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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

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.

Healthcare Unbound #HITsm Chat Thoughts

Posted on June 21, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.