Tech

Closing the Loop on The Need for Better Telemedicine


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I’ve had the great privilege of presenting our virtual care company, CirrusMD, to potential customers and investors at some of the premier health technology conferences this fall, making the cut for both the Health 2.0 Traction event and this week in the finals of the mHealth Summit and HIMSS Venture+ event. (Breaking: we won the mHealth Summit and HIMSS Venture+ mature startup company award!)

Still, we often get an initial response, “Who needs another telemedicine company with the likes of Teladoc and American Well raising big rounds this year?” One writer even went so far as to share the thought in Forbes on the fragmentation of the digital health landscape after Health 2.0.

I want to take the opportunity to use an analogy to explain why were are different from other telemedicine offerings on the market, and why we are getting such great traction and recognition. In fact, we’re working to “unfragment” the healthcare landscape by closing up some very loose ends that occur in a typical telemedicine experience.

Today, finding our way to an unfamiliar address is easy with Google Maps or a GPS system. We just enter an address and go. The system knows where we are, where we are headed, can offer several options on how to get there, even make local recommendations along the way based on people who know the area. That’s where telemedicine needs to be, but not where it is with many of the major vendors.

Imagine if you didn’t know where you were, where you were going, and had no map. You’re lost and you find an old pay phone. You dial a number on a billboard that says “Directions and other Help”.

“Hi, I’m lost, and I have a flat tire and a bent rim,” you say.

“Where are you?” a voice asks.

“Wyoming.”

“Where in Wyoming?”

“Um, on a side road, that’s about all I know.”

“Where are you headed?”

“Somewhere better than here.”

“Well if you can get to a major highway I might be able to help you. I have a map of the major highways.”

“But I only have a bicycle.”

“Well, I can tell you how to fix your tube, but for a rim and tire, you’ll need to go to find a store. Good luck!”

That’s where many telemedicine customers are today. They can get a hold of someone, but the person on the other end of the line has little information on who or where the patient is, little idea of where the patient is in their care plan, and limited ability to effectively direct them on where they need to go. The professional on the line will have little understanding of how well the patient is capable of getting where they need to go and might have a different set of maps from what the patient and their care team have used in the past. At best, they can offer imprecise advice. That advice can only get the person vaguely in the right direction and the person won’t be able to speak to the same person again. There’s little to no opportunity for follow-up and course correction.

Having cohesive medical direction is equivalent to making sure everyone is working from the same map. When you move from one disconnected physician, to another, you may get very different advice, particularly when there is no common management or reciprocity between these two unaffiliated providers. Standards of care may, and often do, vary from practice to practice. That can cause conflicts and misdirection.

A longitudinal history ensures everyone agrees on where the patient is on “the map”. It assures that the best decisions are made under the context of care continuity. To maintain coordination, virtual care providers must have access to the patient’s primary medical record, and bricks and mortar/physical providers must have access to and notification of any virtual encounters that occur.  Additionally, the virtual and physical providers must be able to communicate and coordinate with one another around a patient’s care plan. A patient can wind up going around in circles.  Without the complete view of the patient, different decisions can be made in their care, and those decisions can lead to less than optimal outcomes. We see this happening with many of the virtual care services on the market today, especially for patients that have more complicated medical histories (remember 50% of adult Americans are living with a chronic condition).

We recently had an encounter with a patient suffering from a chronic condition who was traveling in Europe and lost their medications. They had a secure text conversation over the CirrusMD platform, and the physician was able to review their medical record and notes from the patient’s regular specialist and access their medications list.  The doctor knew that replacement medications were available over the counter in Europe and instructed the patient on what to get. The doctor then helped the patient manage their condition over several days to ensure that they were comfortable with the new medications and that the flare-up was being controlled.

That’s the power of telemedicine that knows the patient, their history and their care plan.

On another occasion, an individual with a debilitating chronic disease asked us, “If the person on the other side of the connection does not know my pathology, my meds, my symptoms with my disease, should they really be giving me medical advice?” The short answer, we believe, is “no”. We ensure our patients and physicians have access to the information needed, and the patient’s record is kept up to date through data integrations to HIEs and EMRs.

Documenting where the patient is with follow-up as they move through their care plan is also critical. Telemedicine solutions must ensure a patient receives the proper follow-up care, whether that care is in a physical clinic or via telemedicine. Virtual follow-ups are not currently enabled with the majority of telemedicine services on the market right now, and they cannot provide physical, in-person follow-ups as the doctors are generally not connected to the patient’s local healthcare establishment.  Without the ability to enable follow-up, a telemedicine visit becomes an island, a one-off event known only to the patient, and they can quickly become lost again.  This leads to fragmentation in patient care.

Finally, to guide a patient effectively as they go forward, providing the right referrals for follow-up care is also critical. To provide proper direction, you have to know the local area and where to go for the right service. Our doctors are local to the patient and have that ability.

It will be very difficult for the majority of telemedicine services today to provide common medical direction, longitudinal data access, follow-ups and referrals. With most vendors you’ll likely get a new doctor every time you call, and even if they are licensed in your state (which doesn’t mean they are in your state), they may know next to nothing about the patient, they are operating under very loose clinical guidelines with high variability in quality of care from doctor to doctor, and in some cases the telemedicine physician’s recommendations may fly in opposition to a patient’s current care providers.

We can and are doing better with our clients. We are bringing telemedicine solutions that are more consistent and work in context of a patient’s local healthcare landscape and offer full data continuity between virtual care providers and their regular doctors.

Our closed-loop telemedicine methodology solves these issues with the ability to bring physical and virtual continuous care together, including: a complete and consistent map (a more complete view of the patient with a care plan developed under consistent standards of practice), a continuous pathway of access (opportunity for follow-up and ongoing management), and local knowledge of the area to make specific recommendations on how to get what’s needed to get on track (ability to do local referrals).  With closed-loop telemedicine, we’ll know where patients are, where they are headed with more precise direction all along the way.

Andrew Alterdorfer is the CEO of CirrusMD

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William Palmer MD
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William Palmer MD

We are always told in California that you have to be able to touch and feel and listen to the parient in order to be legally practicing medicine. I do think they are going to have to modify these laws but I bet they will still require that there be a sort of skilled para-doc or advanced NP with the patient–who can do what the doc suggests–at the other end of the connection. Eg the doc at the teleconference says to the para-doc 100 miles away “percuss the RUQ over the hepatic margin.” and “put your electronic stethoscope on the… Read more »