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Telehealth is great. So why isn’t it everywhere already?

 It offers convenience, access and resources. But the widespread adoption of telehealth remains complicated.

A lot of people don’t know this but Hart got its start in telehealth. Well, actually, we started with medication adherence and the more we worked with clients, the more we discovered how important remote patient monitoring (RPM) is to medication adherence.

RPM is one form of telehealth by which devices are sent to a patient’s home to monitor chronic conditions. This is especially useful in a post-hospital situation to maintain quality of care and reduce the chances of the patient ending up back in the hospital.

At its core, that’s what telehealth really is — and should be — about: Providing convenience, delivering excellent quality of care, minimize a patient’s need for unplanned hospital visits and just generally making it easier to improve a person’s overall health.

So if telehealth is so great, why isn’t it everywhere already?

I can answer that question and others for you. But before we dive into the conversations currently surrounding telehealth, let’s add some context.

“Tele-what?”

When “tele-” is used to describe something, it means there are electronic means involved so that two or more parties can accomplish something without having to be in the same room.

When you see “tele-” used with “health” or “care,” it means care provided over electronic means so that the two people — usually a clinician and/or patient, or in some cases, multiple clinicians — can interact without meeting face to face. The idea is that telehealth can allow providers, hospitals and health technology companies like Hart to extend tools and resources to patients; and it can allow patients to receive more instantaneous answers to their health questions.

I’ll give you some examples to help clarify. Let’s look at a few forms of telecare that exist today.

Telehealth is used to broadly describe health information services, education and care services delivered electronically. It’s a term that umbrellas everything that happens under it.

Telemedicine is often confused with telehealth, or the two are wrongly used interchangeably. But telemedicine is more defined in that it specifically refers to using telecommunications technology to provide remote clinical services to patients. Examples include digitally transmitting medical images, doing remote diagnostics (like RPM) and/or video consults (think FaceTime). These interactions may be with your primary care physician; in other cases, they may be with a remote team that will ultimately keep your doctor in loop.

Teletherapy is the practice of therapy done via telemedicine, for example, personal therapy, family therapy or even addiction therapy.

Telecare involves a team of doctors, nurses and others taking care of patients remotely. This allows a patient to maintain his or her independence and quality of care while staying at home.

Just a heads up that I’ll be using “telehealth” throughout the rest of this post to keep things simple. But it’s good for you to have some knowledge of the subtle differences between the related terms.

The term telehealth describes health information services, education and care services delivered electronically.

“How is this technology used?”

Because this technology has such a broad application across so many areas in healthcare, it can offer greater convenience and faster care to everyone. Here are some specific examples.

Remote Care

Arguably the most exciting area is our ability to extend care to people we were not able to reach before. Imagine having doctors providing care to patients in other countries, remote areas or even disaster areas. This significantly improves the care someone receives and can actually help eliminate the need to travel long distances just to receive care.

Remote Patient Monitoring

As I mentioned, Hart began in the RPM area. A great service that allows a care team to remotely take care of a patient after he or she has been discharged from a hospital, RPM enables the patient to enjoy the comforts of home, safely. Plus research has shown patients may heal better and faster when they are surrounded by familiar settings and, in particular, their loved ones.

Consults

Another major way this technology is being used is to provide consultation between specialists and caregivers. For example, maybe your doctor wants a specialist’s opinion on one of your medical images in order to make an intelligent diagnosis. Instead of referring you to the specialist and making you do a lot of back and forth with additional appointments and paperwork, your doctor could use telehealth to get instant feedback, saving everyone time and money.

Employers

I’ve already written about companies establishing on-site clinics for their employees. Sometimes those clinics are criticized by people who point out that remote employees or out-of-town family members are left out. But telehealth allows those individuals to visit with the very same doctors and care team as the on-site employees do. Interacting with familiar faces can be important to retention since many patients perceive these individuals to be more fully involved in their care.

I’m sure you can see and think of many other areas in which we can use these types of services. We’re seeing their numbers grow rapidly and I enjoy learning about new telehealth services that are springing up all the time.

“What are the benefits?”

All of this sounds great but in my opinion there are benefits to telehealth beyond just the ability for tele-visits. Nothing is more important than getting the right answer quickly from your doctor, however, there are other things to consider here that offer amazing value to us as patients, and of course, there’s also value for the physician.

Convenience

No one can argue how convenient telehealth services are. Compare the traditional method of trying to make a doctor appointment to just picking up your smartphone. In the latter scenario, you can access your doctor’s office so much faster. Or if you use voice commands to your Echo or your Google Home device, then your access is even faster still. It might take 5 to 20 minutes to get a member of your care team up on your screen.

Teladoc, a leading provider of telehealth (that just surpassed 2 million visits), advertises an average wait time of 22 minutes. All things considered, that’s not bad. That’s how long it takes most of us just to schedule an appointment with our primary doctor over the phone. That’s 20-some minutes not to be seen but just to be scheduled.

Engagement

If you have a telehealth app on your smartphone, you now have a way for a care team to communicate with you. That’s a great opportunity for engagement, whether it’s before or after your visit — maybe even right after your appointment while you’re waiting for a call back. And in the event you’re an RPM patient, you actually have a device that’s collecting information 24/7 from the medical devices you’re using. All of these are touch points that are ripe for engagement and can allow your care team to better facilitate your overall health.

Prevention

The best part about telehealth services is that they’re not just for those who are sick. There are many times when we need to go see the doctor for simple things that could be accomplished via telehealth technology. And with more and more providers doing this, now we can.

At this point you might be thinking, Wow, this could save all of us a lot of time and money and also make those quick cold flus go away much faster. Why isn’t this widely used already?

I’ll fill you in on the answer. It’s time to explore the other side of telehealth, the one where telehealth meets the law.

Telehealth services can boost prevention and patient engagement plus offer convenience for both patients and doctors.

“Are there laws to regulate telehealth?”

The general premise of laws is that they’re there to protect us as a society and uphold certain values. But in some cases, such as telehealth, the law can’t keep up with the industry’s changes and ultimately hinder growth and innovation.

The freedom to post anything on the internet and reach anyone instantaneously is great. Medicine, however, is something special and, let’s be honest, requires guardrails. When it comes to taking care of you, it’s important that the doctors who are giving you an opinion are board-certified. After all, you don’t want just any random person trying to give you advice about a condition you might have — or end up using Mr. Google, which sometimes ( often) leads to information with a disclaimer that says a condition can result in X, Y, Z “… or death.” Not very comforting.

Not All Laws Are Created Equal

In the U.S., when it comes to healthcare, each state has its own medical board and laws that define things such as:

  • Proxy (the ability to see someone else’s record, for example, your child’s)
  • Lab releases (what kind of labs you get and when)
  • Abortion (perhaps the most controversial of all)

Each state has its own laws for telehealth too. This means a doctor can’t practice across state lines unless he or she is licensed in that state. You can see how this can get tricky where telehealth is concerned.

What This Means for You

There are a couple areas where this hinders the adoption and rate at which this technology can grow. This could mean a few things for you:

  • Not every doctor will do this
  • You can’t always get a doctor right away
  • Slow growth of adoption due to certifications and legal drawbacks

Over time we’ll see this change and there is a lot of movement already on this from a law perspective to allow transportability between state lines. While this will take time, it will gradually get better and better. A great thing about technology companies is that they can adapt quickly, so they should be able to adapt swiftly along with any law changes

Similar to when doctors see patients in person, they must be licensed in every state in which they deliver telehealth services.

“I’m sold, how much does this cost?”

Of course, patients usually like the sound of telehealth but wonder whether it will cost them more or less than what they’re already paying for healthcare. The reality is, it actually costs less than what most people would think, especially when you consider costs associated with your time, gasoline, and the wear and tear on your car.

With telehealth, there are currently two models for payment:

  • User Pays: You cover the cost of the visit.
  • Insurance Pays: Your insurance covers the cost of the visit.
  • Sponsor Pays: Your employer or other entity sponsors/pays the coverage fee.

User Pays

Among the leading telehealth providers, the price for visits ranges between $49 and $99. All things considered, that’s a fairly economical price range so long as you aren’t calling the doctor every day. Or what if it were the middle of the night and your child were crying and you had no idea what was going on? That price would most certainly be worth the immediate answers and peace of mind.

Most of these companies have online signup or even mobile apps — just register and you’re ready to go. Some companies have a subscription model which requires you to pay a yearly fee in exchange for a lower price per visit or several free visits over a certain period of time.

Insurance Pays

A lot of insurance companies are still catching up to this, however, great strides have been made. If you use your insurance, the cost will vary depending on your plan type and your co-pay.

In order for a telehealth company to take insurance, it has to make a contract with each insurance plan provider, which can take some time to get in place. That’s one reason why a company may not presently take insurance or insurance by a specific plan provider.

Most likely you’ll see that by the end of 2017 all insurance plans will have some form of coverage for telehealth. It’s in their best interest, after all, as it lowers their own overall costs when insured customers make use of telehealth.

Sponsor Pays

Additionally, an employer or another sponsor can choose to pay for the entire cost or subsidize the cost of a visit.

Sometimes You Need a Doctor Right Now

There are other companies that allow you to call a doctor to make a house call on demand. While that’s not telehealth, it’s still using digital technology to summon a doctor to your doorstep — kind of like back when your parents were children and the doctor used to visit their homes. The prices for these vary and there are also options for both payment models.

Although the cost of telehealth visits can vary, for many people the convenience and peace of mind is well worth it.
Although the cost of telehealth visits can vary, for many people the convenience and peace of mind is well worth it.

“Why doesn’t my doctor do this?”

By now you’re probably excited about this type of technology. And if you’re like me, you’re probably wondering why your own doctor might not do this yet. Remember the state laws and insurance complications I mentioned? While some aspects of telehealth have evolved rather quickly in response to consumer demands, the area of contracts with doctors is still a work in progress.

Simply put, not all doctors can get paid for this type of service … yet. This is changing more and more as insurance companies are seeing the benefit. Today doctors still requires you to come in so they can bill the insurance company , that’s how they make money. Unfortunately, they can’t yet bill for telehealth visits in all areas or all states.

New Laws

It’s not just telehealth that’s evolving — the healthcare industry as a whole is undergoing many changes. That includes changes in how we pay for value, and there are new laws being put in place to focus more on the value than the fees. Hence, it’s becoming more prevalent to see your health system and/or doctor offering telehealth services.

Operations

There are also other complications to consider, such as balancing the doctor’s schedule — after all, some people still need to go see the doctor in person, as not everything can be addressed via video.

These changes in workflows and operations will take some time to work through, however, I see the industry making great strides and I’m very excited for the next few years in care.`

“What if I still have questions?”

We never talk about anything in healthcare without these questions coming up:

  • Is it safe?
  • Is it secure?
  • How do I trust the service?

The short answer is: Yes, it is safe; yes, it is secure. However, all that said, you should do your research and go with a reputable company.

You’re Not Being Recorded

By law, the encounter you have with the doctor is only between you and the doctor — same as when you visit with your doctor in person. Once the video connection is made, that video connection is secure, private and never preserved as part of your medical record. Regardless, do your homework. Check the privacy terms just as you would for any service you use. And keep in mind that laws can change, so review those terms often.

This Isn’t the End of Going to the Doctor

This is a great question and the answer is no. There are still many cases in which you will need to visit a doctor due to either laws or just the nature of practicing medicine. These include but are not limited to:

  • Getting certain prescriptions or renewals
  • Physicals
  • Critical care
  • Surgery

Maybe in time all of these and others will be possible over tele-means, without the patient ever leaving home. I would argue, however, that there will always be a reason to see the doctor in person. My biggest reason for it?

Simply put, we like the interaction of being with others — we are, after all, social beings.

“What lies ahead?”

You’ll see telehealth practices evolve over time and you may be hearing the term “population health” more and more as healthcare focuses on While this has many different meanings, I have my own predictions about where we will see health go.

Health Coaching: I believe you’ll be assigned some sort of a health coach or care navigator — someone who’ll be your guide on your health journey. Imagine them seeing your step tracking, working with you on your diet and becoming your personal health cheerleader.

Precision Medicine: With DNA sequencing becoming cheaper every day, the thought of precision medicine becomes more and more appealing. This will be the practice of medicine that is tailored to one person and only one person: you. Imagine knowing exactly what you need to do to keep your body in its top shape.


This is an exciting time in medicine and there’s no telling what the future will hold. Whatever that turns out to be, I’m looking forward to all the healthcare transformations which will certainly make our lives a whole lot easier, healthier and longer.

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Published inTelehealth