This week's Washington Post has a story discussing patient's experience getting a second opinion on heart surgery via a remote "e-consultation" with Cleveland Clinic.

At this point, not many people have had direct experience with online second opinions and there are good reasons for this. The whole motivation behind doing things online is to make things easier. Unfortunately it appears that the current roadblocks to telemedicine are significant. Here is a shortlist:

• Start-up Barriers: Only a few institutions, like Cleveland Clinic have resources to offer the service today. This excludes many quality doctors not affiliated with such centers. Technology must be made available to an average solo practitioner.
• Paper Records: Sure, the second opinion is electronic and delivered online, but it has to be based on prior medical records, which are anything but. Obtaining the paper documents, scanning and faxing is a significant burden, subtracting from the experience.
• Antiquated Laws: Many states make telemedicine technically illegal or restrict it beyond reasonable. The stated motivation is to protect the patient from risk (of course!), but in reality medical boards are guarding their turf against interstate competition.
• Cash Patients Only: You have to really want that second e-pinion, since your health plan most likely would not pay for it. Mohit Ghose of America's Health Insurance Plans, says they are "evaluating how patient privacy and other issues can be resolved before covering this Internet service".
• Care Coordination: Your primary physician still has to be actively involved, while remote specialist may not even be made accessible on the phone. In the end you may be forced to choose whether to trust "the remote expert from a leading-edge institution" or "the doctor who knows my heart best".

While the challenges seem daunting, this example of a successful "second e-pinion" shows how medical practice is evolving. Healthcare, as politics, will continue to remain mostly a local affair, but more will be delivered remotely. Yet we cannot expect real adoption until:

• Governments remove regulatory roadblocks
• EMR becomes cheap, widespread and connected
• Payors respond to the consumer demand

To read the story follow the link here.