CNBC: Why TeleMedicine is a Bust

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A fascinating article on “Why telemedicine has been such a bust so far” by Christina Farr.

mHealth Insights

The first thing that should be obvious about why TeleMedicine is a bust can be seen at a glance. The newest mass media (Mobile) has made Telemedicine a bust in the same way that it’s made photography, hailing a cab, shopping in a record store, booking travel, booking a hotel, buying a toy or a house, etc, etc. Healthcare is becoming a Mobile Experience. We’re not dropping the ‘m’ in ‘mHealth’ we’re dropping the ‘Health’

CNBC have it captured well: A MAN IN WHITE COAT WITH A STETHOSCOPE TAPPING AT HIS MOBILE is a perfectly valid and useful depiction of telemedicine today. But watch a Patient using their own ECG machine and having their medical data read by a computer and referred if necessary to a Doctor (who may be casually dressed working from home while her children are at school) and you’ll realise just as video killed the radio star the incredible sensors in the super computers in our pockets have removed the tele (meaning is ‘distant’) and we now have to understand that healthcare is becoming a mobile experience (this is why it’s wiser to use the ‘mHealth’ term I coined 10+ years ago) because the potential for medicine/care is now always with us, continuously carried within arms reach and never turned off.

At the end of watching that video ask yourself do these Patients look like they are ‘distant’ from their medicine/care?

We have elderly Patients using these mHealth devices for years and when you ask them about their experience they’ve never felt closer to their medicine/care. There is no doubt that the convergence of healthcare to mobile (mHealth) has enabled us to evolve from TeleMedicine/Telecare.

“Telemedicine, or apps that let you consult with a doctor via video, was supposed to be the next big thing in health care But lack of awareness, questions about cost and reimbursement, and the human desire to talk to another person when sick have hampered the sector. Tech giants like Apple may ride to the rescue… Billions of investment dollars have been poured into apps and websites that offer this virtual consultations with physicians, ranging from Doctor on Demand to American Well. The theory behind them is that millennials would opt for a digital alternative to an in-person physician’s visit, if the option were available. And patients in remote, rural areas who are miles away from the nearest doctor would have few alternatives…   …But telemedicine is still far from mainstream. Even a study sponsored by a telemedicine provider from late 2017 still found that 82 percent of U.S. consumers do not use it”

I think this is an easy to have predicted outcome of telemedicine meeting with the needs of the USA’s Insurer led SickCare model. VC money has unsuprisingly been haemorrhaging from failing ventures because a subsidised video consult isn’t a substitute for a Doctor visit.

People may be gullible when it comes to sharing their data in exchange for online services (just look at the level of personal health info sharing that Patients provide to advertising networks like Facebook or Google) but most of the more experienced older people (who have healthcare needs or care for children or elderly Parents with them) realise there is value in sharing info with a Doctor who isn’t in the business of trading their personal health data.

Yes you can obviously bluff some naive people with the offer of cheap or free chats with a Doctor advice call but communities dominate brands and Patients/Carers are increasingly becoming aware that it’s not smart to subsidise/exchange your incredibly personal and revealing information with unnamed corporations for the advice of a Doctor.

“Why the lack of adoption? Several factors are to blame. The biggest, and most important, is that many U.S. consumers are still not aware they have the option to chat with their doctor over the phone or via video”

Surely this is just because while Clinicians like Prof John Bachman at the Mayo Clinic pioneered in the publishing the evidence for advancing relationships by moving beyond the office-visit-only relationship the USA’s Health Insurer led market has done everything to undermine the Family Doctor relationship/business so the idea of Family Doctors innovating to offer this effectively (like they now do in the NHS) is just unviable because there’s none of them.

“The awareness piece is a big problem,” admits Ian Tong, a physician and the chief medical officer at Doctor On Demand, an app that offers smartphone consultations for $75. Tong believes that part of the problem is the branding of the term “telemedicine,” which isn’t particularly descriptive, so he’s opting to use the term “video visits” instead when he talks to patients about it”

I think this is a mistake and is not realising the additional value that can be offered now that +100 million Americans can connect via video calls on devices that they always carry with them.

We all need to appreciate that mHealth makes expensive, inconvenient & impossible health care experiences inexpensive, ubiquitous & super convenient because when you are asking ‘what are the benefits of a documented consult with a Doctor over a Video Call?‘ the born mobile generation are struggling to think of reasons why you wouldn’t want to video consult with a Doctor…

mHealth isn’t about replacing office visits with video calls it’s about realising “Go and Get Help” no longer makes sense…

“Another setback: Patients heard of telemedicine apps often fear the expense, especially if it’s unclear whether they can use their health insurance. And in some cases, the apps are offering cash prices that are out of reach. $75 might be a stretch for some”

I think this reinforces the commitment to radical transformation of the USA’s healthcare system that Apple Inc senior management are all committing to eg. Apple’s CEO Tim Cook has made it clear that Apple has the unique privilege of not having to care about reimbursement and that they estimate that the upside of this is that they will create a company that will make their current business small (it’s currently the world’s largest and most profitable corporation!).

“Another common theme is that the doctors who are willing to work with app makers are inexperienced, or low-quality. Companies like Doctor on Demand will say they go out of their way to vet — and pay for — the best clinicians. But there is some merit to this concern, especially with the lower-quality services”

I think the opposite is becoming clear: Patients who see you uncomfortable using the mobile tech that everyone else is familiar with may lose confidence in how current you are with your medical knowledge.

“In 2016, researchers posing as patients turned to 16 different telemedicine apps to diagnose skin issues. The results? Some of the online doctors misdiagnosed conditions like syphilis, others prescribed unnecessary meds, and two of the sites used doctors who aren’t licensed to practice in the state the patient was located. The authors concluded that these apps repeatedly missed diagnoses by failing to ask simple, relevant questions”

This was some great work by Dr Jack Resneck and it made some great recommendations:

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but I think the websites tested were quite scammy eg. they published “a variety of disclaimers that they do “not provide health care services,” and do “not create a physician-patient relationship,” but we found that they did make diagnoses and offer specific treatment recommendations (without sending prescriptions to pharmacies)“.

I can’t see how Dr Resneck hasn’t been obliged to report the Doctors involved to their credentialing authorities before/at same time as publishing a public paper about how they are working dangerously and without licensure.

“Finally, even in the digital age, a lot of people simply want to see their doctor in person. They’re not Luddites. But sick, vulnerable people often need in-person reassurance from another human being in the room. A smartphone app simply won’t cut it”

I think this is classic view of someone who thinks video calls are about just trying to do what’s normally being done with an office visit. Just as Spotify didn’t try to recreate the record shop on our mobiles, Uber didn’t try and recreate the taxi rank, AirBnB didn’t try to recreate the work of the Hotel Reservations department, it’s invaluable that we all try to reimagine the opportunities we have to offer new supportive services to Patients who are always connected and are increasingly having a copy of their medical records and a means to easily and securely share them (this is the rocket fuel that drives demand for video consultations with independent impartial Doctors).

I think it’s important to realise the #1 reason Doctors don’t want to remotely video consult with their Patients is because it encourages Patients to do something most Doctors have little/no training helping Patients with.

“Will this ever change? Roy Schoenberg, the CEO of American Well, believes that doctors, insurers and employers will increasingly inform their patients about the option to use telemedicine, which will help consumers get over many of their fears. If they’ve already got a relationship with that doctor, a virtual consult might seem like an easier alternative to getting across town to a doctor’s office and sitting in a waiting room”

I think this is a very good measure of how wedded the USA healthcare system is to serving health insurers. Amercian Well has taken $210million in venture funding over 6 rounds yet still hasn’t realised the big opportunity is in offering services direct to Patients. Imagine the CEO’s at Uber/AirBnB/Spotify thought that the Taxis/Hotels/MusicLabels would inform their customers about the option to use their mobiles to get their product via their mobile phones!

“But getting doctors to jump on board is easier said than done, and takes time. Many are afraid of liability, as it’s possible to miss something during a remote visit. And for years, it wasn’t clear whether they would get paid as much as an in-person visit. Reimbursement questions are still getting resolved across different states, but most of the commercial and government plans are on board with the idea of telemedicine — at least in specific circumstances.Another marketing boost for telemedicine could come from the big tech companies. American Well got its a plug from Apple, which announced it would work with the company for its heart-health study, so that participants could get easy access to a doctor’s office if they needed it.”

This is a huge problem and the most effective thing we’ve seen to help with it is the provision of accredited mHealth training for Healthcare Professionals that we helped produce.

“Finally, many consumers who use high-quality telemedicine apps are spreading the word. “Consumers are realizing that it can all be done via an app, whether it’s getting a prescription, an exam or ordering labs,” said Doctor On Demand’s Tong. “There’s no need to sit in that waiting room anymore.””

I agree with this and think it’s even more positive. People using other (non-healthcare) apps are coming to expect healthcare services to work as seamlessly. We all know a rising tide raises all boats so has your organisation gone Mobile First yet?

 

*** UPDATE Monday 2 July 2018 ***

Tomorrow at 11am GMT I’ll be discussing this post in a FaceBookLive video discussion with Dr John Bennett MD (and guests) from InternetMedicine.com.

Follow InternetMedicine on Facebook/Twitter to get updates. Click back here after the discussion and  refresh the page and you’ll be able to replay the video recording of the discussion.

*** UPDATE Tuesday 3 July 2018 ***

Click here to watch the video over in the InternetMedicine ‘mHealth Studio’:

Links to videos suggested in the discussion:

At the Doctors2.0 Paris Conference David Doherty shares Mobile Video Consulting best practice.

Here is the link to the video of Apple Health Record being demoed by Dr Ricky Bloomfield at HIMSS.

*** UPDATE Wednesday 4 July 2018 ***

Some interesting feedback via Twitter chat with Irish GP Valerie Morris MD who has now for some unknown reason deleted her tweets which is a great shame as I was going to enjoy hearing Dr Morris explain how a ‘fully computerised’ GP doesn’t yet have a website nor offer Patients any access to Healthcare Records:

@mHealthInsight: I think the vast majority of Doctors outright dismiss the value of video consults yet so many prefer video consultations when they themselves need the advice of a Doctor mhealthinsight.com/2016/11/21/doc

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@DrVBMK: David, don’t kid yourself. Telemedicine won’t replace the traditional Dr-Px consultation which includes EXAMINATION. Vocationally trained GPs know the risks involved if you don’t examine a patient. And guess what, Medical indemnity is higher for those engage in telemedicine.

@mHealthInsight: I think the issue is so many presume telemedicine must be about diagnosis & prescribing. You can also provide care, management, followup etc

@mHealthInsight: Would be great if you could join me and @InternetMeds for a discussion on this topic at noon today internetmedicine.com/homebaner/conv

@DrVBMK: Quick comment: Busy surgery all day – 2 emergencies this morning – child & adult – managed here then sent the ED. And I’m only halfway through my morning list. of patients. Lunchtime is for home visit to see palliative patient. How on earth do you provide care using telemedicine

@mHealthInsight: I think you’ve presumed that I think the benefits of telemedicine is an excuse for under resourcing GP services.

@mHealthInsight: I think you’ve presumed that I think the benefits of telemedicine is an excuse for under resourcing GP services.

@DrVBMK: It’s your words, not mine. You haven’t answered my question In earlier tweet.

@mHealthInsight: Video of the discussion with Dr John Bennett is now posted on @InternetMeds (skip the first 30 mins) internetmedicine.com/mHealth-studio/

@mHealthInsight: in answer to “How on earth do you provide care using telemedicine”? you use your time efficiently, let Patients/Carers help you with documentation etc. It’s quite complicated (otherwise everyone would already be doing it) but you can learn from fellow GPs https://mhealthinsight.com/2016/03/04/the-evidence-is-in-askmygp-is-helping-nhs-gps-work-at-the-top-of-their-license/

@DrVBMK: Are you a GP? Your tweets don’t reflect that you are one nor does it reflect real life General Practice.

@mHealthInsight: would you like a job?

@DrVBMK: Medical indemnity for full time Irish GPs is no less than €20,000 per annum (more if you provide telemedicine, OOH, minor surgery etc). Will you pay that upfront???

@mHealthInsight: How big is your HSE list as if 500+ it’s well worth us meeting up as I’m sure I could save you a small fortune

@mHealthInsight: Probably best to email me as documented video consults with Patients that aren’t enticed with offers of prescription drugs is very low risk

@DrVBMK: 98% of GP practices are fully computerised. The only time I use a pen is to sign my name. I am from the old School of Medicine. A computer will never be the interface between me and my patient. I respectfully decline your offer. I love my job.

@mHealthInsight: Do you really think there is a single “fully computerised” GP practice in the whole of Ireland?

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