Observations on a Telemedicine Shift: An Insider Perspective

Grant Kohler
Grant Kohler

Guest post by Grant Kohler, vice president, Innovation and co-founder, REACH Health.

I began my healthcare career in the hospital setting. While working at Georgia Regents University (formally the Medical College of Georgia), my colleagues and I developed one of the nation’s first telestroke systems. It was rudimentary at first, literally pieced together on an IV pole from existing equipment: web-enabled video cameras, flatbed scanners for CT scans and spare CPUs, with a landline telephone to provide audio. Since then, I’ve worked with many facilities across the country to set up telemedicine platforms. Over that time, I’ve witnessed a variety of approaches to telemedicine.

One major transformation I’ve witnessed more recently: Many hospital systems are now choosing software-based platforms over hardware-based technologies. As I’ll explain shortly, this shift in thinking has important implications worth considering.

Core Technology: Software vs. Hardware

Telemedicine platforms are evolving rapidly with no signs of slowing. It is prudent to ensure that your hospital is in a position to take advantage of the rapid pace of improvements without being locked into a solution that hinders or prevents future technological enhancements or program expansion.

To appreciate the difference between focusing on software vs. hardware, consider the evolution of mobile phones. In 2007, the first smartphone was introduced. At the time, flip phones were considered leading edge. Less than five years later, flip phones were deemed antiquated by most. Why? The cell phone is a hardware-centric device and the smartphone is a software-centric device.

In the telemedicine industry, first-generation solutions such as tele-presence carts and robots began as single-function, hardware-centric devices. Even if they work satisfactorily for their narrow purpose, they lack the flexibility needed to support cost-effective upgrades and expansion for multiple service lines. Also, because the hardware is proprietary, it often isn’t subject to commoditization and is priced at a premium. As telemedicine technologies have evolved, software-centric platforms have become available and offer increased flexibility, including new capabilities and multiple endpoint options.

Support for Creating a Telemedicine Network – Thinking about the Subscribers

The literal goal of telemedicine is to create networks where provider hospitals offer specialty care or expertise to subscribing hospitals. Successful execution produces improved outcomes and patient satisfaction for a larger number of patients and creates economic benefits for both the provider and subscriber hospitals.

Your telemedicine platform can impact your ability to recruit hospitals into your network. In competitive markets where other provider hospitals are vying for the same potential subscribers, a well-designed telemedicine platform provides a recruiting advantage. If a large hospital balks at expensive hardware investments that easily become dated, a smaller hospital will have similar concerns but a tinier budget. Hospitals of all sizes seek to leverage maximum utility out of all investments with a minimal disruption to existing processes and workflows. With hardware-centric platforms, the inherent focus is often on the technology itself rather than the patient. This is unpalatable for most hospitals considering telemedicine, as their primary objective is better patient care.

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What to Look For In a Disaster Recovery Solution

Shannon Snowden
Shannon Snowden

Guest post by Shannon Snowden, senior technical marketing architect, Zerto.  

Electronic health records (EHR) are the tie that binds together the patient with the caregivers. What happens when an extended outage or disaster happens? Caregivers still have to administer treatments regardless if the systems are online.

The longer the outage, the greater the negative impact to the quality of the end product or service. In the healthcare business, it is unacceptable. Every manually tracked record has to be added back into the EHR when it is available once again.

A big concern is that the manual records often get summarized with many of the details those electronic healthcare systems track are missing. These knowledge gaps ultimately could diminish the quality of patient care.

A contributing factor to the difficulty in finding a good disaster recovery solution is the technology necessary to support healthcare information systems (HIS) are complex, involve multiple servers that are tightly integrated and are quite unique from the perspective that the application vendor remains very involved with the customer on an ongoing basis.

This is the challenge faced by healthcare organization CIO/CTOs, IT directors and managers. How do you provide a sound business continuity solution that enables nearly no interruption in patient services is easy to manage and is within a realistic budget? What should be considered requirements for a healthcare information system disaster recovery solution?

Here is what to look for in a disaster recovery solution:

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Electronic Medical Records Increase Potential Liability for Physicians

Guest post by Keith L. Klein, MD, FACP, FASN.

The use of electronic medical records (EMRs) is increasing liability risks for physicians. We have not yet seen the full impact of EMRs, because cases take three to four years to be filed from the time of the adverse event. However, we are beginning to see data that show EMRs are a contributing factor in malpractice suits.

In a study by The Doctors Company of 97 EMR-related closed claims from 2007 to 2014, user factors contributed to 64 percent of claims, while system factors contributed to the remaining 42 percent. EMRs can result in a weak defense by casting the user—the physician—in an unfavorable light.

In a recent presentation I gave at HIMSS, I outlined malpractice cases that involved EMRs that resulted in cumulative awards of more than $30 million and reviewed areas where EMRs present the greatest risks.

Risk 1: Copy-and-Paste

Copying and pasting previously entered information can perpetuate any prior mistakes or fail to document a changing clinical situation. In The Doctors Company study, 13 percent of cases involved pre-populating/copy-and-paste as a contributing factor. While it may be OK to use the copy-and-paste function to save time, whatever is pasted must also be edited to reflect the current situation. Similar to copy-and-paste is the practice of using templates. Some of the biggest pitfalls in these two functions are lack of individualized information on the patient, gender confusion, lengthy notes for each encounter that look like they have been enhanced by the computer, lots of blanks, repeated typos and other errors, and use of similar phrases sequentially.

Risk 2: Informed Consent

Physicians must take care to capture the electronic signature of the patient when loading an informed consent into the EMR. Make certain the signature is legible. Also check to be sure the scanned document is in the record and that the informed consent is documented in the notes.

The following is from a case that involved problems with informed consent in the EMR:

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Health IT Startup: VSee

LogoVSee was created by a team of Stanford University human computer interaction scientists and network experts to overcome the limitations of traditional video conference and telehealth tools. The company’s goal is to create a simple, yet full-featured product that works over any network, and requires minimal training and is perfect for the healthcare environment, which is currently receiving a great deal of attention toward telemedicine.

Elevator pitch

VSee makes it easy for health providers to get started with telemedicine. With a free video app has been downloaded more than 3 million times. For larger health systems, VSee can also custom-design a unique telemedicine solution.

Product/service description

Health providers count on VSee for video software that’s HIPPA-secure, low-bandwidth, and easy to use. VSee allows users to stream data from medical devices, send files, and share your screen for collaboration.

The VSee app is available for download for free, and has been downloaded over 3 millions times already. VSee also builds virtual waiting rooms, where patients can see a doctor through a simple web portal.

Finally, VSee designed Cloud Clinic to serve as your waiting room, appointment calendar, and ePay, all in one.

Founder’s story

Milton Chen
Milton Chen

Milton Chen is the son of an immigrant family and a first-time entrepreneur. While working on his PhD at Stanford University, he became fascinated by the human factors involved in telecommunications – the voice, the body language, the facial expression. He felt driven to figure out how people could be more productive when not working in an office. He also wanted to empower people to collaborate when they’re not physically present in the same room.

With guidance from his mentor Dr. Terry Winograd, Chen created the first version of VSee’s video software as his PhD project. Later, he brought together some fellow students from Stanford and UC Berkley, and in 2008, VSee was born.

Chen’s initial plan was to offer video technology that would allow professionals to work from home. But in 2010 he realized that there were much greater opportunities in healthcare. So the company quickly executed a pivot and rebranded itself as a telemedicine software solution.

Since then, he’s traveled the world, participated in several panel discussions, and presented at multiple conferences. People in the know have recognized Chen as an expert in telemedicine.

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Attitude toward ICD-10 Remains Skeptical

The news about ICD-10 continues to divide providers, one way or another, based on whom is asked and as my friends at NueMD have found, many are still unprepared and most don’t want want it to move forward. These are the primary findings of the recently conducted a third installment of the firm’s survey, “Attitudes toward ICD-10” that was designed to measure how healthcare professionals feel about the upcoming transition. In all, of the 1,000 respondents — primarily from small and medium-sized medical practices — the majority said they think there should be no transition to ICD-10.

The following graphics help explain the sentiment toward the new coding standard for clarification:


According to the results of the survey, NueMD’s data suggest that making the switch to ICD-10 will greatly improve provider’s ability to understand medicine, but can “also introduce some serious struggles for practices while they try to maintain cash flow through the transition.”

For example:


Moving on to expectations, according to the survey, the majority of respondents said they are either highly or significantly concerned about the transition to ICD-10. The greatest concern remains for the training and education pf staff during the transition, for obvious reasons. However, payer testing and software upgrade costs are not far behind.

Respondents were most concerned about claims processing, with 65 percent saying they are either “highly” or “significantly” concerned with the transition.

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Health Technology and Innovation Must Correspond to Quality Care

Richard J. Scholz

Guest post by Richard J. Scholz RPh, J.D., chief strategy officer, Optimized Care Network.

This is an exciting time in healthcare. The field is changing in terms of how and where care is delivered, who is providing those services, even how the care is financed. As the world around us becomes increasingly digital, the medical industry needs to keep up. I believe patients deserve convenient access to the best doctor for their particular case, no matter where that doctor is located. They deserve personal attention and a firsthand look at the images and results their doctor sees.

This is why I was honored to join other national telehealth leaders in the HX360 panel discussion, the Telehealth Turnabout, during HIMSS15 in Chicago. The group brought together divergent perspectives on the future of telehealth, including market opportunities for new entrants, novel opportunities for providers to extend care, capture new patients or establish a new revenue stream using telehealth.

At Optimized Care Network (OCN), we are challenging the healthcare industry to imagine having every world-class specialist available in one office — no matter where you are located. We are moving the industry and the people we serve away from reliance on brick and mortar offices.

Personalized digital healthcare is the future of quality medical care. New developments in technology are making healthcare providers more accessible than ever before. As the digital domain grows, providers and patients alike must be clear on the differences between telemedicine and personalized digital health. Telemedicine can involve seeking treatment over the Internet via a video conference, and personalized digital healthcare enhances your traditional office visit by adding state-of-the-art image sharing equipment and lifelike communication linking the patient in one location with the doctor who could be hundreds of miles away. The digital healthcare delivery offered in an Optimized CareSpace takes digital healthcare to the next level by personalizing it. You meet with a nurse, look your doctor in the eye via exclusive video technology, and you can see the medical images your doctor sees, giving you, the patient, a complete view of your healthcare.

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Robust Data Networks Can Help Support Meaningful Use

Alex Soumbeniotis Sewell
Alexandra Sewell

Guest post by Alexandra Sewell, executive director, enterprise marketing, Comcast Business.

Meaningful use is one of the largest drivers of healthcare IT, with the potential for far-reaching effects. Many healthcare organizations are well on their way to achieving meaningful use, working through related cost, training and resource challenges.

But there is still work to be done. Meaningful use can require significant network infrastructure investment to support electronic health records (EHRs) and other technologies. At the same time, budgets are shrinking, so providers must be strategic about how they allocate IT dollars.

Improving Patient Outcomes

EHRs give doctors a complete view of the patient — from demographics and vital signs to medications, allergies and more. EHRs are a central component to complying with meaningful use Stage 1 requirements and help doctors easily view and transmit records, which can lead to more accurate patient diagnosis and treatment.

Hospitals with EHR systems can better capture data regarding patients’ co-morbidities and other risks. This helps clinicians manage patients, resulting in more positive clinical outcomes and improving mortality rates for heart attack, respiratory failure, and lower intestine surgery. EHRs can help improve the overall quality of patient care.

Integrating PACS

Picture Archiving and Communication System (PACS) technology provides economical storage and convenient access to a range of images from multiple imaging devices, transmitting them digitally and eliminating the need to manually file, retrieve or transport film jackets.

To comply with Stage 2 of meaningful use, healthcare providers must offer patients the ability to view, transmit, and download their health information. And while not explicitly mandated by meaningful use core objectives, many organizations are integrating their PACS and EHR systems so images, such as MRIs and CT scans, can be shared between physicians and with patients through patient portals. However, the size and volume of these imaging files place stress on hospital networks, creating data capacity and data center connectivity issues.

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Health IT Thought Leader Highlight: David Caldwell, Transcend Insights

David Caldwell
David Caldwell

David Caldwell is the vice president of sales and marketing at Transcend Insights, a wholly owned subsidiary of Humana Inc., dedicated to simplifying population health. Transcend Insights helps manage the complexities of population health through community-wide interoperability, real-time healthcare analytics and intuitive care tools. The company’s HealthLogix platform provides healthcare systems, physicians and care teams with valuable clinical insights that enable more informed decisions at the point of care, enhance the patient experience and reduce costs.

Here, Caldwell discusses how the firm serves its clients; the benefits of analytics and its impact on ACOs; population health initiatives; and the future of the company.

Tell us a bit about your product offerings and the role that they play in the health care technology space.

Transcend Insights is a population health management company that provides health care systems, physicians and care teams with advanced community-wide interoperability, real-time health care analytics and intuitive care tools designed to simplify the complexities of population health. The new company represents the merging of three leading health care technology businesses—Certify Data Systems, Anvita Health and nliven systems. We integrated Anvita’s health care analytics into Certify’s HealthLogix™ platform to provide physicians and care teams with the real-time insights necessary to improve health outcomes and reduce costs. In addition, we made these insights accessible at the fingertips of physicians and care teams through a mobile point of care solution, a technology we gained from nliven.

Today, Transcend Insights works with more than 130 health systems, serving at least 600 hospitals and over 20,000 physicians. Through community-wide interoperability, we help large health care systems gain access to both acute care and ambulatory data that reside in various silos across the care continuum.

We analyze 2.3 billion clinical data points on 10.8 million patients every day. Our analytics engine offers more than 33,000 evidence-based clinical rules and last year identified over 36 million opportunities to improve care and helped our clients close 4.3 million gaps in care.

Lastly, we leveraged nliven’s expertise in mobile health technology to develop a mobile point of care solution that allows physicians and care teams to not only visualize data but also gather and assimilate patient data in real-time.

Who are your customers and what level of clinician typically accesses your product on a day-to-day basis?

The vast majority of our customers are multi-hospital, integrated health care delivery networks that have purchased our product to help them move from a fee-for-service to a value-based care delivery model. Our customers utilize the HealthLogix platform to reach both contracted and affiliated physicians, and to piece together disparate electronic health record (EHR) system data across the care continuum.

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How Healthcare Technology is Saving Lives

Guest post by Devin Jollimore, training coordinator, Mission Safety Services.

We live in an age where the use of technology dominates our lives and these technological developments have had an amazingly positive impact on the healthcare industry. Healthcare technology has heavily influenced the improvement in our health and the increased life expectancy we are seeing today.

In particular, the progress we have made in cancer research and the greater survival rates have been heavily influenced by developments in technology. It’s amazing that healthcare technology played a role in saving 1.2 million lives between 1991 and 2009 thanks to progress in cancer treatments and detection.

Malaria is thought to have killed more people than all wars put together and technology is helping reduce this startling statistic. Something as simple as a bed net with insecticide has reduced malaria in children under 5 by 20 percent.

Also, stem cell research has limitless possibilities to save lives. We are still progressing with this development, but diseases, such as heart disease and Alzheimer’s, may be hugely reduced through stem cell research and we are already making good progress.

Let’s not forget the importance of the Internet and how it has increased healthcare efficiency. Healthcare facilities are reaching patients through social media and doctors have access to thousands of medical books at the touch of a button.

This infographic from Mission Safety Services outlines the progress we have made, the work that is being done, and possible future developments in technology that have potential to make real change.

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Doctible: Helping People Save Money with the First Healthcare Cost-Comparison Search Engine

Image result for doctible logoMore than 33 million Americans who have high-deductible health plans, also known as “HDHP” policies, struggle to find local doctors within their budget because healthcare costs have previously remained mysterious, until after one reaches the specialist’s office. To solve this dilemma, Doctible.com has launched a search platform that lists the costs of procedures and checkups upfront so that patients understand prices before booking their appointments. Plus, clients can also quickly search for and compare doctors by price, reviews, location and specialty.

Founded in 2013, the “Doctible” website now serves the San Diego area — with future plans to expand and eventually create a nationwide healthcare search engine to help people make faster, better and more affordable decisions about their options for a wide variety of medical services. Here are the principles that make it work and the positive changes it can lead to:

The solution lies in the search engine’s transparent facts

The Doctible medical-services search engine instantly pulls together all the key information about the type of doctor someone is looking for in a list that takes less than a minute to scan, allowing users to find the right doctor and make a booking more quickly and efficiently without regretting their decision later. The design is simple and powerful. Anyone can get fast results by just entering their zip code, the type of doctor they need to see and the type of procedure they want. Instantly, visitors get a list of doctors that shows exactly how far away they are from one’s home, how much the doctor charges in cash for the procedure, their average insurance price and their ratings based on past reviews from real patients.

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