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More Vendors, Providers Integrating Telemedicine Data With EHRs

Posted on April 27, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

One of the biggest problems providers face in rolling out telemedicine is how to integrate the data it generates. Must doctors make some kind of alternate set of notes appropriate to the medium, or do they belong in the EHR? Should healthcare organizations import the video and notate the general contents? And how should they connect the data with their EHR?

While we may not have definitive answers to such questions yet, it appears that the telehealth industry is moving in the right direction. According to a new survey by the American Telemedicine Association, respondents said that they’re seeing growth in interoperability with EHRs, progress which has increased their confidence in telemedicine’s future.

Before going any further, I should note that the surveyed population is a bit odd. The ATA reached out not only to leaders in hospital systems and medical practices, but also “telehealth service providers,” which sounds like merely an opportunity for self-promotion. But leaving aside this issue, it’s still worth thinking a bit about the data, such as it is.

First, not surprisingly, the results are a ringing endorsement of telemedicine technology. The group reports that 83 percent of respondents said they’ll probably invest in telehealth this year, and 88 percent will invest in telehealth-related technology.

When asked why they’re interested in delivering these services, 98 percent said that they believe telehealth services offer a competitive advantage over those that don’t offer it. And 84 percent of respondents expect that offering telehealth services will have a big impact on their organization’s coverage and reach.

(According to another survey, by Avizia and Modern Healthcare, other reasons providers are engaging with telehealth is because they believe it can improve clinical outcomes and support their transition to value-based care.)

When it comes to documenting its key thesis – that the integration of EHR and telehealth data is proceeding apace – the ATA research doesn’t go the distance. But I know from other studies that telemedicine vendors are indeed working on this issue – and why wouldn’t they? Any sophisticated telemedicine vendor has to know this is a big deal.

For example, telemedicine vendor American Well has been working with a long list of health plans and health systems for a while, in an effort to integrate the telehealth process with provider workflows. To support these efforts, American Well has created an enterprise telehealth platform designed to connect with providers’ clinical information systems. I’ve also observed that DoctorOnDemand has made some steps in that direction.

Ultimately, everyone in telehealth will have to get on board. Regardless of where they’re at now, those engaging in telehealth will need to push the interoperability puck forward.

In fact, integrating telehealth documentation with EMRs has to be a priority for everyone in the business. Even if integrating clinical data from virtual consults wasn’t important for analytics purposes, it is important to collecting insurance reimbursement. Now that private health plans (and Medicare) are reimbursing for telemedical care, you can rest assured that they’ll demand documentation if they don’t like your claim. And when it comes to Medicare, arguing that you haven’t figured out how to document these details won’t cut it.

In other words, while there’s some overarching reasons why integrating this data is a good long-term strategy, we need to keep immediate concerns in mind too. Telemedicine data has to be seen as documentation first, before we add any other bells and whistles. Otherwise, providers will get off on the wrong foot with insurers, and they’ll have trouble getting back on track.

Consumers Want Their Doctors To Offer Video Visits

Posted on February 6, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new survey by telemedicine provider American Well has concluded that many consumers are becoming interested in video visits, and that some of consumers would be willing to switch doctors to get video visits as part of their care. Of course, given that American Well provides video visits this is a self-interested conclusion, but my gut feeling is that it’s on target nonetheless.

According to the research, 72% of parents with children under 18 were willing to see a doctor via video, as well as 72% of consumers aged 45-54 and 53% of those over age 65. Americal Well’s study also suggests that the respondents see video visits as more effective than in-person consults, with 85% reporting that a video visit resolved their issues, as compared with 64% of those seeing a doctor in a brick-and-mortar setting.

In addition, respondents said they want their existing doctors to get on board. Of those with a PCP, 65% were very or somewhat interested in conducting video visits with their PCP.  Meanwhile, 20% of consumers said they would switch doctors to get access to video visits, a number which rises to 26% among those aged 18 to 34, 30% for those aged 35 to 44 and and 34% for parents of children under age 18.

In addition to getting acute consults via video visit, 60% of respondents said that they would be willing to use them to manage a chronic condition, and 52% of adults reported that they were willing to participate in post-surgical or post-hospital-discharge visits through video.

Consumers also seemed to see video visits as a useful way to help them care for ill or aging family members. American Well found that 79% of such caregivers would find this approach helpful.

Meanwhile, large numbers of respondents seemed interested in using video visits to handle routine chronic care. The survey found that 78% of those willing to have a video visit with a doctor would be happy to manage chronic conditions via video consults with their PCP.

What the researchers draw from all of this is that it’s time for providers to start marketing video visit capabilities. Americal Well argues that by promoting these capabilities, providers can bring new patients into their systems, divert patients away from the ED and into higher-satisfaction options and improve their management of chronic conditions by making it easier for patients to stay in touch.

Ultimately, of course, providers will need to integrate video into the rest of their workflow if this channel is to mature fully. And providers will need to make sure their video visits meet the same standards as other patient interactions, including HIPAA-compliant security for the content, notes Dr. Sherry Benton of TAO Connect. Providers will also need to figure out whether the video is part of the official medical record, and if so, how they will share copies if the patient request them. But there are ways to address these issues, so they shouldn’t prevent providers from jumping in with both feet.

One Example Of Improving Telehealth Documentation 

Posted on August 16, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Over the past year or two, the pressure has risen for providers to better document telehealth encounters, a pressure which has only mounted as the volume of such consults has grown. But until recently, telemedicine notes have been of little value, as they’ve met few of the key criteria that standard notes must meet.

The fact that such consults aren’t integrated with EMRs has made such an evolution even trickier. I guess doctors might be able to squeeze the patient’s video screen into one corner, allowing the clinician to work within the existing EMR display, but that would make both the consult and the note-taking rather inefficient, wouldn’t it?  The bottom line is that if telemedicine is to take its place alongside of other modes of care, this state of affairs is unsustainable.

For one thing, health plans that reimburse for telehealth services won’t be satisfied with vague assurances that such care made a difference – they’ll want some basis for analyzing its impact, which can’t be done without at least some basic diagnostic and care-related information. Also, providers will need similar records, for reasons which include the need to integrate the information into the patient’s larger record and to track the progress of this approach.

All of which is to note that I was happy to stumble across an example of a telemedicine provider that’s making efforts to improve its consult notes. While the provider, Doctor on Demand, hasn’t exactly reinvented the telehealth record, it’s improving those records, and to my way of thinking that deserves a shout-out.

As some readers may know, Doctor on Demand is a consumer-facing telemedicine provider which offers video visits with primary care doctors, counselors and psychiatrists. Its competitors include HealthTap and American Well. Because the company works with my health plan, United Healthcare, I’ve used its services to deal with off-hours issues as they arise.

Just today I had a video visit with a Doctor on Demand doctor to address a mild asthma care issue, after which I reviewed the physician’s notes. When I did so, I was happy to see that those notes included a ICD-10 diagnosis code. The notes also incorporated a consumer-level summary of what the diagnosed condition was, what to do about it, what its prognosis was and how to follow up. Essentially, Doctor on Demand’s notes have evolved from a sentence of two of informal suggestions to a more-structured document not unlike a set of hospital discharge instructions.

Don’t get me wrong, I’m certainly well aware that these are just baby steps. Doctor on Demand will have to move a lot further in this direction before consult documentation offers much to other providers. That being said, adding a formal diagnosis code gives the company a better means for analyzing key patterns of utilization internally by presenting condition, which can help its leaders look at whom they serve. Doctor on Demand can also use this information to pitch deals with potential partners, by sharing data on its population and underscoring its capabilities. In other words, these changes should make an impact.

Ultimately, telehealth documentation will have to meet the same expectations that other healthcare documentation does. And it’s not clear to me how freestanding telemedicine firms like Doctor on Demand will bridge that gap. After all, generating complete documentation takes far more than a few useful gestures. Even if the company threw a high-end EMR at the problem, merging it with the existing workflow is likely to be a huge undertaking. But still, making a bit of progress is worthwhile. I hope Doctor on Demand’s competitors are taking similar steps.

Telemedicine Startup Offers Providers A Shot At Equity

Posted on April 22, 2015 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Over the last couple of years, the number of telemedicine vendors out there fighting for business has exploded.  These include DoctoronDemand, GoTelecare, HealthTap, MDLIVE, American Well and many, many more.

Health plans are jumping on the bandwagon too. For example, United Healthcare  has been running a popular national television campaign advertising its “virtual clinic” services. UHC is my plan, so I can attest that this service — shown as embedded in its member site — hasn’t been rolled out yet, but that only makes its desire to get out in front of the trend more noteworthy.

Telemedicine models in play include companies that recruit providers and sell them to consumers, vendors who enable telemedicine via proprietary platforms and firms that lead with community building. At present the direct-to-consumer players seem to be somewhat ahead, simply because they’ve already begun developing a national brand, but the story doesn’t end there.

Though consumer-facing telemedicine companies probably have a viable business model, they’ll have to build a memorable consumer brand to make it, something that takes a great deal of  time and money.  On the other hand, vendors that offer white-label telemedicine technology to hospitals and health plans have at least as much to gain, without having to win the loyalty of fickle consumers.

One telemedicine player doing just that is Nashville-based PointNurse, which has developed a distributed collaboration and communications platform providers can use to deliver telemedicine services. I just spoke to CEO Cyrus Maaghul, who gave me a company overview, and was interested to hear that his venture is taking things in some new directions.

PointNurse is different than most companies in the telemedicine space for a few reasons.

For one thing, the platform includes block chain capabilities, which allow providers to accumulate credits for both community participation and actual care delivery. (In case you aren’t familiar with block chain technology, which powers crypto currency Bitcoin, you may want to click here.)

These credits aren’t just for fun. Eventually, when providers accumulate enough credits, they get a pro-rata share of a dedicated pool of equity.

Consumers, for their part, are given a multi-signature wallet which stores both their personal and clinical information, resulting more or less in a PHR with added capabilities. PointNurse hasn’t yet devised a way to share the data with provider EMRs, but that’s a short-term goal.

A wide range of providers can participate in PointNurse, including not only MDs but also nurse practitioners, pharmacists, RNs, LPNs and elder advocates.

A sister venture, HealthCombix, will license the technology underlying PointNurse to hospitals and payers. HealthCombix will provide APIs and tools to build their own distributed applications.

As Maaghul sees it, it’s critical for providers to realize more than a short-term benefit from participating in telemedicine. “I wanted to make providers feel highly motivated — that they can gain from this [arrangement],” Maaghul said. “This creates value for the patient.”

Of course, there’s no proof yet that this or any particular telemedicine business model is going to capture its market niche.  In fact, it’s not even clear what niches will emerge in this space; after all, though it’s moving fast it’s far from mature.

That being said, this approach has some intriguing aspects. I’ll be interested to see whether its business model and and unusual underlying technology work out.

The Feds Are Supporting Telemedicine

Posted on May 5, 2014 I Written By

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at kylesamani.com.

The Federation of State Medical Boards (FSMB) recently passed a model telehealth policy that promotes virtual visits for first-time encounter. This is notable for 2 reasons: first, many state medical boards liberally borrow from the federal boards, and second, this marks a shift from the old model in which patients were encouraged to see providers in person before engaging in telemedicine consults.

It’s encouraging to see the old, arbitrarily restrictive model fade, in favor of one where patients can begin building a relationship with their physician without travel. Indeed, people meet on the internet all the time; why can’t patients meet their care providers the same way?

The old model was arbitrarily limiting access to care, and thus driving up costs and driving down quality. Under the new model, patients should finally be able to login to a web service and be connected directly to a qualified physician that payers will cover. For telemedicine companies like American Well, Doctor on Demand, and others, this is a major coup.

This combination of technology and new guidelines will reduce ER visits, improve access, and ultimately reduce costs. Once it’s easy to get access to preventative medicine, patients will actually partake in preventative care. As a simple example to illustrate this, let’s examine my wellness check up habits.

I’m a healthy young male. I haven’t been to the doctor for a check up in close to a decade and have no intention of going. The process of booking an appointment, leaving my job that I love, and sitting in a waiting room are enough to deter me from ever going to the doctor. But if I could step into a private space and consult with a physician via a video consult for 15 minutes, I might actually get an annual check up. If the physician discovered something concerning and asked me to come, I would actually come in. But I would never come in for an in person visit without an explicit reason to. It’s not worth the pain and headache of going into the doctor’s office unless I have a reason to; the only way to achieve preventive medicine at scale is to make it easy for patients and providers alike.

Ambulances, ERs, and urgent care centers should expect a similar change in their operations. In these environments, specialists can now be reimbursed for first time consults with patients across a range of devices – iPhones, iPads, Androids, Macs, PCs, and even Google Glass. Neurologists can beam into ambulances for strokes, cardiologists for cardiac resuscitations, and trauma specialists for trauma cases. The opportunities are really endless, and my company, Pristine, is proud to lead the way in these new hyper-mobile telemedicine environments.

On the other hand, the new guidelines set forth by the FSMB aren’t all positive. Perhaps most perplexing, the FSMB did  not classify messaging and audio-only phone calls as telemedicine. They didn’t strictly forbid either activity, but they made it clear to payers and providers that live, synchronous video is necessary for reimbursement. In light of the shift to ACOs and value based models, this is perplexing. It’s been suggested that Kaiser Permanente and Group Health physicians reportedly spend up to 2 hours per day interacting with patients through asynchronous messaging.

Despite some setbacks in the new standards set forth by the FSMB, I’m incredibly excited about the future of telehealth across the continuum of care. The new model put forth by the FSMB is just the first of many steps toward a healthcare delivery system in which telemedicine powers the majority of care delivery across the country.

Telehealth, BYOD Gain Momentum In 2013

Posted on January 4, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I’ll be honest — I’m always a bit skeptical when I read on health IT trends appearing in a general-interest corporate IT magazine.  Ours is such a tricky business that the nuances often escape my brethren in the journalistic field, unless of course they specialize in the health IT business. But in this case, an eWeek piece has delivered some useful information, and even caught me off guard a bit.

The piece contends that BYOD issues and the use of telehealth are likely to shape the year in health IT:

BYOD:  Bring-your-own-device problems aren’t unique to healthcare by any means, but they’re certainly become a particularly high-profile issue in healthcare.

In the piece, eWeek quotes Dennis Schmuland, chief health strategy  officer for U.S. Health and Life Sciences at Microsoft, who argues that BYOD costs, including privacy, security and licensing for virtualization of software are so high that BYOD may actually be costing organizations big money. Good (and interesting) point.

Certainly, healthcare organizations can’t afford to let that keep happening in 2013, and this year, solutions are likely to emerge, Schmuland told the magazine.

Telehealth:  While they’re in their early stages right now, telehealth services such as American Well’s Online Care are likely to get a stronger footing this year, the eWeek article suggests.

Lynne Dunbrack, program director of connected health IT strategies at IDC Health Insights, notes that consumers are getting used to having videoconferencing at their fingertips, given the extent to which webcams are now embedded in laptops and video chat on mobile phones.

Now that they’re accustomed to videoconferencing, they’ll soon want to use this capability for telehealth visits with doctors, eWeek reports:

Sending a blood pressure reading and seeing a doctor online could be more convenient than taking off from work, Dunbrack noted.

“If you can just go in and have these quick visits, people would be more apt to make these appointments and keep them, and organizations will start to experiment with these services,” said Dunbrack.

In all candor, I think both Schmuland and Dunbrack are a bit ahead of the market. I doubt that we’ll see a huge expansion of telehealth this year, though there may be some additional uptake. And as for BYOD, I’m not expecting to see any comprehensive solution that providers can affordably adopt this year; after all, trends are still shifting and there’s tons of moving parts to consider. But I do think we will see some progress in both areas.  All told, the two have offered some useful fodder for thinking about 2013.