Tag Archives: Telemedicine

Health Alerts

Telehealth Opportunity or Telehealth “Parity”?

9 Comments

iStock_000005825665XSmall(A version of this Health Alert was published by Forbes.)

Telehealth provides a great opportunity to reduce costs and improve quality in U.S. health care. It uses information technology to eliminate distance within the system. A subset of telehealth is telemedicine, which allows physicians to consult patients over the phone, by text, or video.

Take a couple of obvious examples: Telepsychiatry, whereby a patient undergoing talk therapy has a session with his psychiatrist over the phone instead of having to go to the doctor’s office; or e-prescribing, whereby a patient can describe symptoms over the phone or send a photo (of, for example, a rash) and the doctor can prescribe immediately (if appropriate).

Most people tend to categorize these as “no-brainers.” If we paid for our own care directly, these and many other examples would have long since taken off. However, because payment for medical care is dominated by health insurers and government, these innovations have been stifled. Third-party payers impose obstacles because they fear paying fraudulent claims. Nevertheless, telemedicine is growing. There is one pure-play telemedicine provider listed on a U.S. stock exchange: Teladoc, Inc. (NYSE: TDOC). Continue reading Telehealth Opportunity or Telehealth “Parity”? →

Health Alerts

First, Do No Digital Harm: Regulating Telemedicine

6 Comments

Laptop and Stethoscope(A version of this Health Alert was published by Forbes.)

Telemedicine, whereby physicians use email, phone, text, or video for prescribing and consultations, is growing rapidly. Seeking to encourage faster uptake of telemedicine, many well-intentioned parties are prodding Congress to take actions which will likely have harmful unintended consequences.

So far, Congress has done well. With respect to regulating actual devices, the 21st Century Cures Act, passed by the House in 2015 with overwhelming bipartisan support, is forward thinking. If passed into law, the policies it would implement would lead to a responsible and responsive regulatory environment for mobile health apps.

However, there are other areas in which a Congressional take-over would do more harm than good. In recent testimony to the House Energy & Commerce Committee’s Subcomittee on Commerce, Manufacturing and Trade, I encouraged Congress to First, Do No Digital Harm. Two of the most important areas of risk are federal interference in the practice of medicine and how Medicare pays for telemedicine. Continue reading First, Do No Digital Harm: Regulating Telemedicine →

Health Alerts

Digital Health Funding Defies Expectations

3 Comments

Oscar(A version of this Health Alert was published by Forbes.)

Investors have not had their fill of digital health deals, according to new fundraising reports from Rock Health and Startup Health, two outfits which have led the digital health revolution and produce complementary reports on how much capital is flowing into the sector. While other sectors have wobbled recently, digital health (which was only defined as a market five or six years ago) continues to attract venture capital.

Digital health refers to businesses that apply new information technology, especially the cloud, to health care. That being said, there is no agreement about where the boundary is. San Francisco’s Rock Health and New York’s Startup Health do not quite agree on which deals are digital health deals. Continue reading Digital Health Funding Defies Expectations →

Health Alerts

Is Telehealth Another Health Care Silo?

4 Comments

Stethoscope(A version of this Health Alert was published by Forbes.)

When we say health care operates in silos, we mean a patient’s cardiologist, psychiatrist, and general practitioner have no idea what each other are doing. Or that the individual departments in a hospital have no idea what each other are doing. Or your new family doctor has no idea what former doctors did to you, and you have to fill in a sheet on a clipboard in the waiting room with decades-old information you barely remember or even understood when former doctors told you.

“Connected care” is supposed to break down these silos. Is telehealth doing it? Probably not. Let me illustrate with an alternative history of consumer banking. Suppose I told you (sometime in the 1970s) that you would no longer have to go to a branch during bankers’ hours to withdraw cash. You could do it 24/7 at a machine called an ATM. However, the ATMs would be operated by different banks than the branches. You would need to have at least one account at a bank with branches and one other account at a bank with ATMs. That would not be very efficient. However, that seems to be the way telehealth is evolving. Continue reading Is Telehealth Another Health Care Silo? →

Health Alerts

Explaining The Fall (And Possible Rebirth) Of Doctors’ House Calls

25 Comments

Medicine Bag and Stethoscope(A version of this Health Alert was published by Forbes.)

“Connected care” refers to a large and growing portfolio of digital tools, from video consultations with psychiatrists to in-home sensors passively detecting when a senior falls to devices that measure diabetics’ blood glucose and send messages to their families’ or doctors’ smartphones when intervention might be needed.

One very valuable service is telehealth, whereby physicians use email, phone, text, or video for consultations, reducing the need for time-consuming in-office visits. The benefit of this is illustrated by the story of Felipe Perez, a patient of the Sharp Rees-Stealy Medical Group in San Diego County, who used to have to take a five-hour long bus and trolley trip to get to his appointments.

However, we should not fall into the trap of all-or-nothing thinking, expecting patients only to see their doctors either in the office or remotely. With a little creativity, we can envision mobile health technology leading to the restoration of an almost forgotten medical tradition: The house call. Imagine the connected doctor travelling to patients as needed, with a portfolio of cloud-enabled diagnostic, therapeutic, and decision-support tools at her disposal. Continue reading Explaining The Fall (And Possible Rebirth) Of Doctors’ House Calls →

Health Alerts

Connected Care Cuts Costs; But Can It Overcome Inertia?

65 Comments

electronic-medical-record(Part two of a two-part series. A version of this Health Alert was published by Forbes.)

The first article in this series suggested that there is a great opportunity for “connected care” to reduce costs by keeping patients out of hospitals and nursing homes. “Connected care” refers to a large and growing portfolio of digital tools, from video consultations with psychiatrists to in-home sensors passively detecting when a senior falls to devices that measure diabetics’ blood glucose and send messages to their families’ or doctors’ smartphones when intervention might be needed.

It does not take a lot of imagination to see that these technologies should be able to cut huge costs out of the health system. Yet, uptake so far has been limited. To the degree that there has been widespread adoption, it is in the use of Electronic Health Records (EHRs). Nine in ten hospitals offer patients the ability to at least view their records online, and a significant share allow patients to download and transmit their records. However, this is not actually leading to better care, because the EHRs were implemented as a consequence of government subsidy rather than patient demand. Continue reading Connected Care Cuts Costs; But Can It Overcome Inertia? →

Health Alerts

Connected Care: Moving (And Keeping) Patients Out Of Hospitals

Doctors Rushing Patient down Hall(Part one of a two-part series. A version of this Health Alert was published by Forbes.)

One of the greatest frustrations in health care is that technology tends to drive up costs. In pretty much every other area of our lives, technology reduces costs. Increased health spending is associated with better health outcomes (as recently summarized by Cynthia Cox of the Kaiser Family Foundation). Nevertheless, we would like to get these benefits at less cost.

The opportunity to achieve this is at hand. A host of technologies promises to significantly reduce costs by eliminating friction in the flow of clinical data between providers and patients, making sense of data from different sources, and allowing patients and providers to interact in new, cost-effective ways. This will allow patients to get more care where they want it, and not where the system demands they show up. Continue reading Connected Care: Moving (And Keeping) Patients Out Of Hospitals →

Science and Other News

Zombies Stalk the Health Care Landscape!

1 Comment

Accenture, the management consulting firm, has concluded that the flood of venture capital into digital health startups is not only maturing, it has created a race of zombies that will be bought up on the cheap by established players. In language not usually employed by the elite ranks of sober-minded management consultants:Zombies

Accenture predicts that more than half of digital health start-ups funded between 2008 and 2013 are not likely to survive longer than 20 months. Some healthcare companies will look to buy these “zombie start-ups” to drive growth by infusing top talent, fueling innovation and bolstering existing solutions.

While digital health and healthcare IT start-up funding is accelerating, the reality is that few start-ups will stand out. Even fewer will survive. Of the nearly 900 digital health start-ups that Accenture studied, 51 percent are zombie start-ups, at risk to die. These are companies that each received less than $50 million in total funding between 2008 and 2013 and have not received funding in 20 months or more.

Science and Other News

Goldman Sachs: $32.4 Billion Digital Health Market; Savings “Indefinitely Large”

2 Comments

GS LogoGoldman Sachs analysts, covering medical technology, life sciences, capital goods, and healthcare supply chain and services, to produce a research report on the potential for the “Internet of Things” to disrupt health care.

The conclusion: The total addressable market is $32.4 billion, and the savings resulting from digitizing health care are “indefinitely large” (see Exhibit 2).

GS2

Continue reading Goldman Sachs: $32.4 Billion Digital Health Market; Savings “Indefinitely Large” →

Policy Updates

One Fifth of States Join Interstate Medical Licensure Compact

2 Comments

StethoscopeIowa has become the tenth state to enact the Interstate Medical Licensure Compact, which will ease the licensing of physicians outside their home states. This is a great achievement for the medical profession and state sovereignty. For almost a year now, I have been supporting this effort and I am glad to see it succeeding.

On June 24, I attended a briefing conducted in the wake of the compact hitting seven members. This started the wheels turning to establish a commission that will actually execute and administer the interstate licensing of physicians. At the meeting I learned a few things, a couple of which surprised me: Continue reading One Fifth of States Join Interstate Medical Licensure Compact →