What ONC Got Wrong in their Guidance on Telehealth

Screen Shot 2015-09-24 at 1.38.45 PMTelehealth – which lets patients see a doctor immediately, anytime, anywhere – shows no signs of slowing.  We are seeing this cross-industry, as more health plans make telehealth a benefit to members, and hospitals fold these services into new or expanded offerings for patients.  Consumer-facing products are also on the rise.  Patients can download an app and in minutes, have a FaceTime-like visit with a doctor for faster, more convenient care.

It was great then to see this week that the Office of the National Coordinator for Health IT (ONC) is picking up telehealth as a new focus – by issuing guidance for consumer companies in the design and delivery of these technologies.  The problem is ONC issued guidance without learning first how telehealth is actually being used in the industry today, leading to some basic… let’s just call them “misunderstandings.”

Some of the most notable misunderstandings:

  1. On-demand, online healthcare is “furthest from the core” [page 9]
  2. Telehealth doesn’t enable data exchange with medical record systems  [page 10]
  3. Telehealth lures patients to the online world and away from real-world physicians  [page 14]

Underlying all three is the premise that online healthcare (telehealth) is a separate system that threatens the integrity of the brick and mortar one.  ONC quietly stipulates that we should look at such efforts as “non-core,” disconnected and therefore inferior in quality.  In short – the online world of healthcare sounds extremely suspicious.

Interestingly, these were the same words used to describe the arrival of online services across almost every other industry.  Banking was insecure, retail would result in lower-quality goods, travel booking didn’t have the agent’s personal touch.  We know how these all panned out.

But, to address the points themselves, one by one:

  1. The term “furthest from the core” assumes that “the core” is physician offices and their electronic medical records (familiar territory for ONC).  Did anyone consider that the core of healthcare services is not EMRs, but the patient and their care that EMRs document?  Telehealth is extending the safe and timely reach of clinicians into the core – as in, where patients are, and where they need care.  This isn’t just about convenience and speed.  It’s about delivering healthcare to home-bound elderly patients or people that live far away from the nearest healthcare center, or when the only viable option is an emergency room or urgent care center.
  2. The assertion that telehealth doesn’t enable data exchange with medical records is factually wrong.  Most large telehealth operators go out of their way to make data exchange an AUTOMATED process with record systems (including EMRs, pharmacy benefit management, claims, analytics, and others).  Unlike many urgent care centers, retail clinics or emergency departments that may leave a patient with a printed summary of their visit, telehealth is digital to its core (pun intended) and is probably the most “data exchange” friendly way of delivering healthcare.  At American Well, our systems speak CCRs, CCDs, ICD-10, NDC, EDIs, and HL7 all as native languages, ensuring we can “talk” to the system and create a frictionless exchange of health information.
  3. On luring patients away from real-world medical care – Oh boy.  Telehealth isn’t “The Matrix.”  Telehealth encompasses real physicians, real specialists, real medical records, and real care.  Patients can see the next available physician in urgent cases (as they do in the real world) or follow-up with their own physicians in scheduled telehealth visits.  Telehealth does not sway patients from the real-world into another – it brings the real world of healthcare closer to its patients.

Roy Schoenberg, M.D., CEO is the Chief Executive Officer of American Well, a leading telehealth provider.

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5 replies »

  1. Great rebuttal to a terribly myopic view of healthcare. Love to see companies like American Well following consumer demand. Looking forward to more complex medical device integrations. Telemed is way more affordable than building full service medical complexes every 10 miles out as our cities grow.

  2. You are right when you say telehealth shows no signs of slowing down, especially in this age of technology. While I wouldn’t mind face-timing a doctor, I don’t see this being very convenient for the elderly population.

  3. Tele health is a moving target for sure, so much going on and you bring a wonderful overview on the new offerings. Thank you for that. In order for ONC and other policy leaders to have all the information about new technology, leaders like you should participate in the advisory process. I encourage you to nominate yourself http://onc-faca.altaruminstitute.net/apply to the federal advisory committees, or provide public comment during the sessions. @m_consolazio My experience is they listen.

  4. Worth noting that although there wasn’t much wrong with ONC’s report, there wasn’t one representative from any of the major “new” Telehealth vendors (American Well, Teladoc, MDLive, DcotorsonDemand) in the group. Most vendors there (Care Innvoations, Zipnosis) were from adjacent fields