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Doctor on Demand Stats Offer Insight Into Telmedicine Trends

Posted on January 5, 2018 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.

Recently, direct-to-consumer telemedicine provider Doctor on Demand released some statistics on its performance in 2017. While some of the report was self-congratulatory, I still think the data points are worth looking at, especially for clinicians.

For starters, it’s worth noting that the company now considers itself a fully integrated medical practice. For example, it’s begun offering lab testing services through Quest Diagnostics and Lab Corp. as part of a program to control chronic conditions such as diabetes, high blood pressure and high cholesterol levels.

Another factoid the stats offer is that its physicians are generally in their mid-career; apparently, Doctor on Demand’s average physician has 15 years of experience. The company doesn’t offer any perspective on why that might be, but it suggests to me that clinicians who participate are both confident that they can manage care remotely and comfortable with technology.

Why is that the case? My guess is that this work may not be attractive to younger doctors, who might feel uneasy managing patients online given their lack of experience. It also suggests older physicians, some of whom still consider telemedicine to be a poor substitute for face-to-face care, probably aren’t engaging with telemedicine either.

Other data provided by Doctor on Demand includes the top reasons for visits included treatment of cold and flu, prescription refills and infections, which isn’t surprising. It also notes that mental health visits climbed 240% over 2016, with anxiety, depression and stress being the most common symptoms treated. This is more interesting, as it suggests that among other problems, consumers feel they aren’t getting their mental health needs met in real life.

Meanwhile, when it comes to the company’s self-reported benefit statistics, I’m taking them with a large grain of salt, but I found them to be worth a look nonetheless. The company says it saved its patients nearly $1 billion in healthcare costs and saved over 1.6 million hours that would otherwise have been spent in doctor’s waiting rooms. These results were allegedly generated by a base of 1 million patients, according to the San Francisco Business Times.

I’m not writing this to suggest that Doctor on Demand is better or worse than other telemedicine companies and video services offered by privately-employed physicians or hospital telemedicine services. Still, I got a kick out of learning what trends a well-positioned telemedicine service was seeing in the marketplace. While Doctor on Demand’s results may not reflect the market as a whole, they certainly offer food for thought.

Alexa and Medical Practices

Posted on December 12, 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.

Today I was asked to do a webinar for Solutionreach on the topic of “What You Need to Know for 2018: From Government Regulations to New Technology.” It was a fun webinar to put together and I believe you can still register and get access to the recorded version of the webinar.

In my presentation, I covered a lot of ground including talking about the consumerization of healthcare and how our retail experiences are so different than our healthcare experiences. In 2018, I see the wave of technology that’s available to make a medical practice’s patient experience be much closer to a patient’s retail experience. That’s exciting.

One of the areas I mentioned is the move to voice-powered devices like Amazon Echo, Google Home, Siri, etc. Someone asked a question about how quickly these devices were going to hit healthcare. No doubt they have experienced how amazing these devices are in their home (I have 2 at home and love them), but the idea of connecting with your doctor through Alexa is a little mind bending. It goes against our normal rational thoughts. However, it will absolutely happen.

Just to be clear, Alexa is not currently HIPAA compliant. However, many things we want to do in healthcare don’t require PHI. Plus, if the patient agrees to do it, then HIPAA is not an issue. It’s not very hard to see how patients could ask “Alexa, when is my next appointment?” or even “Alexa, please schedule an appointment with my OB/GYN on Friday in the afternoon.” The technology is almost there to do this. Especially if you tie this in to one of the patient self scheduling tools. Pretty amazing to consider, no?

I also highlighted how the latest Amazon Echo Show includes a video screen as well. It’s easy to see how one could say, “Alexa, please connect me with my doctor.” Then, Alexa could connect you with a doctor for a telemedicine visit all through the Alexa Show. Ideally, this would be your primary care doctor, but most patients will be ok with a doctor of any sort in order to make the experience easy and convenient for them.

Of course, we see a lot of other healthcare applications of Alexa. It can help with loneliness. It can help with Alzheimers patients who are asking the same question over and over again and driving their caregiver crazy. It could remind you of medications and track how well you’re doing at taking them or other care plan tracking. And we’re just getting started.

It’s an exciting time to be in healthcare and it won’t be long until voice activated devices like Alexa are connecting us to our healthcare and improving our health.

What do you think of Alexa and other related solutions? Where do you see it having success in healthcare? How long will it take for us to get there?

Note: Solutionreach is a Healthcare Scene sponsor.

Telehealth and Its Contribution to Healthcare

Posted on December 6, 2017 I Written By

The following is a guest blog post by Juan Pablo Segura, Co-founder & President of Babyscripts.

In 2016, Americans spent roughly 18% of GDP on healthcare. Abetted by an aging population and continuously rising costs of care, CMS projects that this number will only grow over the next decade, increasing at an average of 5.6% annually. A crisis seems unavoidable: yet a huge fraction of this sum is lost to inefficient spending, which, when compared to other factors like an aging population, socio-economic challenges, or expensive new treatments, seems completely within the industry’s control to control and eliminate. A new OECD report calculates that approximately 20 cents out of every dollar spent on healthcare are considered unnecessary.

Could a simple reallocation of time and resources be enough to check the seemingly inevitable? The potential cost-savings of such a reallocation has policymakers and health professionals poised to revolutionize healthcare, as an industry that has long been resistant to innovation rejects antiquated models of care for more efficient methods that prioritize patient and provider alike.

A simple resolution that is already allowing more patients to receive necessary and important primary care is the extension of care teams through mid-level providers that cost a fraction of the salary of a full time physician. Physician’s Assistants and nurse practitioners are being granted more autonomy, as State governments remove restrictions while enacting legislation that grants PAs and other personnel full prescriptive authority. Allowing these lower cost health professionals to perform routine, primary care instead of more expensive, specialized physicians, immediately eliminates inefficiencies in the system and increases access to care to patients in the midst of a physician shortage.

These changes in personnel are necessary, but not enough to respond to the changing face of care. The answer to more affordable care is in leveraging existing technologies.

The rapid adoption of synchronous, video visits between patients and providers across the country is an exciting example of how technology can eliminate waste and help the system reallocate its resources. Recognizing its potential to decrease the administrative demands on providers and facilitate access to patients in remote areas, the industry has placed great emphasis on this aspect of telemedicine, even to the extent of providing incentives to providers for facilitating care through video.

But far from being the solution, video visits just scratch the surface of technology’s potential contributions to affordable healthcare, and in fact are the least beneficial of the efficiencies that technology is poised to provide. Some studies have indicated that when video visits are included in a medical plan, patients tend to treat them as an add-on, rather than a replacement for traditional in-person care. Furthermore, without integrated systems, video visits function much as if a patient were receiving all medical care at the ER, producing a fractured and incomplete medical record.

The dialogue must be centered on those innovations that revolutionize the way we approach healthcare, not simply attempt to translate an outdated system into a world that has evolved past it.

The conversation needs to focus on the most relevant, effective and impactful technology tools to affect the ultimate cost of care. Already, forward thinking providers like Greenville Health are creating end to end “virtual strategies” that rely heavily on remote monitoring apps and asynchronous visits that have the capacity to identify the problems before they begin. Beyond the immediate benefit of proper allocation of time and resources, the ultimate goal of technological innovation in healthcare has always been the opportunity to identify potential problems and create the necessary infrastructure to allow our healthcare system to focus on preventative health.

Of the healthcare apps currently in the digital marketplace, some have been shown not only to decrease costs but to be as successful as medication in preventing complications, anticipating a future of decreased prescription costs. Remote monitoring programs that use IOT devices like blood pressure cuffs and weight scales have reduced the cost of prenatal care by 40% while detecting problems like preeclampsia and other high-risk illnesses. Yet there is very little coding or direct payer incentive for deploying preventative technologies like that provided for video visits.

And why not? Video visits are a move in the right direction, but the decrease to cost of care does not have to come at the expense of the client/physician relationship or integrated care. Instead, effective technology should cut costs while assuring patient and provider of the continuity and efficacy of care.

The conversation amongst policymakers needs to expand to include these more revolutionary aspects of digital health, rewarding those who are effectively reducing costs without compromising care. Digital health will not be confined to a narrow vision, but it is up to the government and the industry to expedite the future of healthcare.

About Juan Pablo Segura
Juan Pablo Segura is Co-founder & President of Babyscripts, a Washington, DC-based technology company that builds mobile and digital tools to empower women to have better pregnancies. Juan Pablo was named a Wireless Life Saver by CTIA and a health care Transformer by the Startup Health Academy in New York City.

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.

Everything Old is New Again at Lenovo #HIThinkTank Event

Posted on June 28, 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.

Last week in Durham NC, 35 healthcare innovators gathered at the Lenovo offices to discuss three trendy topics: Value-base care, connected health and virtual care. Dubbed the Health Innovation Think Tank #HIThinkTank, it was the first summit-style event hosted by Lenovo Health.

#HIThinkTank was designed to be an opportunity for audience members to learn about the latest innovations from leading academics, technology companies and healthcare organizations. I went into the event expecting to hear about the latest in artificial intelligence, big data, predictive analytics and genomic medicine. It did not turn out to be that kind of event…and it was all the better for it.

I would say that the overall theme of #HIThinkTank was innovation through the application of old ideas in new ways. In other words, everything old is new again in healthcare.

The day started with Rasu Shrestha MD, Chief Innovation Officer at UMPC Enterprises, emphatically stating that we are “in a time of tremendous opportunity in healthcare” and that it was “time for us to move from ‘doing digital’ to truly ‘being digital’”. Shrestha went on to explain that our challenge now was to reimagine clinical processes/workflows in light of modern technologies and methodologies. Like the re-engineering wave that swept through manufacturing in the 1980s, Shrestha believes it’s time to engage all stakeholders and collaborate on reworking healthcare.

Shrestha was followed by Juliet Silver of Perficient who gave us all a dose of reality by telling her personal healthcare story. The day Silver’s husband was diagnosed with cancer was the day she became an advocate – “Google searching and academic research quickly became my constant companions as we struggled to make sense of his disease.” Silver made specific mention of how she had to manually obtain paper copies of her husband’s medical records in order to share them with members of his care team and what a difference that made in his care. She hinted that patients may be the key to truly solving healthcare’s interoperability problem as they are the one stakeholder with the most to lose/gain.

After Silver, several speakers made their case for a return to a more community-based approach to healthcare – one that harkens back to the days of early pioneers when physicians, nurses and members of the community worked together to keep each other healthy.

Holly Miller MD of MedAllies presented the results of a local implementation of CMS’s Comprehensive Primary Care Plus (CPC+) program – a program that stressed simple post-discharge follow-up as a way to reduce readmissions and keep overall healthcare spending to a minimum. Miller specifically mentioned how community doctors do this all the time.

This was echoed by Marty Fattig, CEO of Nemaha County Hospital, a 16-bed facility 60 miles south of Omaha NE. Fattig spoke at length about the successful EHR, HIE data sharing and population health initiatives by his staff. Particularly noteworthy was his repeated statement: “We may not have the financial or technical resources of the large networks, but we get stuff done because we are all driven to improve the health of our community peers. It makes a big difference that we see our patients at church, at the grocery store and at the post office.” Ironically this old fashioned community approach to delivering healthcare is now the goal of many healthcare organizations.

In the afternoon Steve Aylward of Change Healthcare and Dr Sylvan Waller led the discussion on virtual care by first reminding the audience that over 90% of virtual visits still happen via the phone. Video consults is the fastest growing area of virtual care, but it has a long way to go to catch up to the telephone. Dr Waller said it best “In 30 years #telehealth will finally become the overnight success everyone expects it to be”. Both Aylward and Waller stressed that we cannot lose sight of these “older technologies” that work for patients when we think about innovation.

For me, what drove home this theme of old-is-new-again was the afternoon tour of the Lenovo model data center. This new highly efficient and “green” room prominently featured Lenovo’s latest innovation – direct water-cooled servers. The new NeXtScale WCT server series boasts high pressure water lines that physically run through the server and draw heat directly away from the quad CPUs. Back in the early 90’s I remember getting a tour of an IBM facility (not far from Lenovo’s facility in Durham) that still had a functioning 308X mainframe that featured…you guessed it…water cooling technology.

All in all, I walked away from #HIThinkTank feeling encouraged about the future of healthcare. It was refreshing to be at an innovation event and hear about actual successful implementations rather than pie-in-the-sky promises. The event reaffirmed my belief that technology alone is insufficient to fix healthcare. Those of us in HealthIT need to do more than just create cool products, we need to help clients re-engineer their internal processes to better utilize those products to improve community health.

As Dr Shrestha said – It’s time for us to stop doing digital and truly be digital.

 E-Patient Update:  The Impact Of Telehealth Confusion

Posted on January 27, 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 am a huge fan of telemedicine consults. As far as I can tell, all of the chronic conditions I currently cope with can be addressed effectively by a virtual visit unless I’m in a medical crisis.

My reasons are not unusual. Like most people, I hate having to drive to a doctor’s office if I’m already feeling yucky, particularly if it’s not necessary. And since time is money – particularly when you work for yourself like me – there’s some material benefits to telehealth too. Not only that, since I’m a tech fan who lives online, these contacts “feel” as real as face-to-face visits, so I don’t have lingering doubts that I’m not getting much for my money.

Getting a quick visit in regarding an acute medical issue (like, say, a sinus infection) has been pretty easy and relatively affordable as well. But reaching out to a new specialist – or even connecting with my existing providers — is another story. Over the last several months, I’ve encountered a number of barriers which seem to be fairly entrenched in the system.

Garbage contact info

Over the last year, I’ve been with two major health insurers (CIGNA and United Healthcare) whose databases included a list of specialists which were allegedly willing to do telehealth consults. But as it turns out, actually moving ahead with such visits has been impossible.

At one point, I decided to go all out and see if I could actually schedule a telehealth visit with one type of specialist I need. Armed with a list of providers who were supposedly up for it, I called perhaps 15 or 20 offices to see how I could schedule my first virtual visit. But I got nowhere. Most of the physicians simply never returned my calls, and in the rare cases where I got a live person, they had no idea what I was talking about.

I’m assuming that this happened because the doctors had the option to check a “telemedicine” box if they were generally interested in implementing it, and that few if any had actually gone ahead with their plans. But I’m still very annoyed with the whole thing. Sure, insurers don’t have perfect information on hand at any given moment, but isn’t in their interests to steer patients to less-expensive telehealth services if they’re available?

Coverage confusion

Another thing that astonishes me is that while I allegedly have telemedicine coverage via my current insurer (CIGNA) I can’t find anyone who has the slightest idea of how I should use it!  I have called CIGNA’s call center four or five times in an attempt to straighten this out, but none of the reps I spoke with had a clue as to which providers were covered by my policy, if any, and under what circumstances.

At some point, telemedicine coverage will be known as “coverage,” of course. There’s really no reason to segment it out into a separate category if you’re going to pay for it anyway. But at present, if CIGNA is any indication, there’s still some confusion around how and when coverage is even applicable. I can’t understand it, but I can attest to you that such foolishness is a Real Thing.

Launch fears

The other problem I’ve encountered is that while medical practices may have the technical capability to deploy telemedicine, they seem afraid to do so. I’ve asked many of my doctors (and their staff) what it will take for them to begin offering virtual visits, and I’ve gotten a mix of confusion and concern. None, even for example the fairly large and seemingly well-funded PCP office I visit, appears to be anywhere close to rolling out such services.

I can’t prove it, but my sense is that two things are going on here. First, I sense that practice leaders don’t feel ready to take on the technical challenges involved in supporting virtual visits. Though my guess is that security is the only real issue — which can be addressed by using the right vendor — they seem quite timid about even experimenting with this approach. Second, I am pretty sure they’re not sure how to handle billing, or alternatively, what to charge if they don’t bill insurance.

I admit their concerns are reality-based. But I’d argue that the benefits of offering telehealth far outweigh these concerns. Apparently, my doctors don’t agree just yet.

Ultimately, I think we’d all agree that telemedicine uptake will grow by leaps and bounds over the next several years. But it seems we’ll have to deal with a lot of administrivia before that can happen.

American Well Deal Adds Remote Physical Exams To Its Offerings

Posted on December 9, 2016 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.

Telehealth provider American Well has partnered with a vendor allowing patients to conduct and transfer data from their own basic physical exam during telemedical consults.

The partner, TytoCare, offers an “examination platform” allowing patients to do their own medical examination of the heart, lungs, abdomen, ears, throat, skin and temperature at home, then share the information with the clinician before or during their virtual visit.

Tyto’s consumer platform TytoHome, which is priced at $299, combines a digital stethoscope, otoscope, thermometer and examination camera. The company also offers a model, TytoPro, designed for professional use, which offers extended battery life, a headset for listening to heart and lung sounds, initial set of disposables for the otoscope and tongue depressor, and software designed specifically for clinician use. The company doesn’t say what the Pro technology costs.

Tyto’s software platform, meanwhile, offers cloud-based secure digital exchange of clinical data and a clinical repository. The company says it can integrate with most EHR systems as part of its TytoLink integration services. It doesn’t say what those integration services will cost, but it seems likely that they don’t come free.

At least at the outset, the partners plan to deliver services to health systems and employers, but without a doubt plans to scale beyond this. And they’re likely to have the resources to do so. American Well has established a foothold in telemedicine, while Tyto Care has received over $19 million in funding to date from investors that include Walgreens.

It’s worth noting at this point that TytoCare is far from the only player in the market offering remote examination tools. For example, I’m familiar with at least one vendor, MedWand Digital Health, offering a similar bundle of remote examination technologies. The MedWand platform lets consumers measure their heart rate or pulse or pulse ox level, listen to their heart, lungs or abdomen, look into their mouth, throat and ears, examine their skin and take the temperature. It can also integrate with other remote monitoring tools, such as connected glucometers of blood pressure monitors. It sells for $249.

And MedWand, like TytoCare, has venture backing, in this case from a technical partner. The company recently received a “major” investment from the venture arm for Maxim Integrated Products, which designs, manufactures and sells semiconductor products.

In my opinion, however, American Well may have a meaningful advantage over other competitors, as it appears to have fairly strong connections with health plans and health systems. The telehealth vendor has partnerships with more than 170 health plans and systems, and has created an enterprise telehealth platform designed to connect with providers’ clinical information systems.

While a company like MedWand may be better position to scale up a consumer technology offering — given backing by a semiconductor maker — over the near term I’d argue that better to be on good terms with those delivering and financing care. Right now, my guess is that very few consumers are willing to sink almost $300 into a home telehealth platform, even if they occasionally use telemedicine services, but this seems little doubt that health systems and health plans see the value of offering such services in a sophisticated way.

If I were either of these companies — or one of their competitors — I’d try to employers, health plans and health systems to buy and place the devices in the homes of chronically ill or high risk patients. But I don’t know if that’s in their plans. Let’s see how the next 12 months go.

Talking Health Transformation at the First Ever #ATAChat

Posted on October 27, 2016 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.

telemedicine-twitter-chat-ata

I’m excited to be the first host of the newly launched #ATAChat organized by the American Academy of Telemedicine. I was lucky to run into Nathaniel Lacktman, an expert legal resource on telehealth, at a recent conference and from that meeting it led to the opportunity for Healthcare Scene to host the first American Telemedicine Association Twitter chat.

For the first Twitter chat, we left the conversation pretty open ended to cover a variety of innovations and transformations happening in healthcare and telehealth. I imagine future ATA Chats will dive deeper into the challenges of telehealth and healthcare transformation. If you have an interest in this area, come and share your insights in what you see happening and things you’re working on. Plus, you’ll be able to learn and connect with a wide variety of other healthcare innovators.

To join the #ATAChat on Twitter, just search for the #ATAChat hashtag on Wednesday, November 9, 2016 at 2 PM ET (11 AM PT). We’ll post the following 5 questions over the hour long chat:

  1. What role should technology play in healthcare and innovation?
  2. What are some of the most exciting ways providers are using virtual care to deliver services?
  3. How is telehealth changing the role of healthcare professionals’ “human touch”, and is it a good thing for patients?
  4. What are the biggest barriers to healthcare innovation and what solutions can we use to navigate them?
  5. What are the best opportunities and areas of unmet need for telehealth and virtual care in the next 3 years?

If you have an insight, question, or comment, just add #ATAChat to your tweets and everyone that’s following along will see it. We hope to make it a really interactive discussion. Plus, it’s always fun to meet new and interesting people that you can connect with on social media.

I look forward to seeing everyone at the #ACAChat on Wed November 9th!

One Example Of An Enterprise Telehealth System

Posted on August 30, 2016 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.

While there’s a lot of talk about how telehealth visits need to be integrated with EMRs, I’m not aware of any well thought-out model for doing so. In the absence of such standardized models, I thought it worth looking at the approach taken by American Well, one of a growing list of telehealth firms which are not owned by a pre-existing provider organization. (Other examples of such telemedicine companies include MD Live, Teladoc and Doctor on Demand.)

American Well is now working with more than 170 health plans and health systems to streamline and integrate the telehealth process with provider workflows. To support these partners, it has created an enterprise telehealth platform designed to connect with providers’ clinical information systems, according to Craig Bagley, director of sales engineering for the firm.

Bagley, who recently hosted a webinar on EMR/telehealth integration for AW, said its system was designed to let providers offer telehealth consults labeled with their own brand name. Using its system, patients move through as follows, he said:

  • First, new patients sign up and enter their insurance information and demographics, which are entered into AW’s system.
  • Next, they are automatically connected to the provider’s EMR system. At that point, they can review their clinical history, schedule visits and get notifications. They can also contact their doctor(s).
  • At this point, they enter the telehealth system’s virtual “waiting room.” Behind the scenes, doctors can view the patients who are in the waiting room, and if they click on a patient name, they can review patient information collected from the EMR, as well as the reason for the visit.

Now, I’m not presenting this model as perfect. Ultimately, providers will need their EMR vendors to support virtual visits directly, and find ways to characterize and store the video content generated by such visits as well. This is becoming steadily more important as telemedicine deployments hit their stride in provider organizations.

True, it looks like AW’s approach helps providers move in this direction, but only somewhat. While it may do a good job of connecting patients and physicians to existing clinical information, it doesn’t sound as though it actually does “integrate” notes from the telehealth consult in any meaningful way.

Not only that, there are definitely security questions that might arise when considering a rollout of this technology. To be fair, I’m not privy to the details of how AW’s platform is deployed, but there’s always HIPAA concerns that come up when an outside vendor like AW interacts with your EMR. Of course, you may be handing off clinical information to far less healthcare-focused vendors under some business associate contracts, but still, it’s a consideration.

And no matter how elegant AW’s workaround is – if “workaround” is a fair word – it’s still not enough yet. It’s going to be a while before players in this category serve as any kind of a substitute for EMR-based conferencing technology which can document such visits dynamically.

Nonetheless, I was interested to see where AW is headed. It looks like we’re just at the start of the enterprise-level telemedicine system, but it’s still a much-needed step.

E-Patient Update: Video Visits Need EMR Support

Posted on July 11, 2016 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.

From what I’ve read, many providers would like to deliver telemedicine consults through their EMR platform. This makes sense, as doing so would probably include the ability to document such visits in the same way as face-to-face encounters. It would also make it far easier to merge notes from telehealth visits into existing records of traditional care.

Unfortunately, there’s little reason to believe that this will be possible anytime soon. If nothing else, vendors won’t face too much pressure from providers until the health insurers routinely pay for such care. Or one could argue that until providers are living on value-based care models, they have little incentive to aggressively push care to lower-cost channels like telemedicine. Either way, EMR vendors aren’t likely to focus on this issue in the near term.

But I’d argue that providers have strong reasons to add EMR support to their telemedicine efforts. If they don’t take the bull by the horns now, and train patients to see video visits as legitimate and worthwhile, they are unlikely to leverage telehealth fully when it becomes central to the delivery of care. And that means, in part, that providers must document video consults and integrate that data into their EMR anyway they can. After all, patients are already beginning to understand that it data doesn’t appear in their electronic record, it probably isn’t important to their health.

It seems to me that the lagging EMR support for telemedicine visits springs in part from how they grew up. Just the other day, I had a video visit with a primary care doc working for one of the major direct-to-consumer telehealth services. And his comments gave me some insight into how this issue has evolved.

As sometimes happens, I ended up straying from discussion of my health needs to comment on HIT issues with the visit, notably to complain about the fact that I had to reenter my long list of daily meds every time I sought help from that service. He agreed that it was a problem, but also pointed out that the service’s founders have assumed that their users would almost exclusively be seeking one-off urgent care. In fact, he noted, none of the data collected during the visit is formatted in a way that can be digested easily by an EMR, another result of the assumption that clients would not need a longitudinal record of their telemedical care.

Admittedly, this service is in a different business than hospital or ambulatory care providers with a substantial brick-and-mortar presence. But my guess is that the assumptions upon which the direct-to-consumer businesses were founded are still shared by some traditional providers.

As a patient, I urge providers to give serious thought to better documenting telehealth today, rather than waiting for the vendors to get their act together on that front. If your clinicians are managing relationships by a video visits today, they will be soon. And when that happens I want a coherent record of my digital care to be available. Letting all that data fall through the cracks just doesn’t make sense.