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Providers: Today’s Telehealth Tech Won’t Work For Future

Posted on July 5, 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.

A new study has concluded that while healthcare leaders see major opportunities for growing their use of telehealth technologies, they don’t think existing technologies will meet the demands of the future.

For the study, which was sponsored by Modern Healthcare and Avizia, researchers surveyed more than 280 healthcare executives to see how they saw the future of telehealth programs and delivery models. For the purposes of the study, they defined telehealth as encompassing a broad mix of healthcare approaches, including consumer-focused wireless applications, remote monitoring of vital signs, patient consultations via videoconferencing, transmission of still images, use of patient portals and continuing medical education.

The survey found that 63% of those surveyed used telehealth in some way. Most respondents were with hospitals (72%), followed by physician groups and clinics (52%) and a grab bag of other provider organizations ambulatory centers in nursing homes (36%).

The most common service lines in use by the surveyed providers included stroke (44%), behavioral health (39%), staff education and training (28%) and primary care (22%). Other practice areas mentioned, such as neurology, pediatrics and cardiology, came in at less than 20%. Meanwhile, when it comes to telehealth applications they wish they had, patient education and training was at the top list at 34%, followed by remote patient home monitoring (30%) and primary care (27%). Other areas on providers’ wish lists include cardiology (25%), behavioral health (24%), urgent care (20%) and wound care (also 20%).

Not only did surveyed providers hope to see telemedicine extended into other service lines, they’d like to see the technologies used for telehealth delivery change as well. Currently, much telehealth is delivered via a computer workstation on wheels or ‘tablet on a stick.’  But providers would like to see technology platforms advance.

For example, 38% would like to see video visits with clinicians supported by their EMR, 25% would like to offer telemedical appointments through a secure messaging app used by providers and 23% would like to deliver telemedical services through personal mobile devices such as tablets and smartphones.

But what’s driving providers’ interest in telehealth? For most (almost 75%) consumer demand is a key reason for pursuing such programs. Large numbers of respondents also cited the ability to improve clinical outcomes (66%) and value-based care (62%).

That being said, to roll out telehealth in force, many respondents (50%) said they’d have to make investments in telehealth technology and infrastructure. And nearly the same number (48%) said they’d have to address reimbursement issues as well. (It’s worth mentioning, however, that at the time the study was being written, the number of states requiring reimbursement parity between telehealth and traditional care had already risen to 29.)

This study underscores some important reasons why providers are embracing telehealth strategies. Another one pointed out by my colleague John Lynn is that telehealth can encourage early interventions which might otherwise be delayed because patients don’t want to bother with an in-person visit to the doctor’s office. Over time, I suspect additional benefits will emerge as well. This is such an exciting use of technology!

Telemedicine Coverage and Payment Parity

Posted on June 14, 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.

I recently heard Nathaniel Lacktman from Foley & Lardner LLP give the best presentation on telehealth I’d ever seen. I’d never heard someone so familiar with the challenges and laws associated with telehealth. In fact, with that in mind, I’m hoping to get him on a Healthcare Scene interview in the future.

One of the key things he said about telehealth is the need for: Coverage and Payment Parity.

I thought it was the perfect synopsis of what’s holding telehealth back. If we had telehealth insurance coverage and payment parity, then telehealth services would go through the roof! Although, it’s worth pointing out that you need both of these things.

One problem I’ve seen with many telehealth initiatives is that a telehealth visit is treated like a second class citizen. Why would a doctor want to do a telehealth visit if they aren’t getting paid the same? This is why payment parity is so important and hasn’t been addressed nearly enough in the telehealth laws that have been passed.

The real question is why shouldn’t a telehealth visit be paid the same? If you’re able to document and code the telehealth visit to the same level as you would an in-person visit, why would we pay a doctor less for doing the same type of visit, just virtually?

There are a few states where they’re making progress with coverage and payment parity. It’s too bad we don’t have a national effort to get this in place. Telehealth is not the end all be all. It won’t replace all in-person visits to your PCP, but it could replace a lot of them. Plus, it will encourage a lot of early interventions that would have been delayed because a patient didn’t want to go to the hassle of an in-person visit to the doctor’s office.

3 Benefits of Virtual Care Infographic

Posted on May 20, 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.

The people at Carena have put out an infographic that looks at 3 ways virtual clinics are improving care quality. I’d like to see better sources since most of the sources for the data in this infographic come from virtual care providers. However, it’s also interesting to look at the case virtual care providers are making so we can test if they’re living up to those ideals.

What do you think of these 3 benefits? Are they achievable through virtual care?

3 Ways Virtual Clinicals are Improving Care Quality

Telemedicine Rollouts Are Becoming More Mature

Posted on May 19, 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.

For a long time, telemedicine was a big idea whose time had not come. Initially, the biggest obstacles providing video consults was consumer bandwidth. Once we got to the point that most consumers had high-speed Internet connections, proponents struggled to get commercial insurers and federal payers to reimburse providers for telemedicine. We also had to deal with medical licensure which most companies are dealing with by licensing their providers across multiple states (Crazy, but workable). Now, with both categories of payers increasingly paying for such services and patients increasingly willing to pay out of pocket, providers need to figure out which telemedicine business models work.

If I had to guess, I would’ve told you that very few providers have reached the stage where they had developed a fairly mature telemedicine service line. But data gathered by researchers increasingly suggests that I am wrong.

In fact, a new study by KPMG found that about 25% of healthcare providers have implemented telehealth and telemedicine programs which have achieved financial stability and improved efficiency. It should be noted that the study only involved 120 participants who reported they work for providers. Still, I think the results are worth a look.

Despite the success enjoyed by some providers with telemedicine programs, a fair number of providers are at a more tentative stage. Thirty-five percent of respondents said they didn’t have a virtual care program in place, and 40% had said they had just implemented a program. But what stands out to me is that the majority of respondents had telehealth initiatives underway.

Twenty-nine percent of survey respondents said that one of the key reasons they were in favor of telehealth programs is that they felt it would increase patient volumes and loyalty. Other providers have different priorities. Seventeen percent felt that implement the telehealth with help of care coordination for high-risk patients, another 17% said they wanted to reduce costs for access to medical specialists, and 13% said they were interested in telemedicine due to consumer demand.

When asked what challenges they faced in implementing telehealth, 19% said they had other tech priorities, 18% were unsure they had a sustainable business model, and 18% said their organization wasn’t ready to roll out a new technology.

As I see it, telemedicine is set up to get out of neutral and pull out of the gate. We’re probably past the early adopter stage, and as soon as influential players perfect their strategy for telemedicine rollouts, their industry peers are sure to follow.

What remains to be seen is whether providers see telemedicine as integral to the care they deliver, or primarily as a gateway to their brick-and-mortar services. I’d argue that telemedicine services should be positioned as a supplement to live care, a step towards greater continuity of care and the logical next step in going digital. Those who see it as a sideline, or a loyalty builder with no inherent clinical value, are unlikely to benefit as much from a telemedicine rollout.

Admittedly, integrating virtual care poses a host of new technical and administrative problems. But like it or not, telemedicine is important to the future of healthcare. Hold it is at arms’ length to your peril.

Getting Paid for Telemedicine

Posted on March 30, 2015 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.


In case you’re like me and missed the slow rolling out of reimbursement for telemedicine, it looks like it’s slowly becoming a reality. 22 state mandated reimbursement of telemedicine is a really big deal. Makes you wonder if a federal law will be far away.

The biggest complaint I’ve heard over and over from doctors about telemedicine is that they don’t get paid to do it. Sure, every once in a while some will say that they’re not sure how well they can treat a patient over video (which is true in a number of cases), but the majority of the physicians I talk to would have no issue using telemedicine if they could just get paid for doing the work.

In fact, I think it’s some pretty genius marketing of Chiron Health (who created the tweet above) for mentioning in their Twitter profile that they’re a telemedicine provider and they want doctors to get paid for it. That’s a message the resonates with many doctors.

In fact, I think Chiron Health’s website hits the key areas where I’ve seen telemedicine taking off: Follow-Up, Chronic Patients and Behavioral Health. This image from their website describes well where I see Telemedicine working well:
Telemedicine Options

I’ll admit that I didn’t know anything about Chiron Health until today (Looks like they’re hiring which is a good sign for a company). However, I’m impressed by the way they’re approaching the telemedicine market. I’d love to learn more about the ways they help doctors get paid for telemedicine. Although, I’m certain that list is about to grow in a really amazing way. I have no doubt that telemedicine will be an important part of the future of healthcare.

Telehealth, or ‘How to Ditch the Waiting Room’

Posted on February 13, 2015 I Written By

The following is a guest blog post by Ryan Nelson, Director of Business Development for Medical Web Experts.

Navigating the doctor’s office for a non-emergency can feel like getting lost in a quagmire of lengthy routines. For those who choose to forego the experience for as long as possible, haphazardly browsing WebMD in the middle of the night is no better. This could all change soon.

Telemedicine is on the rise as health insurers and employers have become more willing to pay for online video consultations in recent years. Convenience (imagine not having to leave the comfort of your home for every service!) and positive health outcomes – not to mention significant cost savings for both employers and patients – are propelling online video consultations to the forefront of healthcare strategies.

Convenience
People don’t like driving far, and they don’t like spending 45 minutes in a waiting room only to be discharged in under 15. The average wait time for a doctor’s appointment is 20 days in the US. This is more than enough time to deter patients from booking appointments for conditions that could be minor. Doctors usually don’t get reimbursed for time spent taking phone calls, so they often nix the medium altogether. Virtual doctor visits can fulfill patients’ need for instantaneous advice, closing a potentially dangerous communication gap while opening a new business opportunity for healthcare professionals.

A recent Harris Poll survey commissioned by Amwell found that around 40% of consumers would opt for video appointments for both antibiotics and birth control prescriptions, while at least 70% would rather have an online video visit to obtain a prescription than travel to their doctor’s office. Telehealth also offers a good solution for patients with mobility issues or chronic conditions, and it gives patients and doctors in rural or remote communities more options for receiving and dispensing care.

Health Outcomes
Biomed Central’s systematic review of telehealth service studies revealed that health outcomes for telehealth and in-person appointments are usually similar. About one-third of studies showed improved outcomes and only two indicated that telehealth was less effective. One way that online video appointments can improve health outcomes for the general population is to filter out minor health concerns and free up ER staff to deal with more serious ailments in-house. Additionally, video consultations can make it easier for physicians to track the recovery of discharged patients and to monitor patient adherence in a time-sensitive manner.

Cost Savings
The Amwell survey revealed that 64% of patients are willing to attend virtual appointments, challenging the dated assumption that in-person interactions tend to be perceived as a better experience. Contributing to this popularity is the fact that virtual appointments cost much less than an ER visit and are cheaper than an urgent care center or most face-to-face consults, generally figuring in around $40 to $50.

Biomed Central also found that out of 36 studies, nearly two-thirds showed cost savings for employers and patients. Meanwhile, Towers Watson predicted that the number of employers offering telemedicine will increase by 68% in 2015, which would result in $6B in employer savings.

Consumer Concerns
Consumers are concerned about how doctors can thoroughly examine patients through video, according to Amwell. However, the proliferation of self-monitoring mobile devices that can be used in conjunction with video consultations suggests that doctors may be able to get much of the information they need online. Besides, it can be argued that during most medical appointments a doctor doesn’t have much time to perform a comprehensive examination or truly get to know a patient.

Amwell subjects also questioned how a patient can be certain that he or she is speaking to a real doctor; however, this can easily be addressed by medical web platforms that thoroughly screen physicians and can thus provide adequate proof of their qualifications.

Digital Relationships
Research has shown that online video communication improves patient satisfaction and increases efficiency and access to healthcare for all demographics, at all times. While the medium appeals to people across all age groups, it especially appeals to younger, tech-savvy patients. This demographic tends to prefer instantaneous communication for non-emergencies and is generally comfortable communicating despite physical distance.

Consumers already use technology to communicate with their friends and families. Finally, doctors – another one of every person’s most intimate relationships – can join the ranks.

References:
Amwell
Biomed
Towers Watson

Digital Health, Connected Health, Wireless Health, Mobile Health, Telehealth – You Choose

Posted on May 7, 2014 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.

Neil Versel posted a great poll asking people which term they prefer. You can vote on it below:

I usually don’t dig into the terminology and branding side of things. At the end of the day, for me it’s all about making sure that we understand each other. If you call something digital health or connected health or mobile health, they’re all the same genre of item. To be honest, I mostly ignore all of those words and want to know what the application actually does.

However, Neil brought up a good point in his post about the lack of consensus in his poll. Here’s his summary of the poll results:

In any case, these results, however unscientific they may be, are representative of the fact that it is so hard to reach consensus on anything in health IT. They also are symbolic of the silos that still exist in newer technologies.

Consensus in healthcare is really hard. I’m reminded of what someone at the Dell Healthcare Think Tank event I participated in said, “Healthcare is second only to florists when it comes to market fragmentation.” It’s like steering a ship with hundreds of rudders all pointing different directions. Certainly not an easy task and not something I see changing soon.

How Telehealth Connects Patients Healthcare Professionals Infographic

Posted on November 8, 2013 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.

How Telehealth Connects Patients Healthcare Professionals Infographic

Could High Deductible Plans Save Small Practices?

Posted on October 8, 2013 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.

I’ve had a number of really interesting conversations with EHR vendors around the future of small practices in healthcare. In fact, many EHR vendors are focusing their marketing efforts around saving the small practice (more on that in a future post). Although, one topic that’s come up multiple times recently is how the new high deductible plans might be a tremendous opportunity for small practices.

To give credit where credit is due, I first heard this idea from Dr. Tom Giannulli (Check out this Google Hangout I did with Dr. Tom), CMIO of Kareo.

The core concept I took from talking with Dr. Tom and have since morphed with other viewpoints is that patients with high deductible plans can be more selective about who they visit for their care. This presents an opportunity for small physician practices to provide a personalized service to those patients that a large group practice or hospital owned system can’t or won’t provide.

Of course, at the core of this question is whether the small practice does offer a more personalized service than a large group practice. There are many arguments to be made that a small practice can offer a better service. In some ways it’s the eternal battle between mom and pop vs big company. We all love the idea of mom and pop locations that know are name and know our needs. In many ways small practices can provide this same level of service and relationship which is hard to create in a large group practice that’s ruled by numbers.

However, I think one challenge to this idea is that large groups could provide some services which small practices can’t or won’t provide as well. Of course, this assumes that they aren’t too distracted and immovable to actually implement change. I expect that we’ll see some patient facing services that do much better in a large group practice and that would be nearly impossible in a small practice. For example, once telehealth visits become popular, a large group practice could implement a 24×7 telehealth service for patients with emergent needs. A small practice couldn’t do this (although, they could partner with someone to offer something close).

The point is that the battle for these high deductible patients is just beginning. I usually like to put my money on the faster, more nimble organization. The problem is that many small practices aren’t that nimble. In fact, healthcare isn’t nimble (see Mandi’s post today about Inflicting Agile on the Waterfall World of Healthcare). Although, small practice can be nimble if they chose to do so.

Coming full circle, does this present an opportunity for EHR vendors? Can the small practice focused EHR vendors offer a set of features to small practices that enable them to offer a more personalized service to patients? I think there is this opportunity starting with features as simple as e-communication with the clinic, online payments, and personalized care. The real challenge for these EHR vendors is how to balance customer service focused features that patients will love against the onslaught of government regulations which bog down their development teams.

Health IT Costs, Health IT Adoption, HIE and CommonWell – Pre #HITsm Thoughts

Posted on June 28, 2013 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.

Last week I took the #HITsm Chat topics and created a blog post about Healthcare Unbound. I enjoyed creating the post so much that I decided to do it again this week. Not to mention I’ll be on the road to Utah during this week’s chat and won’t be able to participate. (Side Note: If you live in Utah and want to do lunch, I’d love to meet and talk EMR or health IT. I’ll be in Hawaii in July if you want to do the same.)

The chat topics make perfect discussion items. Plus, I love that I have more of an opportunity to really dig into the topics in a blog post. You can’t dig in quite as much in 140 characters.

Topic 1: Costs vs benefits. Will high costs always be the #1 barrier cited to #healthIT adoption?
We’ve seen an enormous shift in the cost of healthcare IT since I first started blogging about EMR 8 years ago. Cost use to be a much bigger issue when the cheapest EMR software you could find was about $30,000+ per doctor (in the ambulatory space). Plus, they expected you to pay the entire lump sum payment up front (many did offer financing). These days the cost of EMR software has dropped dramatically and fewer and fewer EHR vendors are using the lump sum payment model. This change means that costs are much more in line with a practice’s revenue.

These days, I’d say that those who use cost as the reason for not adopting health IT are really just using it as an excuse not to do it. There are a few rural providers where cost is more than just an excuse, but those are pretty few and far between. I’m not saying that cost isn’t an important part of any health IT project, but I’ve most often seen cost used as a mask for other reasons people don’t want to implement health IT. The most common reason is actually just a general resistance to change.

Topic 2: Why does ePrescribing have such widespread acceptance while #telehealth adoption is so low?
If providers could be reimbursed for telehealth, adoption would be high.

It is ironic that doctors don’t really get reimbursed for ePrescribing, but they do it at a high level. Although, the doctor does get reimbursed for the visit that generates the need for the prescription. A deeper investigation of why ePrescribing has had good adoption would be interesting. Certainly there are many doctors who miss their sig pad. However, once you have to record the prescription in the EHR, you might as well ePrescribe it.

Plus, there are some obvious reasons why ePrescribing is better. Whether it’s replacing the unreadable prescriptions or the drug to drug and allergy interaction checking that’s built into every ePrescribing platform, the benefits can be understood quickly.

The sad thing is that the benefits of Telehealth can be seen quickly as well, but you can’t get paid to do it.

Topic 3: #HIE as a noun or a verb? Does negative press for HIE org$ hinder health data exchange as a whole?
HIE is currently more of a noun than a verb. Verbs require action and we’re not seeing enough HIE action.

In some ways negative press could discourage healthcare organizations from participating in an HIE organization. However, negative press about HIE’s weaknesses can also put pressure on healthcare organizations to finally step up to the plate and have more HIE action and less HIE talk.

The biggest hindrance to HIE is business model, and good or bad press won’t do much to change that.

Topic 4: Is #CommonWell just a bully in a fairy godmother costume?
I love this question mostly because I sent the tweet that inspired it. Although, a smart health IT PR/marketer was the one who said it to me.

It’s a little too early to tell if the fairy godmother costume that CommonWell has on is real or fake. I think there path is paved with good intentions, but will the almighty dollar get in the way of them realizing these good intentions? I don’t know. I’m hopeful that it will be a success. I’m also glad that at least the conversations are happening. That’s a step forward from where we were before CommonWell.

Topic 5: Open forum: What #HealthIT topic had your attention this week?
There are so many topics that I discuss each week, but I think I’m most excited by the project announced this week to create a Common Notice of Privacy Practices. I hope their crowdfunding is successful and they get a lot of great healthcare organizations on board with what they’re doing. I also found the Vitera Healthcare acquisition of Success EHS quite interesting. EMR is slowly but surely consolidating.