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Time To Treat Telemedicine as Just “Medicine”

Posted on October 25, 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 last year or two, hospitals and clinics have shown a steadily growing interest in offering telemedicine services. Certainly, this is in part due to the fact that health plans are beginning to pay for telehealth consults, offering a new revenue stream that providers want to capture, but there’s more to consider here.

Until recently, much of the discussion around telehealth centered on how to get health insurance companies to pay for it. But now, as value-based purchasing becomes more the norm, providers will need to look at telemedicine as a key tool for managing patient health more effectively.

Evidence increasingly suggests that making providers available via telemedicine channels can help better manage chronic conditions and avert needless hospitalizations, both of which, under value-based payments, are more important than getting a few extra dollars for a consult.

Looked at another way, the days of telehealth being a boutique service for more-sophisticated consumers are ending. “It’s time to treat telemedicine as just ‘medicine,’” one physician consultant told me. “It’s no different than any other form of medicine.”

As reasons for treating telehealth as a core clinical service increase, barriers to sharing video and other telemedical records are falling, the consultant says. Telemedicine providers can already push the content of a video visit or other telehealth consult into an EMR using HL7, and soon information sharing should go both ways, he notes.

What’s more, breaking down another wall, major EMR vendors are offering providers the ability to conduct a telehealth visit using their platform. For example, Epic is offering telemedicine services to providers via its MyChart portal and Hyperspace platform, in collaboration with telehealth video provider Vidyo. Cerner, which operates some tele-ICUs, has gone even further, with senior exec John Glaser recently arguing that telehealth needs to be a central part of its population health strategy.

Admittedly, even if providers develop a high level of comfort delivering care through telehealth platforms, it’s probably too soon to rely on this medium as an agent of change. If nothing else, the industry must face up to the fact that telemedicine demand isn’t huge among their patients at present, though consumer plays like AmWell and DoctoronDemand are building awareness.

Also, while scheduling and conducting telemedicine consults need not be profoundly different than holding a face-to-face visit — other than offering both patient and doctor more flexibility — working in time to manage and document these cases can still pose a workflow challenge. Practical issues such as how, physically, a doctor documents a telehealth visit while staring at the screen must be resolved, issues of scheduling addressed and even questions of how to store and retrieve such visit records must be thought through.

However, I think it’s fair to say that we’re past wondering whether telemedicine should be part of the healthcare process, and whether it makes financial sense for hospitals and clinics to offer it. Now we just have to figure out where and when.

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.

Telemedicine A Critical New Approach To Primary Care

Posted on August 15, 2014 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.

Telemedical treatment has been a tantalizing possibility for many years, for reasons including a failure of health plans to pay for it and too little bandwidth to support it, but those reasons are quickly being trumped by the need for quick, cheap, convenient care.

In fact, according to research by Deloitte, 75 million of 600 million appointments with general practitioners will be via telemedicine channels this year alone.

While one might assume that this influx is coming from traditional primary care practices which are finding their way online, that doesn’t seem to be the case.

Instead,a growing number of entrepreneurial startups are delivering primary care via smart phone and tablet, including Doctor on Demand and HealthTap, which offers videoconferences with PCPs, and options like Healthcare Magic and JustAnswer, which offer consumers the opportunity to get written responses to their healthcare queries from doctors.

Primary care doctors going into direct primary care are also joining the primary care telemedicine revolution; a key part of their business is based on making themselves available for consultation through all channels, including Skype/Facetime/Google Hangout meetings.

To date, most of the thinking about telemedicine have been that it’s an add-on service which is far to one side of the standard provision of primary care. However,with so many consumers paying out of pocket for primary care — and virtual visits typically priced far more cheaply than on-site visits — we may see a new paradigm emerge in which victims of  high-deductible plans and the uninsured rely completely on telemedical PCPs.

Rather than being merely a new technical development, I believe that the delivery of primary care via telemedical channels is a new form of ongoing primary care delivery.

It will take some work on the part of the telemedicine companies to sustain long-term relationships with patients, notably the use of an EMR to track ongoing care. And telemedicine PCPs will need to develop new approaches to working with other providers smoothly, as coordination of care will remain important. Health IT companies would be wise to consider robust, unified platforms that allow all of this to happen smoothly.

Regardless, the bottom line is that primary care telemedicine isn’t an intriguing sideline, it’s the birth of a new way to think about financing and delivery of care. Let’s see if traditional providers jump in, or if they let the agile new virtual PCP companies take over.