Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Patient Demand For Digital Health Tools May Exceed Providers’ Ability To Deliver

Posted on March 15, 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.

It’s taken a long time, but it looks like consumers are getting serious about using digital tools to improve their health. According to a new survey by Accenture, in some cases consumers are actually more interested in using such tools than their providers are, researchers found.

Patients are taking advantage of a wide range of digital health options, including mobile tech (46%), accessing electronic health records (38%), social media (35%), wearable technology (33%), smart scales (27%), remote consultations (16%) and remote monitoring (14%). All of these numbers are up from 2017, notably mobile and access to electronic health records, use of which grew 10% and 9% respectively.

The survey also notes that the number of consumers receiving virtual healthcare services has increased since last year, from 21% in 2017 to 25% this year. Seventy-four percent of those accessing virtual care were satisfied with the encounter. Meanwhile, about three-quarters of consumers said they would use virtual care for after-hours appointments, and about two-thirds would choose this option for follow-up appointments after seeing a doctor in person.

Key takeaways for clinicians, meanwhile, include that while patients agree that in-person visits provide quality care, engage patients in their health care decisions and diagnose problems faster, virtual visits offer some significant advantages too. Virtual care benefits they identified include reducing medical costs to patients, accommodating patient schedules and providing timely care, respondents said.

Clinicians should also note that AI-based virtual doctors may someday become the competition. When asked whether they would use an AI virtual doctor provided by their provider, some were doubtful, with 29% saying they prefer visiting the doctor, 26% that they didn’t understand enough about how AI works, and 23% that they did not want to share their data.

However, 47% said they would choose a virtual doctor because it would be available whenever they needed it. Also, 36% said they’d use a virtual doctor because it would save time by avoiding a trip to the doctor, and 24% said they’d like to access a virtual doctor because the AI would have access to large amounts of relevant information.

Right now, it’s far more likely that hospitals will have the capacity to deliver such services, which may demand a higher level of IT expertise and staff time that many medical practices have available. Nonetheless, it seems likely that at some point, medical practices will need to offer more digital services if they want to remain competitive.

Medical Groups Adopting Telehealth, But Cautiously

Posted on February 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.

Telehealth has gone from a neat idea to an accepted part of the spectrum of care. However, it’s largely been hospitals, not doctors, which have dived into telemedicine wholeheartedly

Recent data suggests that while doctors are gradually adopting telecare, they have many reservations about doing so. A study published last year by Reaction Data found that while 68% of physicians said they were in favor of telemedicine, most were using it only in special situations such as reaching patients in rural areas, visit follow-ups and managing specific patient populations.

A new survey by the Medical Group Management Association has reached a similar conclusion. In a poll conducted last month by the trade group, the MGMA found medical practices’ approaches to telemedicine have changed only marginally since January of last year.

In this year’s Stat poll, which had 1,292 respondents, 26% of respondents said their organization offered telehealth services, and another 15% said they planned to offer them in the future. That’s up only 3% from January 2017 research, which found that 23% of respondents provided such services and 18% planned to add them.

Meanwhile, two key statistics have stayed in place from last year. Thirty-nine percent of respondents to this year’s survey said they didn’t offer telehealth services and 20% weren’t sure if they would, the same percentages found in last year’s research.

When it announced the results, MGMA shared some specific suggestions for planning and implementing a telehealth program. They include:

  • Researching and understanding patient needs
  • Setting clear goals for telehealth and tying them to an existing strategic plan, which demands fewer organizational changes and speeds adoption
  • Understanding how telehealth supports value-based care
  • Researching telehealth vendors and platforms
  • Researching reimbursement and licensure requirements (if any) in the practice environment
  • Engaging and educating practice staff members on telehealth issues and strategies
  • Having doctors reach out to colleagues in their specialty to learn how their telehealth implementation experience has gone
  • Bearing in mind that telehealth implementations typically take an average of one year from plan to rollout

All that being said, it seems likely that some of the practices which are hanging back from telehealth have taken most or even all of the steps outlined above. The thing is, even if a practice has researched the telemedicine market, understands its patients’ needs and knows what issues it will face during a service rollout, these steps still can’t address some of the fundamental realities holding telehealth back today.

The truth is, from what I’ve seen medical practices still face two difficult issues when they consider telehealth seriously: how to make money at it and how to fit it into their workflow. These are major problems and won’t be resolved by advice alone (not that this is MGMA’s fault of course).

Despite medical groups’ concerns, there will doubtless be a tipping point where practices begin to see telehealth services as a routine part of what they provide. However, it seems clear that we’re far from getting there.

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.

 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.

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.