not only making care more accessible and convenient, they are also raising quality and containing medical costs.”

Convenient Care and Telemedicine
This study examines the contribution of telemedicine and other information technology to innovative solutions to some of the problems patients and health care providers encounter under the traditional model of health care delivery. It also identifies obstacles to progress and the public policy changes needed to remove them.

Telemedicine: Helping Consumers and the Environment
Over the next 10 years, broadband applications such as telecommuting, distance learning, teleconferencing, and e-materialization will decrease greenhouse gas emissions by one billion tons, the American Consumer Institute finds. This ConsumerGram takes a second look at one of the more promising and fast growing applications, telemedicine, and identifies several new ways these applications can help both consumers and the environment.

Telemedicine: An Inquiry in the Economic and Social Dynamics of Communications Technologies in the Medical Field
Francis Pereira, Elizabeth Fife, and Antonio A. Schuh identify barriers to telemedicine which can be addressed by policymakers, broadband equipment manufacturers and service providers, and key players in the health care industry, to exploit the opportunities these new technologies offer. 

Telemedicine Can Build Bridge to Expanded Health Care, Say Panelists
Increasing demand for health care, particularly in underserved rural areas, is creating more demand on physicians, including family physicians. At a recent Robert Graham Center health policy forum, speakers provided examples of how telemedicine was working in three separate situations. Speakers argued the technology holds great promise for the future of health care. 

3 Solutions for Major Telemedicine Barriers
This article from Becker’s Hospital Review discusses a recently published study in Telemedicine and e-Health which found three major barriers to telemedicine implementation and use that must be addressed. 

Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced?
Widespread telemedicine adoption has been stymied by unnecessary technological, financial, and legal barriers for 40 years. In addition, business strategy and human resources have contributed to the delay of implementation. Cynthia LeRouge and Monica J. Garfield canvass recent events and activities in these areas and overall U.S. health care reform which might help to break down these barriers. 


Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News at, The Heartland Institute’s website at, and PolicyBot, Heartland’s free online research database, at 

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