How do you provide care to underserved patients who have difficulty getting to the office? This was the challenge we were trying to solve at the Clark Clinic. Some of our patients don’t have access to a vehicle or are physically restricted and unable to travel far. But, as most of our community is underserved, we needed to collectively identify a solution to ensure we can serve all our patients.
I knew from conversations with other healthcare executives that telemedicine was the solution. I recently learned of a pediatrics office in Jacksonville that uses telemedicine to serve its ADHD patients better. Like the Clark Clinic, its patients found it difficult to comply with required visits. Telemedicine allowed ADHD patients to conduct their appointments remotely. Rates of visit compliance skyrocketed. We realized then that telemedicine technology would be ideal for a rural community.
We have experienced seismic shifts in the popularity of telemedicine. Technology has largely influenced every aspect of our society. With instant access to every component of life, people are developing a dependence on technology. In healthcare, patients want easy and efficient access to healthcare, without having to wait for hours in the office. After a telemedicine visit, they are convinced of its value. The process is simple — download the healow TeleVisits app and schedule an appointment. There is no doubt patient satisfaction has improved.
At the Clark Clinic, our slogan is “We are wherever you are” and telehealth allows us to provide the same level of care no matter where our patients are located. With multiple clinics across central Florida, our doctors are often on the road. There have been various situations where patients had urgent visits but couldn’t be seen because our doctor was miles away. But with telemedicine, the doctor can schedule a remote appointment and conduct and treat patients in need while maintaining the established provider-patient relationship. Amazingly, our physicians have even noted that in most cases they are able to make accurate judgments, all from observing a patient’s speech, breathing, motions, and mood.
Our patients who reside at local assisted living facilities also love the convenience of telemedicine. These individuals appreciate the ability to download the app directly onto their phone or tablet and schedule an appointment with their doctor. Typically, they take the call in their room, and all their health questions are quickly answered. We’ve also heard from their families and loved ones, who enjoy the reassurance that, with telehealth, the level of care never wavers and access to quality care is not limited.
Global IT consulting firms, especially those with an India heritage, have had a long run at high growth rates, fueled by one idea: Outsourcing information technology (IT) operations to countries with low labor costs and a skilled engineering talent pool with a strong English language proficiency offered a huge arbitrage opportunity. The Indian IT services industry monetized this idea with a single-minded focus over the past 25 years and is now estimated to be more than $150 billion. Over the past decade or so, many western multi-national firms, including end-user clients for these companies, have jumped on the labor arbitrage model.
My firm has been focusing on how global technology consulting firms have been doing in the healthcare markets, and reviewing their financial and operating performance since 2015. Our latest mid-year review of 11 publicly held global technology consulting firms indicates that organic growth from the healthcare vertical is trailing overall company growth for most consulting firms, and is slowing down relative to previous quarters. Three of the 11 firms we cover in our report have seen leadership exits for the healthcare business, and the Board of Directors of one high-profile firm is looking to replace its CEO. No major contract signing in healthcare has been reported by any of the firms.
Where is the whole sector headed next? No one knows for sure, but the labor arbitrage model is now surely past its sell-by date. The question therefore is: what’s the next killer app for global IT consulting firms ?
If one were to go by the term most-often used by these firms in earnings calls, annual reports, and marketing messages, it would seem that the new killer app goes by the all-encompassing name of “digital.”
However, unlike a clear concept like low cost labor, digital is much harder to understand. In much the same way as that other overused term – artificial intelligence or AI — the technology vendor market has whipped itself up into a frenzy of “digital” offerings, with each firm defining “digital” in its own way.
However, the global IT consulting firms, and in particular the India heritage firms, seem to discuss a common theme when referring to digital. They are mostly referring to automation when they say digital. These firms are betting on intelligent automation (IA) as the killer app for the future of their business model.
Consulting firm KPMG has released a report declaring that IA is fueling the next generation of outsourcing. As IT operations move to the cloud, automation targets the same IT operations that substituted high-cost labor pools a generation ago, and is eliminating the low-cost pools with even lower cost robots a.k.a robotic process automation or RPA. The implications are like a double-edged sword: Automation is a new revenue opportunity, but it is one that necessarily cannibalizes a current revenue opportunity. The implications reach far beyond the board rooms of multi-billion dollar tech firms, and raise questions about a low-cost labor-pool based model of IT services.
In other words, the killer app of tomorrow is killing the jobs of yesterday, a fact that the KPMG report delicately refers to as a “negative though not significant (at least in the near term) impact on the use of traditional outsourcing and shared services.” However, the Schumpeterian principle of creative destruction may be at play here, with an entirely new class of jobs and entirely new revenue opportunities on the horizon arising from the increasing savings and efficiencies brought about by automation.
While telehealth has been around for years, virtual care technology is emerging as a powerful tool that goes beyond the traditional telehealth model. What will it take to reach the tipping point of virtual care adoption?
To become the “next generation” of telehealth, virtual care will need to improve access, availability, application, and acceptance considerations. Virtual care is poised to be embraced by the healthcare ecosystem, helping to optimize satisfaction and outcomes for all.
Timing is everything in critical care situations. Providers need instant access to specialists who can make vital diagnoses and decisions on-demand. Virtual care technology enables specialists to provide an immediate consult via video and ensure that patient questions and emerging conditions are addressed. Remote video-based consults allow a specialist to examine and diagnose the patient in real time, regardless of the specialist’s location. Virtual care will move into the mainstream as more providers (whether at a healthcare facility or home health agency) realize they can obtain timely answers, prevent return trips to the ED, and minimize readmissions. Smaller and rural hospitals will be able to strengthen their role in the community by using virtual care to access offsite, specialized staff. The time-to-treatment will be reduced; providers will not need to waste precious minutes attempting to contact available specialists. And, specialists can provide the needed consult via video, without needing to rush to the patient’s bedside.
Many patients fail to follow up with their provider for post-discharge care. No-shows may result when a patient is unable to leave his/her residence due to a medical condition. Some patients are unable to secure reliable, timely, and/or affordable transportation to a follow-up appointment. Virtual care will improve the standard of care by providing patients with more convenient, comfortable, and cost-effective access to follow-up care. Once out of the hospital or nursing facility, a patient can participate in virtual visits on commodity devices such as tablets and smartphones.
Healthcare organizations typically pilot the use of virtual care in one department, with one use-case or for a specific patient population, before rolling out the technology across a facility, health system, and/or health plan’s member base. Organizations may hesitate to expand virtual care across departments if they anticipate the implementation may be disruptive to their current processes. However, virtual care technology is designed to complement (and even automate) current workflows. Providers jump on the virtual care bandwagon when they realize that the application factors in a patient’s choice of communication devices (e.g., tablet, smartphone, and computer) and language. Because the technology features the ability to include interpreters in a video call and also provide messaging in the patient’s primary/preferred language, more healthcare organizations will accelerate the deployment of virtual care as they can now engage all patients in their care and across any level of connectivity.
One of the most recognized annual awards programs in the world today—the MedTech Breakthrough—has recently announced the results of its 2018 awardees. Evaluated by an independent expert panel, the nominees were carefully examined, and winners were selected based on various considerations. Awards were given according to the following categories: medtech leadership, clinical and health administration, patient engagement, electronic health records, genomics, internet-of-things (IoT) healthcare, medical data, mobile communication and telehealth, healthcare cybersecurity and medical devices.
This award program is a testament to the continuous innovations in the field of medicine brought about by the incorporation of various technological advancements in other fields of science.
The Progress of Medicine
The progress of medical science at present is obviously at its zenith as compared to its level of progress in the past. Medicine, for example has existed for several millennia, and most of it was largely non-scientific, for in earlier times medicine was closely associated with religious and superstitious beliefs.
In our contemporary time, however, every aspect of medicine seems to be innovating at an unprecedented pace, and other technological advancements in fields like physics, genetics, computer programming and engineering, and chemistry seem to be all contributing to the progress of medical science and medical institutions.
By simply looking at the above mentioned awards distributed by MedTech Breakthrough, for example, you would immediately see the inclusions of the internet-of-things, genomics, medical data, mobile communications and electronic records, all of which seem to have a somewhat detached relationship to medical science. Yet, it is obvious that the progress of medical science can no longer be isolated from other technological advancements.
Medical Science and Alternative Medicines
Medical science has slowly detached itself from alternative medicines by strictly subscribing to the scientific method in the diagnostic and treatment of diseases. If a medical practice, therefore, is based only on alternative medicines without the backings of scientific studies, it is presumed to be based on unwarranted assumptions without scientific merit. Scientific medicine, however, does not peremptorily debunk the efficiencies of alternative medicines, for that would be unwise. What it is debunking is the method by which alternative medicines assume the efficacious of their alternative methods of treatments.
A good point of reference would be the practice of chiropractic. Chiropractors for example, start with the premise that diseases are simply indicative of the effects of subluxations. They focus then on the detection and eventual correction of vertebral subluxation to heal maladies. Although there are mixer chiropractors who combine diagnostic and treatment approaches from different osteopathic viewpoints, most of them still solely attribute diseases to subluxation. Yet, subluxation and its relationship to a disease is really hard to prove scientifically.
That was the subject line of the message from Lantern, a behavioral health startup whose app and coaching services I had used for a while. Lantern’s letter stated it is shuttering its business on August 1, helpfully offering to continue the coaching services for a limited period and pointing to other resources for those who relied on its services for six years since it started. News reports say Lantern is laying off 25 employees after failing to find a buyer for the company.
Firstly, I want to say this to the folks at Lantern: I’m sad we have to say goodbye. Although I had ceased to use the app a while back, I had developed a relationship with my personal behavioral coach who checked in with me regularly to see how I was doing with my meditation practice, often prodding me with a gentle nudge when I missed reporting on my sessions. I had the benefit of several conversations with my coach who was helpful, understanding and skilled at her work. Despite my short relationship with Lantern, I felt a positive impact on my well-being through regular meditation and mindfulness.
I came to know about Lantern back in December 2016 when I shared a stage as a speaker at an industry event with one of their executives. Back then, behavioral health was getting recognized as a $280 billion problem, which I wrote about after the Senate Health Committee announced the Mental Health Reform Act. Behavioral health is a complicated and expensive issue in U.S healthcare, which consulting firm McKinsey estimated affected 20 percent of the U.S population and was significantly underfunded in terms of treatment infrastructure.
In late 2016, there were more than 200 behavioral health startups, all of whom were responding to a brewing mental health crisis, and a favorable legislative and funding environment. Lantern was one of the highly visible ones, raising $17 million in series A money from marquee names, such as UPMC, Stanford University and Mayfield Ventures. The opioid epidemic and the exacerbation of related mental health issues was about to explode into public consciousness. Health insurance companies, faced with increasing costs for mental health and substance abuse, had started taking an interest in these startups. High profile partnerships were announced, such as the one between Highmark BCBS and Quartet. For a while, behavioral health seemed like a sure shot.
So what went wrong?
I’m sure the folks at Lantern and their VCs are pondering the question hard. However, back when I wrote about it, the signs of trouble were already visible. The Lantern executive I met at the time indicated that the lack of a reimbursement model for behavioral health was a huge challenge for growth. In healthcare, as we know, following the money is a prerequisite for success. The Department of Health and Human Services (HHS) had thrown $44.5 million at the problem, a drop in the ocean relative to the size of the problem.
Even for those who had access to funding, finding and recruiting trained clinicians with experience in behavioral health was a massive challenge.
Many startups, looking to stay outside the purview of regulation, tried to sidestep the FDA and go straight to employers and consumers (an expensive mistake that many failed digital health startups have learned the hard way).
Eventually, these problems had to come to a head. Lantern’s sad demise, brought about by a lack of ability to scale, and a lack of interest from the same insurance companies who were bullish on the sector two years ago, tells us that a business model with no revenue model has limited chances of success.
Is behavioral health dead then? Perhaps not. Many new telehealth companies, such as Teladoc, now offer behavioral health services. The CMS’s new rule to boost telehealth payments could be a shot in the arm that revives the fortunes of struggling behavioral health startups.
According to the Office of Coordination of National Health Information, 50 percent of healthcare dollars are wasted on inefficient processes. Transformative innovation must not only change the current way things are done, it must be disruptive by having a meaningful impact on time, quality, cost and operational effectiveness – it must dramatically simplify and accelerate the process it enables.
There are very exciting ways in which digital technology is creating transformation across the entire healthcare system in areas such as connected health, artificial intelligence (AI), blockchain, mobile data gathering, analytics, digital therapeutics and remote patient monitoring. All of these technological developments will improve healthcare efficiency, but more importantly they will drive the delivery of individualized care and dramatically improve patient outcomes as follows:
Access to Care
Connected health, or telehealth, is enabling the delivery of care to rural areas, where access is often nonexistent or very limited. It is also being used to address growing medical staff and physician shortages by providing access to timely care through collaborative tools such as eConsults. Telehealth delivers faster, less expensive and more convenient healthcare and in doing so significantly improves patient outcomes.
Conventional patient engagement systems display information at the hospital bedside, which is only one of many relevant ways to connect with patients. Companies are now integrating artificial intelligence or ‘virtual’ health coaches into interactive educational platforms, resulting in higher utilization and engagement, and delivering more robust, actionable content.
Remote Patient Monitoring (RPM)
A vast array of innovative wearables and sensors such as the biosensor bra patch, implantable glucose sensor, electronic tattoos and the cardiac mapping vest are revolutionizing remote monitoring capabilities. These remote monitoring systems have the potential to help achieve triple aim goals by leveraging the latest advancements to collect and analyze patient data beyond the bedside. Patients and providers can use smart phones, tablets and apps to remotely assess, diagnose and monitor their patients. Electronic monitoring can be an effective solution to identifying issues as they happen while also enabling more effective tracking of patients post-discharge, improving compliance and adherence, and reducing the number of re-admissions.
By James Smith, blogger and researcher of latest technological trends in the fields of health and lifestyle. He has his work published on various authoritative blogs and is currently working on a telemedicine project at Mend Family. For all the updates follow him on Twitter @JamesSmith1609.
E-Heath, telehealth, telemedicine are different approaches towards accessible healthcare in remote areas or over a long distance. Technology has come a long way, opening new gateways for communication and transmission of information. To a certain extent, it has helped healthcare become more accessible, especially in remote areas.
Because of a lack of infrastructure, facilities, equipment and other factors, it is not always possible to offer quality healthcare in specific remote regions. Opening a healthcare facility requires time and resources, which would be challenging to amass in the remote areas due to lack of infrastructural development, lack of talent, lack of investors and so forth. However, due to efforts to make healthcare accessible to all, which is also a major Sustainable Development Program (SDG) objective, technology is used.
Healthcare service delivery has improved over the last few decades by adapting to new technologies. Terminologies such as e-health, telemedicine, and telehealth are all formulations of healthcare delivery, combined with communications technology. The initiatives taken towards developing the health service delivery is phenomenal. However, it is essential to establish an understanding of the differences in e-health, telehealth, and telemedicine. Most people would confuse them to be the same; however, they are quite different.
In simpler terms, telemedicine refers to the use of electronic communications channel/mediums, as well as information technology to deliver clinical services to remote patients. While telemedicine is a part of telehealth, it is more concentrated towards the use of technology for clinical service delivery. The service delivery is the same as medical practice. However, the critical difference is that it is used towards reaching out to patients in remote destinations via electronic platforms. This usually works when a patient and medical practitioner interact using video/voice conferencing to offer professional advice on medication and clinical services.
Telehealth is a broader spectrum of delivering quality health care via online mediums. The primary aim of telehealth is to provide healthcare services in remote areas with lack of healthcare services. Telehealth operates on the same principals of traditional healthcare practice with the use of technology. Because of the practitioners’ inability to be physically present in the area, they rely on telecommunications, internet and other communication platforms to interact with the patient and offer professional guidance.
According to the Health Resources and Services Administration (HRSA), United States, telehealth is used to promote and support long-distance clinical health care. The use of telehealth helps with delivering professionalized clinical healthcare remotely. Furthermore, it also helps with developing and improving health-related education, health administration, and improving general public health.
Telemedicine can be delivered using various technologies, including the internet, still imaging, video conferencing, streaming media, wireless communications, etc. This means that it can be used in more than one way. For example, a patient can acquire professional consulting and diagnosis remotely.
Similarly, it can be used for educational purposes, for delivering quality healthcare education on recent discoveries, prognosis, diagnosis, and other evaluations. Telehealth is the primary method of providing quality clinical health care in underdeveloped regions. It is widely present in the African region and helps in offering quality clinical care to long-distance patients. In most cases, the practitioner would conduct examination using imaging devices, live video conferences, and by obtaining patient’s medical history. Moreover, doctors use telehealth to seek second-opinion or expert advice on complex medical cases.
In urgent care situations, being able to provide timely and quality healthcare is essential to the impact and satisfaction of the ED staff and related EMS team members. Using telehealth, current ED workflows can be enhanced to increase access and make collaboration between onsite providers and offsite colleagues and specialists easier and more timely. Virtual care platforms can rapidly improve the delivery of care, effectively addressing urgent patient needs while reconciling the gap in having available specialists on-hand / in-person for immediate consults. Virtual consults are a viable and valuable solution to helping improve outcomes in emergent care situations.
Providing Critical Care On-Demand in the ED
Seconds and minutes count in the ED. With a virtual care platform, a hospital’s ED staff can quickly access remote specialists and facilitate a virtual consult between offsite specialists and patients. Instead of losing crucial minutes, hours, or even critical days in the ED to call a specialist or wait for an in-person consult, ED staff can quickly reach the first available, designated specialist who can deliver a timely virtual consult and provide guidance as to diagnosis, admission, and/or transfer. With virtual care technology, specialists can provide the needed consult from anywhere and on any device. Key decisions as to whether the patient needs to be admitted, transferred or discharged can be made in minutes (vs. hours or days). The costs involved with keeping a patient in the ED are also contained, and the hours or days which a patient spends in the ED are reduced. As hospitals struggle to have multiple specialists on-hand at any time, virtual consult platforms can empower hospitals to leverage specialists within their networks to support their patient care objectives around-the-clock.
Reducing Waiting Time and Minimizing Leakage in the ED
Virtual care platforms are also being used to reduce waiting times in the ED and deliver routine care to patients with non-emergent conditions. In a recent study published in Telemedicine and e-Health, rural hospitals using telehealth reduced the time between patients entering the ED to receiving physician care, according to University of Iowa researchers.
Virtual care had decreased door-to-provider time by six minutes. The researchers also concluded that the length of stay in the ED of the initial hospital was shorter for patients who were eventually transferred but had initially participated in a virtual care consultation. At New York-Presbyterian/Weill Cornell Medicine, the Express Care program allows patients with minor injuries or non-life-threatening symptoms to be seen virtually by an offsite provider via video. When asked by the Wall Street Journal, “What’s the number one complaint of patients in the emergency room?” Rahul Sharma, the emergency physician-in-chief at Weill Cornell, responded: “Wait time.”
The hospital reported that the Express Care telehealth program has cut the average wait time in the hospital’s ED by more than half; between 35 to 40 minutes. As hospitals struggle to prevent leakage and minimize the chance of patients leaving their ED waiting room for another healthcare setting, virtual consults can help the waiting patients access the diagnoses and care they need in a more timely and convenient manner.
Expanding Impact into the Community
ED staff can also use virtual care platforms to expand their impact within their respective communities. Rural hospitals face some of the biggest deficits in terms of having a range of specialists on staff. Providers in these hospitals can have access to a greater pool of specialists who can support urgent patient care via video when a particular specialist is not already on staff or readily available in-person. Giving ED staff the ability to facilitate virtual consults on-demand improves their impact within their own community – regardless of distance between the ED and the specialist. ED staff can also conduct HIPAA-compliant virtual meetings to drive better collaboration amongst the broader care team across the care continuum. Communication can be maintained with the appropriate care team members (including the patient’s PCP, a pharmacist, a coordinator at the next care facility, etc.) to ensure the patient’s overall health needs are regularly discussed and addressed in the ED and during the transition of care – without requiring care team members to drive to/from meetings at different locations and facilities.
Looking back at 2017, we see some of the same significant trends that have been gaining momentum, along with a few newcomers. Together, these top-five trends will impact hospital medicine in 2018 in both traditional and unexpected ways.
Growth Despite Reimbursement Parity Confusion
The telemedicine industry’s growth continues rapidly despite the widespread confusion over reimbursement for telemed services from state to state. Why? Because most hospital leaders understand they face far more significant costs from the lack of proper physician and specialist coverage than they ever would by a less-than-optimal reimbursement rate for telehealth. A teleneurologist consult in the ED might be reimbursed at a lower rate than an in-person visit with an onsite neurologist, but keeping the stroke patient in the hospital could mean a $10,000 DRG reimbursement that the hospital would lose if the patient had to be shipped to a tertiary referral center for treatment. Which is the smarter investment? And more importantly, which scenario better serves the patient?
Expansion into New Types of Inpatient Settings
As micro-hospitals and long-term acute care hospitals (LTACHs) grow, they are looking for single-source providers of solutions, with one point of contact, one operating system, and one set of tools and processes. Telemedicine fits their models very well, helping them avoid contracting with a wide array of specialists to meet their patients’ needs. Micro-hospitals are already established in 19 states, and LTACHs are growing since a federal moratorium prohibiting their expansion expired on Sept. 30, 2017. Being able to access a variety of specialists via telemedicine, depending on the needs of patients on any day, is something these facilities need in order to fulfill their commitment to the communities they serve.
Increasing Use of Telemedicine in Metropolitan Hospitals
Rural hospitals have long been a sweet spot for telemedicine. The physician shortage is certainly more acute in rural areas as community hospitals struggle to recruit physicians, keep beds filled and, in many cases, stay solvent. Recently, however, more metropolitan hospitals have seen the advantage of telemedicine in two key areas. When cross-coverage calls are handled by telemedicine teams, it takes considerable pressure off night hospitalists who may already be overwhelmed with admissions, and yet their phones are ringing constantly with requests to respond to patient issues on the floor.
By the same token, telemedicine offers “surge protection,” providing assistance with patient admissions during ED bottlenecks, and cost-effective relief from hospitalist overload.
Virtual Partners for Solo Specialists
Individual specialists in pulmonology, cardiology, nephrology, and other areas might be on call with a local hospital 24/7/365, with no backup for nights, weekends, holidays, or vacations. Telemedicine specialists share coverage with these physicians—individuals and small practices alike—to help ease the demands on them. For example, a community hospital has a local cardiologist on call 15 days a month, and a telecardiology team on call the other 15 days of the month. This is just one real-life example we’ve seen as hospitals find new ways to meet the challenges of another trend that just keeps growing: physician burnout, coupled with a greater value placed on work-life balance than in generations past.
One of the largest barriers of delivering mental healthcare is the critical shortage of mental health professionals across the country, despite the significant prevalence and impact of mental health conditions. The National Alliance on Mental Illness and the National Institute of Mental Health report that 1 in 5 Americans live with a mental health condition and more than half of American adults with mental illness did not receive treatment in 2016. The U.S. Health Resources and Services Administration estimates an additional 70,000 mental healthcare providers are needed by 2025 to meet the expected growth in demand. In Chicago alone, patients may wait upwards of 10 months for a psychiatrist appointment.
Timely and quality behavioral healthcare is essential for improving patient mental health outcomes and increasing provider satisfaction. Telehealth is emerging as a viable approach to traditional on-site care methods, as it can rapidly improve the delivery of care by effectively addressing patient needs while reconciling the workforce gap. Specifically, telehealth can allow for immediate consultation (especially crucial in time-sensitive situations), increased treatment capacity and collaboration across the continuum of care, and improved outcomes (especially by allowing patients to receive care in the comfort of their own home).
Increased Access to Care In a given year, approximately one in 25 adults in the U.S. experiences a serious mental illness that substantially interferes with, or limits, one or more major life activities according to the National Institute of Mental Health. The American Journal of Psychiatry reported that untreated mental illness is estimated to cost approximately $100 billion annually in lost productivity.
Patients can benefit from providers who use video-based technology to conduct “virtual consults” when providing an initial diagnosis, as well as making recommendations for admission, treatment, transfer, or discharge. Additionally, for ongoing treatment, video offers patients a way to participate in ongoing care and support via “virtual visits” with mental healthcare providers. Convenient access to care can help patients who may avoid seeking initial mental healthcare and/or ongoing treatment as some patients may unfortunately avoid visiting a nearby mental health clinic or provider for a needed diagnosis if they are wary of public recognition and social disapproval. Patients might also not adhere to scheduled follow-up appointments if visits to these “known” mental health clinics in one’s community are required. With telehealth, patients can remain comfortably at home and confidentially receive the care they need.