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CMS Redefines Telemedicine by Bringing Better Care to 15 Million Patients and Huge Profitability to Medical Facilities

Posted on September 17, 2015 I Written By

The following is a guest blog post by Donald Voltz, MD.
Donald Voltz - Zoeticx
Telemedicine is about reaching out to patients in remote locations, but limited to videoconferencing between patients and health providers. It is similar to a face-to-face service with the exception that the patient and primary care provider are not physically together. Such efficiency is limited in term of scope and only addresses the geographical challenge and scarcity of physician availability, a far cry from what CMS wanted for its Chronic Care Management Services (CCM) which would fundamentally change telemedicine as it is practiced.

CCM services bring the telemedicine definition to the next level – a quiet continuous monitoring and collaboration from all care services to the patient, given the ability to anticipate and engage in care issues. Such ability not only curbs care costs, it would also increase care provider bandwidth, giving them the ability to cover more patients with better efficiency. The challenge is not on the requirements part of CCM services, but the lack of an IT solution to really address all CMS guidelines, including its intent to enforce the concepts through the healthcare industry.

The New England Journal of Medicine has covered the major challenges from the new CCM guidelines, touching on all the major shortcomings in today healthcare IT offerings.  Healthcare providers recognized that the fee-for-service system, which restricts payments for primary care to office-based visits, is poorly designed to support the core activities of primary care, which involve substantial time outside office visits for tasks such as care coordination, patient communication, medication refills, and care provided electronically or by telephone.

The time has come for a paradigm shift to reengineer how we deliver care and manage our patients. To arrive at a new plateau requires rethinking the needs of our patients and how to meet these needs in an already resource constrained system. Unless we develop solutions that both integrate with and enhance the technologies currently available and those yet to be realized, we will not realize a return on health IT investment.  This needs to be an area of focus for hospital CEOs, CIOs and CMOs.

Huge Market Opportunity

According to the 2010 Census, the number of people older than 65 years was 40 million with increasing trends to 56 million in 2020 and not reaching a plateau until 2050 at 83.7 million.  With two-thirds of Medicare beneficiaries having two or more chronic conditions while one-third has more than three chronic conditions according to CMS data, putting the number of patients who qualify for CCM services at 15 million. This number is predicted to continue on an upward trend until 2050.

The World Health Organization (WHO) recognized the growing burden this trend in chronic disease places on the healthcare system and addressed the need for innovative solutions in their 2002 report. While the potential market is huge, in the billions of dollars yearly, healthcare organizations have been struggling to address the CMS guidelines with key requirements from CMS. We can no longer afford not to address the needs of patient with chronic medical conditions along with engaging them in their healthcare decisions.

CMS’ CCM guidelines are as follows:

  • 24×7 access to clinical staff
  • Patient care continuum
  • Collaboration, coordination between primary care providers and other care services
  • Electronic management of care transition among care providers
  • Coordination between home and community care services
  • Patient engagement

Here is how these guidelines are now being addressed:

The Patient-Centric Model

While each patient has a primary care provider who is responsible for CCM service, they are not confined to receiving care in a single practice or institution. The primary care provider assumes the role of care coordinator, but care is likely to be distributed between multiple care providers, often across different care locations. In a patient-centric care model, care services can come from any care providers – geographically and organizationally diverse, necessitating an accountable provider to coordinate and orchestrate high-quality care across multiple chronic conditions.

Secure Electronic Care Transition

CMS clearly states these CCM care plans must be electronically available at all times to all care providers who will be delivering care to these patients, not available by faxing, or scanning as patient data is currently shared. The chronic care management plan must be available to all healthcare providers who might take care of these patients 24×7. In addition, the primary care provider who assumes the care coordinator responsibility for a patient is expected to follow-up on the care delivered, additional needs of the patient and changes in chronic condition that may have been addressed by a healthcare professional remote to the patients’ primary practice.

CMS neither authorizes how such a CCM system is designed nor enforces how efficient the implemented care service is. The monthly reimbursement limits the time and additional resources physicians are able to allocate for the development, implementation and daily operations of a CCM program in their practice. The manual implementation of a system that meets all of the requirements defined by the CMS will far exceed the reimbursement recovered. It is also likely to be inferior to one with some degree of automation coupled with messaging when a patient’s condition changes or their chronic care management plan is accessed by other providers. Efficiency along with automated logging of time spent on care coordination are critical requirements for a service to be effective.

A CCM service solution must meet the requirements defined by CMS while integrating into the current operational structure of primary care practice and integrate with current health IT systems and manage the secure documentation flow.  It must also offer a built-in notification system to alert physicians to changes in patient status and/or access to the care plan while maintaining an efficient operation in clinics with a lower overhead and no need for additional infrastructure.

While CMS does not enforce the efficiency of a CCM care service, the monthly payment must represent an increase of revenue to care providers. Care providers cannot implement a new potential code while increasing its cost due to manual labor increase. So, efficiency must be part of the solution requirements.

The answer to CCM service would be a new healthcare application offering secure documentation flow, built-in notification and collaboration services to support a low cost, efficient operation for clinics.

The CCM application must address the following requirements:

  • No disruption of existing services. The application must operate and integrate seamlessly with any existing EHR so to not change provider workflow or disrupt current processes; defining a very stringent requirement to keep the existing EHR systems untouched and unchanged while allowing for this new service to co-exist.
  • Secure electronic care transition with CCM care plan sharing. Patients can engage with this new care service even when the service may not be contained within the same network as the primary care provider. Patients ultimately maintain control of what information and with whom this information is shared. The primary care provider is responsible for maintaining the CCM care plan, as well as the patient, and should expect any information shared will be used for a single care session and not beyond it. Although the CCM care plan is expected to contain the most up-to-date medication information, primary care providers are not interested in opening up their entire system to others, but instead need to maintain control and secure access while allowing for access to these protected documents.
  • Automation, automation and automation. Efficiency of the whole CCM service must be at the core so that primary care providers can enhance patient care without adding expense and resources to implement it. Consider a patient with Congestive Heart Failure (CHF) where continuous monitoring of weight is critical for early intervention and the avoidance of hospitalizations. To engage patient’s in their care, they must be given a mechanism to report daily weight to their primary care provider. The primary care provider must have a solution where attention is given if the patient’s condition so it not has exceeded a certain threshold. Automation is required so that primary care providers can be efficient and only given attention when attention is required. Automation must be in place so that no activities such as follow-up would be omitted.
  • An EHR-agnostics solution. Implementation of a CCM service must address the constraints of a non-homogeneous environment. Healthcare organizations and physician practices are not able to control the EHR environments when patients receive care outside of their primary practice. The requirement for electronic document exchange along with the expectation of the latest patient health data being contained in the CCM care plan goes beyond a static solution offered by a data duplicated HIE (Health Information Exchange) infrastructure.
  • Visible value to a patient. A critical requirement for CMS reimbursement is a patient’s opting into a CCM management program that includes out-of-pocket monthly co-pay for the service of 8 dollars per month. A patient must see the value for CCM services which can be demonstrated through enhanced engagement, access to providers and the assurance that their condition is being overseen each month by their chronic care coordinator. Anticipation of an early intervention for potential problems along with the ability to inquire and receive feedback on their condition(s) brings added value to patients and their loved ones. This value can only be delivered if such a service can be developed in an efficient manner with a low cost of operating and a limited expansion of personal to bring it about.
  • Documentation of discontinuous time spent on care coordination. CMS requires at least 20 minutes are spent on care coordination activities each month in order to bill for this for patients enrolled in the program. Without a seamless component to log such activity, the efficiency of the overall process comes into question. A comprehensive CCM application must address the practice management side to account for and generate monthly reports of the CCM activities completed.

Future of Healthcare Impacted by Integration, Patient Data and New Modes of Delivery

The future of healthcare will be impacted by the integration of technology, patient collected data, and enhancement of healthcare professionals’ ability to deliver care in modes not yet imaged. With respect to management of chronic medical conditions, leveraging technology to coordinate the care delivered so these patients can lead productive lives at a reduced cost with less time in the hospital for exacerbations of their disease is a goal that is now possible.

Development of tools to coordinate care without additional health IT expense, in either time spent learning a new workflow or cost of such an application, is now available. Finding such an innovate model that works for patients, healthcare professionals and health systems for chronic care management will likely spread into other areas of healthcare. CCM services and care coordination allow remote, discontinuous, non-face-to-face management of patients with complex health conditions when it meets stringent requirements – a quiet, continuous monitor of health status and interventions, collaboration of all care delivered to the patient, an ability to anticipate, engage and alert patients and care professionals of impending issues, along with the administrative side of billing and logging such activity.

This ability not only changes the direction of the chronic care cost curve, it also increases care provider bandwidth, giving them the ability to successfully manage more patient, with better efficiency while delivering high quality, valuable care.

About Donald Voltz, MD
Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.

Board-certified in anesthesiology and clinical informatics, Dr. Voltz is a researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices.

Thanh Tran, CEO of Zoeticx, also contributed.

We Need Technology to Scale Healthcare

Posted on June 2, 2014 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.

I was recently talking with one of my healthcare IT friends about the future of technology in healthcare. As we were talking, they made this really interesting observation:

“We Need Technology to Scale Healthcare”

I don’t think I need to go into too much detail with readers of this blog about the possible shortage of doctors that could happen. In fact, Kyle Samani covered some of this shortage in his post, “The Nurse Will See You Now.” In that post he talks about the limited number of residency slots that are available. Not to mention the lengthy path to becoming a doctor. I read an astute observation recently that the only reason we don’t have a real crisis in general medicine is because there’s a limited number of residency slots for the other specialties. When a med student can’t get into their desired specialty, then they fall back into general medicine. The idea of general medicine being a “fall back” profession doesn’t bode well for us, but that’s a topic for another day.

Consider the supply and demand constraints that Kyle talks about, we’re going to have a growing problem where the demand for healthcare outstrips the supply of doctors. Kyle covered the move towards nurse care, but I think there’s also an important case to be made for how technology can help to scale healthcare as well. As one example, Telemedicine has the potential to make our healthcare visits much more efficient. Properly implemented technology can do that across a wide variety of healthcare. Plus, technology has the potential to reduce unneeded office visits as well.

What I find even more intriguing is that right now we look at a visit to the doctor as a last resort for our healthcare. How many of us go to the doctor in order to remain healthy? Almost no one. If we really want to scale health care to the point that we’re providing health care and not just sick care, then that will require a scale that healthcare has never seen. I personally call this movement “Treating Healthy Patients” and I think this movement will be data driven with technology at its core.

Lest those reading at home get confused. I don’t think most of the healthcare technologies out there today work on scaling healthcare. Most of the healthcare IT solutions out there today are about optimizing the status quo. That’s very different than what will be required to scale health care. I’m excited to see these later technologies come to fruition.

You Get What You Ask For

Posted on May 19, 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

I recently had a chance to meet Dr. Dave Levin, the first CMIO from Cleveland Clinic, at the Texas HIMSS conference, where I spoke about Google Glass in healthcare. During his keynote, he gave a quick overview of his book – mHealth: Global Opportunities and Challenges – that I’m reading now.

The most important thing I took away from his presentation is that people will do exactly what you tell them to do, not what you’d like them to do. More specifically, people will optimize against what they’re measured against. This is a classic business truism, but one worth repeating.

In order to receive Meaningful Use cash for adopting EMRs, providers are jumping through an excruciatingly difficult series of hoops. Among those hoops is the primary theme of MU Stage 2: patient engagement.

But patient engagement is not an end. Patient engagement is a means to an end. Although there are certainly disagreements on what the end should be (depending on one’s political alignment), the federal government is clearly pushing value-based care delivered through PCMH and ACO models.

So why are we measuring arbitrary metrics such as “5% of patients engaging with their providers” through some sort of patient engagement product? By incentivizing arbitrary usage metrics, we will see little healthcare delivery transformation, despite all the intent in the world. Instead of flipping the clinic by utilizing patient engagement tools as part of a broader healthcare delivery strategy, providers are just going to optimize to barely get by getting 5% of their patients to send them a message through their patient portal.

Consider instead these potential alternative metrics, that better reflect the spirit of the MU regulations:

1) Percentage of patient population cared for under a value-based rather than volume-based model.

2) Percentage of simple visits – script refills, ear infections, etc. – conducted remotely via telemedicine instead of in person.

3) Percentage of visits avoided simply by answering questions via asynchronous secure messaging/pictures.

4) Percentage of complex visits handled by an MD (in which the intention is to hand off simpler visits/procedures to non-physician practitioners to lower costs)

There are certainly problems with some of these proposed metrics. They don’t solve all incentive problems; the system can always be gamed. But compared with existing measures, the above metrics do much more to force providers to rethink care delivery models and flip the clinic.

Some people will interpret these metrics as a way for the federal government to institute socialist control over healthcare delivery. These fears, though, are disproportionate. While a slippery slope argument can be made in this case, the US government has only on a few occasions actually nationalized private functions. In most of those cases, the nationalization was short-lived (such as General Motors 2009).

Given the clout of the AMA and other players, the probability of sliding down this slope seems exceedingly low. History has shown that there is too much friction in the status quo in the US healthcare system for the system to change on its own. At any rate, some change is better than none!

So, Uncle Sam, hear this: you get what you measure. So please measure what you actually want.

The Nurse Will See You Now

Posted on May 13, 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 Atlantic just wrote a piece highlighting the growing trend of non-physicians (commonly referred to as midlevels) providing healthcare. The reason is simple: supply and demand–more precisely, a fixed supply.

For any location where a patient demands healthcare services, there is only a binary result: either there is a qualified healthcare professional available to deliver care, or not. This slide (from Pristine’s investor presentation) illustrates this:

Screenshot 2014-05-04 21.01.17

The supply and demand problem is further compounded by an archaic regulatory system. The path toward becoming a physician, at least in the US, is so arduous that the decision to pursue becoming an MD must be made by age 18 or 19. Even if a huge cohort of 18 year olds suddenly decided they wanted to be physicians, the artificially capped supply of available residency slots each year stimies traditional supply and demand economics.

Nursing, on the other hand, has a more varied cohort in terms of age of entry. Many nurses don’t enter the profession until well into their late 20s or 30s. The same is true of physician assistants. This has resulted in a more liquid supply of non-physician practitioners, and these non-physician practitioners are available to respond to the influx of new patients resulting from the ACA, and to the growing number of retiring baby boomer population.

Given the fixed supply of physicians, there are two fundamental ways to solve the supply and demand problem: make physicians more efficient, or substitute physicians with others who can do an equally good job for a given patient’s needs.

The realities of practitioner supply suggest that nurses and other non-physician practitioners will deliver an increasingly large percentage of healthcare services. Physicians will be relegated to the “high end” per Clayton Christensen’s disruption theory. That could manifest itself in a future in which midlevels deliver primary care and triage more acute conditions to “higher end” specialist physicians.

The greatest challenge in the triage-centric model led by midlevels is the (historically quite poor) communication among healthcare providers. We will need a robust technological infrastructure to support the seamless transfer of patient data among providers. Additionally, we’ll need more capable communication tools to empower providers to connect with one another and with patients regardless of location.

Telemedicine seems to be taking hold to power a future in which location is irrelevant. Interoperability is improving within health enterprises, though there are some signs that community health information exchanges (HIEs) are not doing as well as many had hoped.

At some point down the line, we’ll likely look back and wonder why location mattered so much. It shouldn’t, and because of telemedicine, and liquid data connectivity, it won’t.

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.

Health IT Interoperability, HIE, and mHealth — #HITsm Chat Highlights

Posted on June 8, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

A couple of the Health IT regulars got together again this week to video chat during the #HITsm Chat Highlights. Here are some of their thoughts. If you want to participate, be sure to comment!

Topic One: How far off is a solution to the problem of #healthIT interoperability? Is one actually within reach?

Topic Two: Is patient consent being overshadowed by sustainability as the most significant obstacle to #HIE?

Topic 3: What is the role of #telehealth and #mHealth in #healthcare reform and patient engagement?

Topic Four: Are competing deadlines (e.g., Stage 2 Meaningful Use v. ICD-10) going to be responsible for undermining healthcare reform?


Topic Five: Who or what will be most influential in determining the next phase in the evolution of #healthIT?

Integrating Telemedicine And EMRs

Posted on May 17, 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.

Have you considered what an EMR would look and feel like if it integrated telemedicine? Rashid Bashshur, director of telemedicine at the University of Michigan Health System, has given the idea a lot of thought.

In an interview with InformationWeek Healthcare, Bashshur tells IW’s Ken Terry that it’s critical to integrate HIEs, ACOs, Meaningful Use and electronic health records.

Makes sense in theory. How would it work?

To begin with, Bashshur said, healthcare providers who have virtual encounters with patients via a telehealth set-up should create an electronic health record for that patient.  The record could then be ported over to the patient’s PHR.  The physician can also share the health record via an HIE with other providers.

When providers attempt mobile and home monitoring, it steps the complexity up a notch, as such activities generate a large flow of data. The key, in this situation, is to use the EMR to sensitively filter incoming data.

Unfortunately, few EMRs today can easily pinpoint the information providers need to process, so most organizations have nurse care managers sift through incoming monitoring data. That’s the case at University of Michigan Health System, where care managers sift data manually to determine whether patients seem to be seeing changes in their conditions.

Unfortunately, even attentive care managers can’t catch everything a properly-designed system can, Bashshur notes.  To integrate EMRs and telemedicine/remote monitoring, it will be important for EMRs to have sophisticated filters in place which can pinpoint trouble spots in a patient’s condition, using a standard protocol which is applied uniformly.

According to InformationWeek, vendor eClinicalWorks has promised a new feature which can pick out relevant data from a large data stream. But until eCW or another EMR vendor produces such a feature, it seems that remote monitoring will be labor-intensive and expensive.

The Anti-ACO / Hospital Medical Practice Consolidation

Posted on February 11, 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.

A physician, Charles Beauchamp, recently left the following comment (shown below) on my ACO and Hospital Consolidation post on EMR and EHR. This might be another example of the EHR Physician Revolt. I wonder how many other doctors will go “against the grain” like Dr. Beauchamp.

As a physician who is going “against the grain” (ie “hospital owned” to private practice” rather than in the opposite direction) I have the following model of action to become part of a patient centered rather than exploitative ACO:

1) Establish my rural practice in my house at a very low cost, including asking some of my patients who volunteered to help with construction.

2) Employ myself, a front desk person and a Medical Assistant with backups

3) Establish Telemedicine links to needed specialties (rheumatology, pulmonary, cardiology) AND use physician social networks (eg, Sermo, MedLink Neurology Forum) for informal networking

4) Use LabCorp as a reference lab with negotiated discounts on high yield labs for one of the practice’s centerpieces: preventing stokes, heart attacks, renal insufficiency, onset of diabetes and diabetes complications. Likewise have a systematic literature scan process using EMBASE rather than PubMed for enhancing the testing and intervention effectiveness of the practice’s goals

5) Embed in the practice’s patient education, instruction and self-care facilitation expertise in efficiently discussing and following up on patient-centered discussions

6) Embed in the practice’s counseling activities the ability to counsel patients about which Part-D plan to choose and which health insurance plan to purchase (minus Medicare)

7) Use a general internist centric and concept driven EMR as the practice’s EMR and optimize its functionality for delivering efficacious brief interventions

8) Participate in community groups (eg, Rotarians) and recruit community leaders interested in enhancing the value of care that is being delivered to the community

9) Intersect with the state’s evolving HIE and structure information collection so that disease classification information can be transmitted to an HIE capable of accepting that information. Constantly improve the practice’s ability to collect disease classification information and include that information within the practice’s concept driven EMR.

10) Code reponsively with the help of a viable clinical concept parser, emphasize patient communication, use evidence and experience to follow-up on disease classification information by using efficacious brief interventions and systematically track outcomes while emphasizing 24 x 7 continuity of outpatient internal medicine care.

Telemedicine Panel at CES Hosted by HealthSpot

Posted on January 9, 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.

I had the chance to attend a Telemedicine panel today at CES that was put together by HealthSpot (see my previous post about HealthSpot at CES). They put together a good panel that included:
Peter Tippett, MD, PHD – Vice President, Connected Healthcare Solutions, Verizon
John F. Jesser – Vice President, Health Care Management, WellPoint
William Wulf, M.D. — Central Ohio Primary Care
Leslie Kelly Hall — Healthwise

The panel was an interesting discussion, but I think the underlying discussion really centered around how screwed up many parts of healthcare are right now. This showed itself in two different ways. One was that telemedicine could possibly fix some of those screwed up parts of healthcare. Second, telemedicine is actually hard to execute because of some of the screwed up parts of healthcare. It’s kind of odd to look at it that way.

I tweeted a number of the comments that struck me and so I thought I’d share them here for those who weren’t following along on Twitter.

This was a fitting comment at a “consumer” electronics show.

I think there are still some wackos;-), but I think the message they send is clear.

This would be a monumental achievement if we can embrace HIPAA and make the technology happen. I think the key message is: HIPAA should not be used as an excuse.

Such a no brainer question with an easy answer. Why is it so hard to do?

Will telemedicine become the “standard of care” so that this becomes a big issue? I hope we don’t reach the point that this is the reason we implement telemedicine, but it might take something like it to get people off the proverbial couch.

2013 Health IT Predictions – 3-D Printing in Healthcare

Posted on January 6, 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.

I never can resist clicking on a tweet that looks at the future landscape of healthcare IT. I love to see what other people are saying about it. Although, as is the case above, I usually find that people are pretty cautious in their predictions. The challenge is that a year is probably not a big enough time frame to really make bold predictions.

For example, the above article suggests the following as major healthcare IT trends: patient portals, mobile devices, and telemedicine. They are absolutely right. Does anyone doubt that all of these things won’t be major happenings in 2013? We know they will because they’ve already started happening today. Next year will just be an extension of this year.

On the other hand, I was intrigued by this tweet about 3-D Printing in healthcare:

If you don’t know about 3-D printing, then check it out on Wikipedia. It is an absolutely incredible technology that’s going to absolutely revolutionize manufacturing products as we know it. That includes many of the products we use in healthcare. Is it going to happen next year? I don’t think so. Certainly much progress will be made in 2013, but 5 years from now 3D printing is going to be able to do insane things when it comes to creating your own products with a simple 3D printer.

I’d love to hear your thoughts. What drastic things do you think will happen in healthcare 5 years from now? Feel free to look even farther out if you prefer.