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.
At HIMSS this year, multiple speakers laid out visions for a future where parents could consult with a pediatrician via a telemedicine encounter during the middle of the night, take their children to receive immunization shots at a retail clinic, and have all of this information aggregated in their primary care provider’s record so that providing an up to date immunization record at the start of the next school year is as simple as logging into the PCP’s patient portal and printing out the immunization record. In short, multiple speakers presented visions of a truly interoperable future where patient information is exchanged seamlessly between providers, healthcare applications on smartphones, and insurers.
While initiatives such as the CommonWell Health Alliance, Epic’s Care Everywhere, and regional health information exchanges attempt to address the interoperability challenge, these fall short of fully supporting the future vision described above. Today’s solutions do not address smartphone applications and still require manual intervention to ensure that suggested record matches truly belong to the same patient before the records are linked. This process is costly but manageable in an environment where a low volume of patient records are matched between large provider organizations. In a future world where patient data is available from a multitude of websites, smartphone applications and traditional healthcare organizations, it would be cost prohibitive to manually review and verify all potential record matches.
Of course, one solution to this dilemma would be to improve patient matching algorithms and no longer require manual review of records before they are linked. However, for this to be possible, a standard set of data attributes would need to be captured by any application that would use or generate patient data. In a 2014 industry report to the Office of the National Coordinator for Health Information Technology, first name, last name, middle name, suffix, date of birth, current address, historical address, current phone number, historical phone number, and gender were identified as data attributes that should be standardized. Many of the suggestions in this report were incorporated into the Shared Nationwide Interoperability Roadmap that the ONC released in January 2015.
Deb Dahl, vice president of patient care and innovation at Banner Health, discusses her experiences managing the telehealth program for the health system. Banner Health is a nonprofit health system based in Phoenix operating more than 20 hospitals and specialized facilities. It is the second largest employer in Arizona, providing emergency care, hospital care, hospice, long-term care, outpatient surgery centers, labs, rehab services, pharmacies, and ambulatory clinics, which include Banner Arizona Medical Clinic and Banner Medical Group.
The health system is a long-time user of telehealth technology, which has had a profound positive impact on providing patient care and is seen as a major benefit to the organization.
Have you used telehealth services in your practice to provide care?
Yes, we have had a long standing relationship with Philips collaborating on telehealth programs, using a “technology, people and process” approach to healthcare. We started with a single facility in 2007, and our telehealth program now reaches more than 400 beds at 18 facilities in Arizona, Colorado, Wyoming and Nebraska with plans to cover our Fairbanks, Alaska, facility and Nevada site some time in 2015. Across these facilities we utilize telehealth in the intensive care unit, acute care, skilled nursing facility, and ambulatory space (patients at home). We use a command center approach, which allows a dedicated team of physicians, nurse practitioners, nurses, pharmacists and social workers. We provide coverage to more than 400 ICU beds in five states, more than 200 medical/surgical patients, neuro and behavioral health ED coverage, 500 complex chronic members at home, as well as simple low acuity on demand home visits.
What’s it like? Is it all it’s cracked up to be?
Yes, we went live with our first 50 ICU beds in 2006. With our program growth, we’ve experienced great results: in 2013 our ICU results were among the top three in the U.S. Using APACHE as the actual to predictive model Banner saved more than 33,000 ICU days, 47,000 hospital days and 1,890 lives in 2013. We are expecting similar results for 2014.
PipelineRx is a telepharmacy company offering remote and SaaS pharmacy services to rural hospitals, as well as larger integrated delivery networks (IDNs). For smaller hospitals, PipelineRx offers 24/7 staffing during nights and weekends, verifying medication orders remotely to promote patient safety. The SaaS technology platform allows larger IDNs to essentially create their own telepharmacy, using one of their own pharmacists to staff additional locations.
CEO Brian Roberts has spent most of his career focused on healthcare services and staffing. Prior to co-founding PipelineRx, he was the president of Canopy Healthcare until it was acquired in late 2008. Canopy Healthcare was the leading allied healthcare staffing firm on the West Coast. Prior to Canopy Healthcare, Roberts was the EVP of business development at CHG Healthcare Services, a $600 million leader in diversified healthcare staffing which supplied physicians, pharmacists, nurses, and allied healthcare professionals to hospitals nationwide.
Here, Roberts discusses his firm and its capabilities, technology developments he’s seeing, telemedicine challenges and trends we’ll see in the coming year.
Tell me more about yourself and what inspired you to found PipelineRx?
I spent the first half of my career as a venture capitalist investing in early stage healthcare services and healthcare IT companies. I spent the second half of my career building companies from the ground up as an entrepreneur. I love the operations and technologies that are critical for building a sustainable business model. After building two successful medical staffing companies, I figured out that we could “staff” hospitals using remote pharmacists that work from home. The labor arbitrage of enabling one pharmacist to work on multiple hospitals drove on average a three to one return for hospitals. This all was enabled by creating a technology that allowed interchange between PipelineRX and hospital pharmacy information systems and EHRs.
We now have an amazing management team bringing more than 100 years of experience in building pharmacy technology companies.
Tell me more about your desire to lead a telepharmacy company? Who uses this service? How is it growing and how has it changed?
Leading PipelineRx is exhilarating each and every day. Overcoming challenges are what makes it interesting and trying to apply cloud based technology to a service that must be completed (pharmacy verification services).
Hospitals of all sizes use the service. From the small side, critical access hospitals with 25 beds use the service for long stretches, say 6 p.m. to – 6 a.m. and 24 hours on the weekends. Our service allows them to save significant costs yet have world class medical coverage of their hospital. We can also fill in if an employee pharmacist calls in sick or if there is a big snow storm and the employee pharmacist can’t make it to work. We also work with larger hospitals and hospital systems that are looking to optimize their staffing levels. While pharmacies traditionally were staffed like a firehouse with ample coverage, PipelineRx allows the hospital to staff to the median levels and then use our staff for peak or overflow. It’s been an amazing journey to see hospital administrators and C-suite’s understand that we assist in moving traditional fixed costs to variable costs through our unique service.
eVisit is the telemedicine software platform for physician’s offices. Its cloud-based SaaS application allows physicians, PAs and NPs to evaluate and treat their existing patient population remotely, via webcam interaction. Unlike competitors, eVisit is the only platform for providers, designed to allow telemedicine reimbursement from third party payers. eVisit can increase patient flow up to 300 percent; and can decrease “no shows” by 80 percent, allowing a practice to recover up to $120,000 a year.
Elevator pitch
eVisit is telehealth software that enables providers to increase patient flow and revenue, while providing convenience to their patients with online treatment.
Leadership team
Bret Larsen, Co-Founder, CEO. Glen McCracken, MD, Co-founder, president.
Marketing/promotion strategy
We are actively marketing through strategic channel partnerships and product integrations.
Market opportunity
The Primary Care Market generates $135B/year in revenue with a CAGR of 2.6 percent. It employs 745,642 (246,090 physicians) over 130,526 medical practices; 90 percent of primary care physicians operate in SMB medical practices, our target segment (IBISWorld). This segment represents a $9.99B/year addressable market (221,481 buyers x $1,200) + ($121.5B x 8 percent billing fee).
How your company differentiates itself from the competition
Competitors offerings include B2B models with value propositions of lowering costs, B2C models offering convenience or enterprise hardware and software (none offer physicians ability to bill a patient’s insurance, the doctor-patient relationship is non-existent and patients are being asked to pay more).
Business model
Healthcare practice sign up on a subscription that is charged on a per user, per month fee of $99.
Current needs
We are currently raising our seed round of investment ($1M) and actively looking to hire talented developers.
Guest post by Steven Chau, CTO and co-founder, Doctor Quickly.
Healthcare is one of the last industries to be disrupted by technology. Although unprecedented levels of biomedical knowledge, surgical procedures, and condition management have been amassed, we are not using them to their potential to create the tools to improve healthcare experiences. A balance of privacy and policy regulations with technology is the key to creating a secure yet efficient healthcare system.
The State of Healthcare
A staggering portion of healthcare costs are wasted. According to the Institute of Medicine (IOM), $765 billion or 30 percent of the 2009 total U.S. healthcare spending was wasted. Key areas that were tracked include unnecessary services, services inefficiently delivered, prices that are too high, excess administrative costs, missed prevention opportunities and medical fraud.
Key findings:
Overused services, defensive medicine and higher-cost services total $210 billion in excess cost;
Medical errors, care fragmentation and preventable complications total $130 billion in excess cost;
Duplicative costs to administer insurance and insurances’ administrative inefficiencies drive $190 billion in excess cost;
Product prices beyond competitive levels total $105 billion in excess cost;
Missed prevention opportunities like primary, secondary and tertiary prevention total $55 billion in excess cost;
Fraudulent claims total $75 billion in excess cost.
Additionally, there will not be enough physicians in the next few years to meet the growing demand. The Association of American Medical Colleges (AAMC) projects a shortage of 62,000 physicians by 2015. This shortage is expected to increase to 91,000 by 2020. This physician deficit is due to an aging Boomer Baby population, the insuring millions of new patients through the Affordable Card Act, and the retiring of a large number of doctors in the coming decade.
Technology can curb inefficient health management, increase knowledge sharing, and improve access to a shrinking physician pool. However, proper precautions must be taken to safeguard patient information privacy while empowering healthcare providers to provide more efficient care.
HIPAA
Healthcare technology is largely regulated by the Health Insurance Portability and Accountability Act (HIPAA). It was created in 1996 to protect the privacy of electronic patient data, known as protected health information (PHI) and to restrict access to PHI. Predating the iPhone by 10 years, the HIPAA rules were strengthened in 2013 to increase rigor on de-identifying PHI, to broaden HIPAA’s reach to include all entities that touch PHI directly and indirectly, and to notify affected parties if a PHI breach has occurred.
As we head into Christmas, and 2015, millions of Americans have hopes for a bright holiday willed with hope, health and happiness. And while America’s consumer engine is in full force, presents are getting bought, wrapped and covered with ribbons and bows, it’s hard to image that there’s little that can’t be bought and given in the spirit of good cheer for the betterment of man and for the greater good. But, as in all areas of life there are a few things that won’t fit nicely in the stocking or under the tree.
If only everything we wanted and needed could be placed in our stocking to be unwrapped on Christmas morn, but there’s just too much on the list. The list would be long for those in healthcare – interoperability, improvement of policies, better communication with care providers, and even more, qualified employees to join healthcare-related ventures.
If only some of these Christmas wishes could be packaged and stuffed in the stocking. Here are a few ideas from several healthcare folks who wish they could make the world’s dreams come true.
Allen Kamrava, MD, MBA, attending staff, Cedars Sinai Medical Center, Department of Surgery, Division of Colorectal Surgery
Common language between all healthcare electronic health records (EHR) systems, such that they can communicate with each other and patient notes may be accessed between all providers. We have gone digital, but none of the systems communicate with one another. This does not make any sense. Patients should be able to elect to have their records “shared” between systems when they visit other physicians, and more so to have their accounts sync’d between systems so that all physicians are up to date with all tests, procedures and visits. For now, the only thing EMRs have provided for is more legible notes that are inundated with information required by national standards regulations. Healthcare is far beyond the rest of the IT world. Indeed, it functions in the pre-internet era – we have electronic systems, but they do not communicate in any meaningful way. Healthcare IT is still functioning as if we are in the 1990s.
Bill Marvin, president, chief executive officer and co-founder, InstaMed
Bill Marvin
Health IT Christmas wish: Interoperability. By integrating technology and processes across heterogeneous environments, providers automate administrative processes and simplify compliance requirements, resulting in lower operational costs.
I would love to see a fully functional telemedicine capability in every hospital and office across the country. What I mean by fully functional is that reimbursement hurdles have been cleared, apps are standard, we have a maturity and adoption model in place all so that patients are receiving the best care from the right clinician in the most optimal manner possible.
Charles Settles
Charles A. Settles, product analyst, TechnologyAdvice
There are a myriad of things I’d like to find in my figurative “stocking” come Christmas morning, but perhaps the one I’d like to see the most is more widespread patient, provider and payer use of health wearable devices or fitness trackers, i.e. Fitbit, FuelBand, Jawbone, etc. The spread of these devices is something we are keeping a close eye on here at TechnologyAdvice; we recently surveyed nearly 1,000 adults about their use of fitness trackers and uncovered several key insights. Perhaps the most actionable of those insights was that nearly 60 percent of adults would use a fitness tracking device if it would help reduce their monthly health insurance premiums. Of course, there are potential benefits to payers and providers as well — in the push to switch the healthcare reimbursements from a fee-for-service to a outcomes-based model, these devices could provide invaluable information to physicians that would aid in health maintenance, preventative care, and overall population health modeling. As these devices evolve and are able to track more and more biometrics, they could enable less expensive and higher quality telemedicine.
MedWand Solutions develops and distributes the MedWand solution, a patent-pending telemedicine device that easily connects to a PC or mobile device, like a cell phone or tablet. MedWand contains a set of fundamental, easy-to-use vital sign measurement and examination devices integrated into a single wand about the size of a large electric toothbrush. It includes a pulse oximeter, an otoscope camera for ear examinations with attachments to also allow views of the eyes, throat, or nose, an in-ear thermometer, a digital stethoscope and provision to support optional third party Bluetooth wireless devices, such as glucose meter or blood pressure monitor. In addition enabling remote examinations, MedWand can assemble all measurements and required information into a secure electronic health record, enabling a clinical-quality, interactive, at-home telemedicine experience for both patients and their doctors.
Elevator pitch
With all the advancements we have experienced in technology, routine telemedicine still doesn’t allow examination capabilities for all patients. With MedWand, no matter where the location, patients can experience remote examinations like never before.
Product/service description
MedWand is the first handheld telemedicine device that allows doctors to examine patients and gather important medical vitals, remotely, via secure Internet channels on tablets and personal computers. In the rapidly growing industry of telemedicine, the majority of remote consultations are limited to audio and video without the possibility of direct physician examination. Now, with a MedWand, doctors can listen to a patient’s heart, lungs, and abdomen; look at skin and into ears, nose, and throat with an embedded high-definition video camera; obtain basic vital signs, including blood oxygenation; and even obtain a thre-lead EKG – all remotely, with a single unit that can be cradled into the palm of a hand. In addition, MedWand provides continuous medical vitals monitoring services with alerts when patients may be headed in the wrong direction.
Founders’ story
The MedWand telemedicine device was conceived by former Pebble Beach house doctor Samir Qamar, a family physician and founder of MedLion Direct Primary Care, one of the nation’s leading direct primary care companies. It was after being dissatisfied with current limitations of telemedicine that Dr. Qamar came up with the idea to build a compact telemedicine device capable of remote patient exams. After an extensive search, Dr. Qamar approached engineer Robert Rose, founder of Cypher Scientific engineering, formerly of Red Digital Cinema, who agreed to join the project. Together, on a mission to advance telemedicine, Dr. Qamar and Mr. Rose created the MedWand.
Marketing/promotion strategy
MedWand appeals to the entire telemedicine industry. Having already been approached by branches of the U.S. military and many large telemedicine companies worldwide, MedWand will soon be helping hospitals, accountable care organizations, and companies control healthcare costs by allowing real-time examinations to telemedicine services. A major computer manufacturer has offered to be a launch partner for MedWand, and MedWand is ripe for international distribution. Eventually, the MedWand will be distributed directly to patients and their families worldwide.
