Healthcare Unbound #HITsm Chat Thoughts

Most of you have seen that we’ve been working on a number of ways to stretch and deepen the amazing #HITsm community. Check out the EMR and HIPAA YouTube channel for some post #HITsm video chats we’ve done. Plus, we do our weekly #HITsm Twitter Roundups (Every other week our #HITsm roundup is on EMR and EHR). At the core of all of this is the weekly #HITsm twitter chat. If you’ve never participated, it’s an incredible community of people.

I’ve always wanted to do a blog post before the regularly scheduled #HITsm chat where I write some thoughts about the planned #HITsm topics. Leonard Kish (@leonardkish) got the topics for this week’s chat up early, so I thought it was the perfect opportunity for me to write a post based on his topics. Hopefully some can read it before the chat and it will enhance their chat experience.

Topic 1: So how long will it be before office visits are no longer the norm? (via Mark Blatt, MD, CMIO Intel)
This is a bit of a hard question because it depends on how you define office visit. Is an e-visit with the doctor considered an office visit. What if the visit is in a HealthSpot like kiosk? Is that an office visit. I’ll assume for the sake of this question that he means any visit where you didn’t have to go into the office. This could be a telemedicine visit or some other electronic method of interacting with a care provider.

My prediction is that it will probably be 3 years before it’s common for the early adopters to do an e-visit of some sort. It will probably be 6 years before someone like mom is doing an e-visit. Although, there’s a subtle caveat to my answer. Many office visit types will be perfect for an e-visit and some office visit types will never be possible in an e-visit. So, I’m mostly making my prediction based on the former visit type.

Topic 2: What technologies will lead the way?
The Google Plus hangout simplicity has made very clear to me that a video connection between two people is easily possible today. Of course, I’m not suggesting Google Plus will be used for a healthcare office visit, but video and audio using the off the shelf and built in cameras and microphones that come on every laptop, smartphone, and tablet is going to be the preferred method.

As for software, the early adoption is going to be based on which companies the insurance companies choose to reimburse. The insurance companies I’ve talked to are more than happy to have doctors reimbursed for an electronic visit. However, they need some way to know if an e-visit was actually done by the doctor. Even a small space for corruption can cost an insurance company billions of dollars because of their scale. Their method to battle this will be to reimburse only a few telemedicine companies for whom they’ve created deep ties.

Let’s also not count out secure text and secure email as a simple method to replace many unneeded visits.

Topic 3: How will these at-home and mobile technologies integrate with existing systems?
As Anne Zieger recently pointed out, Telemedicine is Not Connecting with EHRs. EHR vendors have so many interoperability challenges as is that integrating with Telemedicine is far down their list of priorities. Instead, I think we’ll see the insurance companies take the lead on integrating Telemedicine into their platforms. We may also see some PHR and patient portals work out deals with the companies that are recognized for reimbursement by the insurance companies.

The other beautiful area for this technology is the cash pay patients. I see a whole new group of cash pay patients emerging. Many people and companies will be willing to pay cash for an e-visit versus making the trip to a doctor’s office for a regular visit. The key question is how the company that provides these visits will get enough locally licensed doctors on board to make this happen, but someone will crack the nut.

Topic 4: Aetna’s CarePass will track customer behavior. Will this become the norm, is it a good thing?
I believe that this will be the norm. In fact, they’re already doing some of this customer behavior tracking already, but most people just don’t know about it. Things like CarePass will just be a public way to do it. I think many will hop on board. I think that this will be a good thing for insurance companies, a good thing for healthcare, and a good thing for many patients. However, a few patients will get really hurt by it.

Topic 5: We’ll need culture change to bring this massive about. what will it take to change culture?
1. Reimbursement 2. Medical Licensing Laws 3. Trusted Technology

If we figure out those 3 areas, we’re going to see the culture change that will unbind healthcare. I personally think we’re headed this direction already and I see nothing that will stop it. It’s just a question of how quickly we can get there.