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Ensuring Patient Comprehension

Posted on October 31, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Erin Gilmer recently posted a very interesting “Literacy Comprehension” form from an Endoscopy Center. Check out the form below:

You have to applaud this effort by a practice to make sure that the patients understand the information being presented to them as part of the procedure. The cynic might argue that the clinic is just trying to cover their backside. However, Erin asks the more important question, “Is this an effective way to prove comprehension?”

I do like how this can open the patient up to the option to have a discussion about something they don’t understand. It sends a good message to the patients in that regard which could make the patient feel more appreciated and help the patient feel comfortable asking a question about something they would have just previously kept to themselves.

However, for those that aren’t literate, I don’t think this form will do much. I expect that many patients that aren’t literate likely get into a zone where they just sign whatever the medical practice gives them regardless of what it is and regardless of whether they can read it or not.

I think the idea is a good one but could be executed better. Could this be done verbally and have a bigger impact? What other ideas have you seen implemented? Do you like this approach or are their better ways to accomplish it?

MACRA Twitter Roundup – MACRA Monday

Posted on October 30, 2017 I Written By

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

We took last week off from our MACRA Monday series of blog posts. It seems like we’re in a kind of lull period for the program. Either you’ve started collecting the data you’ve needed or you haven’t. Plus, we’re kind of waiting for the next MACRA Final rule to drop for more details.

With that in mind, I did want to see what some of the latest things that were being shared on Twitter when it comes to MACRA. I found a lot of strong opinions about the program, some good resources, and some forward-looking thoughts on what could be coming in the next MACRA final rule.


It’s hard to argue with John. Not just because he’s a smart guy, but because he’s right that it’s hard to imagine a path forward that’s fee for service and doesn’t include a shift to value based care in some form or fashion. At least given the current market dynamics.


This caution from Workflow Chuck should have us all nervous about the shift. I see a lot of healthcare organizations going after the target as opposed to the goal of value based care.


MACRA is going to impact your biz. I liked the way Kelly broke it out into 4 areas. No doubt some of these things could be argued both ways.


This is still how most doctors I know feel about MACRA and even meaningful use before it. They feel like they’ve been thrown under the bus.

Here are two forward looking resources that look at what we might get from the MACRA Final Rule:

What else are you hearing about MACRA? Would love to hear your thoughts, insights, questions, perspectives, rants, etc in the comments.

Independent Clinical Archive Brings Complete Patient Record Together in One Place

Posted on October 27, 2017 I Written By

The following is a guest blog post by Tim Kaschinske, Senior Product Manager, North America, BridgeHead Software.

How many photos and documents do you have stored on your home computer or in the cloud? How easily would it be to find those photos of, say, the family beach vacation you took in 2010? What about the trip in 2001? Most of us would have to search blindly through scores of electronic file folders and myriad devices before finding what we need.

Now think about your physicians who need to access historical patient information, such as baseline mammograms, medication history, lab results or the course of a patient’s cancer treatment. Nearly every hospital is on its second or third EMR, and any new EMR vendor wants as little previous data to come over from legacy systems as possible to help ensure a “clean” install. So that leaves physicians and assistants poring through older EMRs, or other applications and media to find needed data. This takes time away from direct patient care, an increasingly critical consideration in value-based care arrangements.

But that older information still has value, for both patient care as well as for regulatory reasons. The problem, then, is how to store, protect and share that information in a way it remains readily accessible, available and readable even as technology changes.

Disparate data, common archive

The answer is an independent clinical archive (ICA) that can accept disparate data from multiple systems such as an EMR or a PACS and store it using open data standards commonly found in healthcare. An ICA does not replace an EMR or a PACS – it works in concert with them, allowing a hospital to formally retire previous EMRs, PACS and other IT systems while ensuring the electronic patient data contained within lives on as part of the 360-degree patient view. This saves money on licensing fees, storage costs and IT personnel costs to maintain and update rarely used technology.

An ICA is a centralized, standards-based data repository that ingests disparate data types such as DICOM images, HL7 reports, physician notes and other unstructured data. Information is managed based on unique patient information and further subdivided by specialty or date, for example. The ICA works best when integrated with a hospital’s EMR (via an application programming interface (API)), allowing providers to seamlessly compile a complete, longitudinal patient record without having to remember additional log-ins.

APIs are also used to connect to multiple legacy systems. However, security protocols on legacy systems are not as stringent as they are with newer technology, leaving hospitals potentially vulnerable to accidental or intentional data breaches. A hospital using an ICA as a central data repository only requires APIs among the ICA, the EMR and the PACS. Plus, the ICA has built-in security and protection features to ensure the safeguarding of critical patient data.

A true, 360-degree patient view

When an ICA is properly implemented, providers access the information being populated from the EMR and the information coming from the ICA through one system and in the appropriate context for the patient. And that’s the holy grail of patient information: one environment aggregating all of the information outlining chronic conditions, physician notes, medications, diagnoses, surgeries and much more.

And if a physician needs to drill down into radiology reports, for instance, he can pull up just that data. Finding information about a specific hospitalization is as easy as inputting the correct date range to locate just those records.

While Software-as-a-Service revolutionized the delivery of IT services, an ICA can revolutionize the way physicians find all of the data they need, quickly and within their normal workflows. At the same time, hospitals can save money and increase data security by retiring older electronic systems.

EHR Data Allows Hospital To Find C. Diff Source

Posted on October 26, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Here’s a kind of story that makes you feel better about your EHR investment. A new journal article is reporting that researchers were able to find a source of Clostridium difficile within a hospital, not with elaborate big data analytics but simply by using basic EHR data.

According to the item, which appeared in JAMA Internal Medicine, a group of researchers examined EHR data on time and location to map roughly 435,000 patient location changes at the University of California San Francisco Medical Center. The effort was led by Russ Cucina, chief health information officer at UCSF.

After analyzing overall data, the researchers found a total of 1,152 cases of laboratory-documented CDI. The data indicated that CDI-positive patients moved through an average of four locations during their hospitalization, but that the CDI events came from a single location.

Researchers concluded that when patients were exposed to C. diff infections in the emergency department’s CT scanner, it was associated with a 4% incidence of CDI. They also noted that the association between CT exposure and CDI was still significant even after adjusting other influences such as antibiotic use and patients’ length of hospital stay. The association also remained significant when their sensitivity analysis extended the incubation period from 24 to 72 hours.

Having identified the CT as a potential vector of infection, the hospital next looked at how the that happened. It found that cleaning practices for the device didn’t meet the standards set for other radiology suites, and took steps to address the problem.

While healthcare leaders will ultimately use EHR data to make broad process changes, addressing day-to-day problems that impact care is also valuable. After all, finding the source of CDI is no trivial manner.

For example, a study recently concluded that ambulatory care organizations can do a pretty good job of analyzing their workflow by using EHR timestamp data.

Researchers had developed the study, a write up of which appeared in the Journal of the American Medical Informatics Association, to look at how such data be could be used in outpatient settings. Aware that many outpatient organizations don’t have the resources to conduct workflow studies, the researchers looked for alternatives.

During the research process, the team began by studying the workflow at four outpatient ophthalmology clinics associated with the Oregon Health and Science University, timing each workflow step. They then mapped the EHR timestamps to the workflow timings to see how they compared.

As it turned out, the workflow times generated by analyzing EHR timestamps were within three minutes of observed times for more than 80% of the clinics’ appointments. The study offers evidence that outpatient organizations can examine their workflow without spending a fortune, using data they already collect automatically.

Of course, hospitals will continue to do more in-depth workflow analyses using higher-end tools like big data analytics software. These efforts will provide a multidimensional picture that wouldn’t be available using only timestamp analysis.  But for hospitals and clinics with fewer resources, timestamp analysis may be a starting point for some useful research.

IBM Works To Avoid FDA Oversight For Its Watson Software

Posted on October 25, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I live in DC, where the fog of politics permeates the air. Maybe that’s given me more of a taste for political inside baseball than most. But lest the following story seems to fall into that category, put that aside – it actually involves some moves that could affect all of us.

According to Stat News, IBM has been lobbying hard to have its “cognitive computing” (read: AI) superbrain Watson exempt from FDA oversight. Earlier this year, eight of its employees were registered to lobby Congress on this subject, the site reports.

Through its Watson Health subsidiary, IBM has joined the crowded clinical decision support arena, a software category which could face FDA regulation soon.

Historically, the agency has dragged its heels on issuing CDS review guidelines. In fact, as of late last year, one-third of CDS developers were abandoning product development due to their uncertainty about the outcome of the FDA’s deliberations, according to a survey by the Clinical Decision Support Alliance.

Now, the agency is poised to issue new guidelines clarifying which software types will be reviewed and which will be exempt under the provisions of the 21st Century Cures Act. Naturally, IBM wants Watson to fall into the latter category.

According to Stat News, IBM spent $26.4 million lobbying Congress between 2013 and June 2017. While IBM didn’t disclose how much of that spent on the CDS regulation issue, it did tell the site that it was “one of many organizations, including patient and physician groups, that supported a common sense regulatory distinction between low-risk software and inherently higher-risk technologies.”

IBM also backed a bill known as the Software Act, which was opposed by the FDA office in charge of device regulation but backed enthusiastically by many software makers. The bill, which was first introduced in 2013, specified that health software would be exempted from FDA regulation unless it provided patient-specific recommendations and posed a significant risk to patient safety. It didn’t pass.

Now, executives with the computing giant will soon learn what fruit their lobbying efforts bore. The FDA said it intends to issue guidance documents explaining how it will implement the exemptions in the 21st Century Cures Act during the first quarter of next year.

No matter what direction it takes, the new FDA guidance is likely to be controversial, as key regulatory language in the 21st Century Cures Act remains open to interpretation. The law includes exemptions for advisory systems, but only if it’s they allow “health care professional to independently review the basis for such recommendations.”  Lawyers representing software makers told Stat News that no one’s sure what the phrase “independently review the basis” means, and that’s a big deal.

Regardless, it’s the FDA’s job to figure out what key provisions in the new law mean. In the meantime, waiting will be a bit stressful even for giants like IBM. Big Blue has made a huge bet on Watson Health, and if the FDA doesn’t rule in is favor, it might need a new strategy.

AMA Promotes Common Model For Health Data Organization

Posted on October 24, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

What do we really need to make the best use of shared patient data?  Some say that once we have adequate data sharing protocols in place (such as FHIR or Direct), organizing and using the data will be well within our capabilities. Other efforts assume that if we pulled together the right common data set, deciding how to exchange the data physically won’t be as big of an issue as it has been.

A new initiative from the American Medical Association seems to fall into the latter category The AMA has announced that it’s created a common data model which it says is missing in healthcare. The Integrated Health Model Initiative (IHMI), which has attracted the support of heavy hitters like IBM and Cerner, is a “shared framework for organizing health data, emphasizing patient-centric information, and refining data elements to those most predictive of achieving better outcomes,” according to an AMA statement.

The AMA and its partners said that the new model will include clinically-validated data elements which it says can speed up the development of improved data organization, management and analytics. Its initial focus will be on costly chronic diseases such as hypertension, diabetes and asthma.

The effort will include technical development efforts which will address interoperability problems, cumbersome or inadequate data structures and poor interface designs which forced physicians to click far too often, the trade group said.

From my standpoint, there’s a lot that’s hazy about this announcement, which was long on form but pretty short on substance.

For one thing, it’s not clear what Cerner, in particular, is getting out of this effort. It’s already an anchor member of the CommonWell Health Alliance which, having merged with rival group Carequality, arguably offers as mature an interoperability model as any out there today. Also, while even a giant like IBM needs continued press attention, I’m not sure how much benefit it will realize here.

Not only that, it’s hard to tell where the AMA and partners will take IHMI. The trade group has posted a set of data model specifications to its site. The group has also created a process wherein physicians review data elements and missions and decide whether they meet clinical applicability and consistency requirements. In addition, it’s creating technical and clinical communities focused on key sub-areas of interest. But it’s still not clear what all of this means and why it’s important.

Ultimately, the initial press release is as much a buzzword cloud as it is a statement of intent. Pardon my cynicism, but I doubt even a group with the AMA’s clout can fix interoperability problems, streamline data structures and foster more elegant UI design in health IT in one fell swoop.

The announcement does do something useful regardless, however. While I’m not personally qualified to say whether it will take universally accepted standards for data exchange, a widely-used reference set for health data or both, I believe someone should address these questions. As proposed interoperability solutions pop up on both sides, perhaps we’ll get some answers.

 

Better Performing Practices More Efficient with IT Spending According to MGMA

Posted on October 23, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The Medical Group Management Association (MGMA) recently released its 2017 MGMA DataDive Better Performers data, a report that provided a glimpse into the health of US medical practices across four key performance categories:

  1. Operations
  2. Profitability
  3. Productivity
  4. Value

Of the 2,941 physician practices that provided their performance data for the report, only 32 were found to be “better-performing” than their peers in three of the four categories. No practice was considered better-performing on all four categories.

For a deeper dive into the report, check out this post from Anne Zieger.

The report’s most surprising results were in the Operations – Information Technology category:

  • Physician-owned practices spent more than 2x on IT Per FTE Physician than their hospital-owned practices
  • Better performing physician-owned practices spent LESS on IT than their peers
  • Better performing hospital-owned practices spent MORE on IT than their peers

At first glance these results run counter to what many would expect. How could independent physician practices be spending more than 2x hospital-owned practices on IT – especially when you consider that a hospital has many more IT systems and applications.

To help make sense of the results, we sat down with David N Gans, MSHA, FACMPE – Senior Fellow, Industry Affairs at MGMA.

Why are hospital-owned practices spending less overall on HealthIT?

Gans: The raw numbers that we received from the practices was a bit deceiving. What we found was that not all IT costs borne by the hospital are filtering down to the practices owned by that hospital. Server costs, IT department salaries, support costs and network infrastructure costs, for example, did not appear as line item costs for the practices. Only equipment and the EHR licenses used by the practice’s staff were considered IT costs. Independently owned practices, however, bear all the costs associated with IT including licensing, servers, support and ongoing maintenance. Thus, it only appears that hospital owned practices are spending less than their counterparts. It is a quirk of the way costs are allocated in a hospital setting.

Why are better performing physician-owned practices spending less on HealthIT than their peers?

Gans: The scoring system we used for this report rewards efficiency. The more efficient you are in any category, the higher you will score. Using that lens, practices that were more judicious with their IT spending achieved higher efficiency scores. What you are seeing in the report results is an associative effect – the more effective you are with IT, the more efficient your practice is considered.

Gans was quick to point out that the survey did not measure the impact of or the outcomes achieved from the implementation of HealthIT. There was also not linkage between overall IT spend and practice profitability.

Why is it important that practices strive to be efficient. Isn’t that an antiquated notion?

Gans: It’s actually more important than ever for practices to focus on being efficient. If you go back to 2001 and look at three key economic indices it becomes painfully obvious why efficiency is the key to practice survival. Just look at this chart we have compiled:

The red line is the % increase in practice operating costs per FTE Physician relative to what it was in 2001. By 2020, costs will be 116.7% of what they were in 2001. The blue line is the consumer price index. The green line is the rise in Medicare reimbursements. There is no way a physician practice can stay in the black without taking a serious look at their operational efficiency. If you do nothing, costs will eat up your practice.

Gans is hopeful that new technologies and changes to the reimbursement mechanisms will help reduce the performance gap for practices. According to Gans, Artificial Intelligence, like IBM’s Watson, could make practices exponentially more efficient. It can crunch numbers much faster than a human ever could, which would allow physicians to offer more personalized care or care via less expensive channels (ie: telehealth).

“One thing is clear,” says Todd Evenson, Chief Operating Officer at MGMA. “As we change from volume to value, the financial metrics we track in this report will have to change. We will need to de-emphasize the production-style metrics we have used in the past to more value based ones. We will also need to find a way to measure the quality of care provided by practices. This will make this report even more important and relevant in the years to come.”

Mercy Shares De-Identified Data With Medtronic

Posted on October 20, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Medtronic has always performed controlled clinical trials to check out the safety and performance of its medical devices. But this time, it’s doing something more.

Dublin-based Medtronic has signed a data-sharing agreement with Mercy, the fifth largest Catholic health system in the U.S.  Under the terms of the agreement, the two are establishing a new data sharing and analysis network intended to help gather clinical evidence for medical device innovation, the company said.

Working with Mercy Technology Services, Medtronic will capture de-identified data from about 80,000 Mercy patients with heart failure. The device maker will use that data to explore real-world factors governing their response to Cardiac Resynchronization Therapy, a heart failure treatment option which helps some patients.

Medtronic believes that the de-identified patient data Mercy supplies could help improve device performance, according to Dr. Rick Kuntz, senior vice president of strategic scientific operations with Medtronic. “Having the ability to study patient care pathways and conditions before and after exposure to a medical device is crucial to understanding how those devices perform outside of controlled clinical trial setting,” said Kuntz in a prepared statement.

Mercy’s agreement with Medtronic is not unique. In fact, academic medical centers, pharmaceutical companies, health insurers and increasingly, broad-based technology giants are getting into the health data sharing game.

For example, earlier this year Google announced that it was expanding its partnerships with three high-profile academic medical centers under which they work to better analyze clinical data. According to Healthcare IT News, the partners will examine how machine learning can be used in clinical settings to sift through EMR data and find ways to improve outcomes.

“Advanced machine learning is mature enough to start accurately predicting medical events – such as whether patients will be hospitalized, how long they will stay, and whether the health is deteriorating despite treatment for conditions such as urinary tract infections, pneumonia, or heart failure,” said Google Brain Team researcher Katherine Chou in a blog post.

As with Mercy, the academic medical centers are sharing de-identified data. Chou says that offers plenty of information. “Machine learning can discover patterns in de-identified medical records to predict what is likely to happen next, and thus, anticipate the needs of the patients before they arise,” she wrote.

It’s worth pointing out that “de-identification” refers to a group of techniques for patient data protection which, according to NIST, include suppression of personal identifiers, replacing personal identifiers with an average value for the entire group of data, reporting personal identifiers as being within a given range, exchanging personal identifiers other information and swapping data between records.

It may someday become an issue when someone mixes up de-identification (which makes it quite difficult to define specific patients) and anonymization, a subcategory of de-identification whereby data can never be re-identified. Such confusion would, in short, be bad, as the difference between “de-identified” and “anonymized” matters.

In the meantime, though, de-identified data seems likely to help a wide variety of healthcare organizations do better work. As long as patient data stays private, much good can come of partnerships like the one underway at Mercy.

Current Security Approaches May Encourage EMR Password Sharing

Posted on October 19, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

In theory, you want everyone who accesses a patient’s health data to leave a clear footprint. As a result, it’s standard to assign every clinician using EMR data to be assigned a unique user ID and password. Most healthcare organizations assume that this is a robust way to document who is using the system and what they do when they’re online.

Unfortunately, this may not be the case, which in turn means that providers may know far less about health data users than they think. In fact, this approach may actually undermine efforts to track health data access, according to a new study appearing in the journal Healthcare Informatics Research.

The researchers behind the study created a Google Forms-based survey asking medical and para-medical personnel whether they’d ever obtained another medical staff member’s password, and if so, how many times and what their reasons were.

They gathered a total of 299 responses to their questions. Of that total, 220 respondents (just under 74%) had “borrowed” another staff member’s password. Only 57% answered the question of how many times this had happened, but among those who did respond the average rate was 4.75 episodes. All of the residents taking part had obtained another medical staff member’s password, compared with 57.5 percent of nurses.

The reasons medical staffers gave for sharing passwords included that “I was not given a user account despite having to use the system to fulfill my duties.” This response was particularly prevalent among students. Researchers got similar results when naming the reason “the permissions granted to me did not allow me to a fulfill my duties.”

Given their working conditions, it may be hard for medical staff members to avoid bending the rules. For example, the authors suggest that doctors will at times feel compelled to share password information, as their duties are wide-ranging and may involve performing unplanned services. Also, during on-call hours, interns and residents may need to perform activities that require them to use others’ EMR account information.

The bottom line, researchers said, is that the existing approach to health data security are deeply flawed. The current password-based approach used by most healthcare organizations is “doomed” by how often clinicians share passwords, they argue.

In other words, putting these particular safeguards in effect may actually have the paradoxical effect. Though organizations might be tempted to strengthen the authentication process, doing so can actually worsen the situation by encouraging system workarounds.

To address this problem over the long-term, widely-accepted standards for information security may need to be rethought, they wrote. Specifically, while the ISO standard bases infosec on the principles of confidentiality, integrity and availability, organizations must add usability to the list. Otherwise, it will be difficult to get an-users to cooperate voluntarily, the article concludes.

Telemedicine Becoming Popular, But Seldom Profitable

Posted on October 18, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

New research suggests that while most physicians are supportive of telemedicine, others have grave reservations about providing this type of care, and that more than half of organizations aren’t making money delivering telemedicine services.

In an effort to learn more about attitudes toward telemedicine, Reaction Data surveyed 386 physicians, physician leaders, IT leaders and nurse leaders as well as differences in adoption levels between different types of organizations.,

Some of the top benefits of telemedicine cited by respondents included that it helped providers to meet demand for simpler and more cost-effective care delivery (28%), allowed them to treat more patients (23%) and that it was easing demands on staff (19%). Interestingly, just 10% said that telemedicine was proving to be a viable source of revenue, and elsewhere in the survey, 14% reported that telemedicine was revenue-negative.

The majority of physicians (68%) reported that they were in favor of telemedicine, while another 15% took a neutral position. Only 17% didn’t support widespread telemedicine use.

Their responses varied more, however, when it came to how much of care could be effectively delivered via telemedicine.

Thirty-two percent felt that 0 to 20% of care could be delivered this way; 33% of physician respondents felt that 30 to 40% care could be delivered digitally; 19% of respondents said 50 to 60% of care could be provided via telemedicine; 14% felt that 70 to 80% of care could be provided digitally. Just 2% felt that 90 to 100% of care could be delivered via this channel.

When it came to actually delivering the care themselves — rather than a hypothetical situation — respondents seemed less flexible. For example, 33% said that they would never contract with an outsourced telemedicine company to provide patient consults.

On the other hand, 50% said they’d considered moonlighting as a telemedicine consultant, 7% said they’d already done so frequently, 8% said they delivered such consults occasionally 2% said that was all they did for a living.

Regardless, many healthcare organizations are adopting this approach on a corporate level. Sixty-one percent of hospitals in a health system said they adopted telemedicine: 40% of standalone hospitals had done so; 58% practices owned by a health system has that this technology. Only 17% of physician-owned practices had done so, which could reflect cultural issues, costs or technology adoption concerns.

Physicians that were delivering telemedicine services most often used them to reach patients in rural areas (24%), provide follow-up care (24%) and manage specific patient populations (23%).

Among organizations that haven’t adopted telemedicine, many are scarcely getting their feet wet. While one in three providers are evaluating telemedicine options currently, 20% are two years or more away from adoption and 26% said they would never move in this direction.

Meanwhile, roughly one-third of physician-owned practices reported that they would never adopt telemedicine. One responding physician called it “inherent malpractice,” and another called it a “blatant attempt to circumvent the physical examination.” It seems unlikely that these clinicians will change their views on this topic.