"We've moved to a belief that you have to deliver this to a phone or tablet in order to get the adoption you want," says Margaret Laws, the Innovations for the Underserved program director at the California Healthcare Foundation.

Direct patient-physician communication via a tablet is a far cry from earlier telehealth services, which were available primarily only in rural clinics allowing a patient access to specialists at distant hospitals.

With personal technology improving at such a rapid pace, the remaining challenges limiting the widespread adoption of telehealth are largely systemic, with the two major barriers essentially the same as they were a decade ago: reimbursement and regulation.

Lately, though, policymakers have stepped up.

"Regulatory boards are not caught up, but they are finally coming to the table," Henderson says. "Some people are even saying now that telehealth is regulated more than personal care."

Determining telehealth encounters can provide an equivalent standard of care as an in-person appointment is paramount to its success. To that end, the Federation of State Medical Boards has released a series of guidelines for the appropriate use of telehealth in practice.

While the framework is likely to be helpful for policymakers, it does not address the variance among licensure and medical practice laws from state to state, a huge concern for early adopters.

"Providers should not have to make sure they are following the rules of 50 different states to start offering their services remotely. A patient in Georgia expects the same level of care as one in North Carolina," says Daniel Castro, a senior analyst at the Information Technology and Innovation Foundation.

Clarification of the regulatory language is likely the next step in overcoming this hurdle, with the focus on individual states defining what can and cannot be done in a telehealth encounter. By comparing these definitions, it might be possible to create what Kristi Henderson calls "a baseline regulation — a known standard."

The benefit would be two-fold: protection for clinicians operating in a yet-to-be established legal framework, and helping to limit the workflow concerns that have made providers uneasy.

By necessarily relying on the schedule of the patient and not the physician, some clinicians are hesitant about changing the way that care has traditionally been delivered. The issue of workflow is something that tech functionality is beginning to address, but many early adopters cite it as a substantial conceptual hurdle that still needs to be overcome.

For providers who are willing to dedicate the time to establish telehealth services, the reality of reimbursement represents the other significant obstacle that has been present since the early days.

Medicaid coverage is relatively broad with 43 states providing some form of reimbursement, but according to the American Telemedicine Association, only 21 states and the District of Columbia currently have laws mandating that private plans cover the telehealth version of benefits available both in-person or remotely.

Read: Huge growth predicted for telehealth

For Medicare, policymakers recently introduced legislation aimed at establishing a framework for coverage. The Medicare Telehealth Parity Act of 2014 is aimed at expanding acceptable care sites to include retail clinics and allow reimbursement for outpatient services, but it remains to be seen if the Act will make it through Congress. 

"There's been some progress, but there are still a number of restrictions on reimbursements," Castro says. "Some policies still require patients to receive care while at a clinic rather than at their home or place of work, but now that patients can easily have a two-way video chat with their doctor using high-speed broadband networks, the difference between seeing a doctor in-person and remotely is shrinking."

Joe Kvedar, the Director of the Center for Connected Health in Boston, is more optimistic about the ground that has been covered, saying that "payers and large employers are now seeking out programs to help members and employees better manage chronic conditions like hypertension and diabetes, and make positive behavior changes to improve health and wellness."

In fact, consulting firm Towers Watson released a survey finding that 37 percent of employers were planning on implementing telehealth coverage by 2015, an increase of nearly 15 percent from this past year.

Despite this substantial uptick in benefits offered, the survey also reveals that the actual per-member use of telehealth services covered on employer plans is still less than 10 percent, leaving plenty of room for growth.

Read: Consumers optimistic about telehealth

As the demand from consumers grows, there is little doubt that the regulatory and financial barriers also will continue to fall, but only through smart planning and organization will telehealth successfully scale to its projected numbers.

The earliest adopters are now uniquely situated to capitalize on their experience in the growing industry, but despite advances in regulation, reimbursement and tech in the last decade, the biggest hurdle to widespread adoption may still be one of perception.  

As Henderson puts it, "As every health system starts incorporating this technology, I don't want telehealth to be seen as a division in another health system. It really needs to be seen as its own form of health care."