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Tag: Telemedicine

How Online Prescription Services Are Closing the Access Gap for Patients Who Skip the Doctor’s Office

By DAMIAN WONJO

Every clinician keeps a private list of the patients they don’t see. Not the ones who cancel, the ones who never book. The shift worker who reschedules the same appointment three times and then quietly gives up. The parent who can’t justify half a day off and a waiting-room afternoon for a routine refill. The patient whose condition carries enough stigma that the friction of a face-to-face visit becomes, in itself, a reason to do nothing. These people don’t show up in no-show statistics. They show up later, as complications, as emergencies, as avoidable deterioration.

This is the access gap, and from where I sit as a physician in Europe, it has less to do with the raw supply of doctors than with the cost of reaching one, measured not only in money but in time, distance, and effort. When that cost climbs higher than a patient’s tolerance, care simply doesn’t happen. Online prescription services and remote consultation won’t fix every part of this problem. But they target precisely the variable that most reforms ignore, which is friction.

The patients who fall through

It is tempting to frame telemedicine as a convenience for the already-healthy and already-connected. In practice, the people who benefit most are often those with the least slack in their lives. A patient stabilised on the same antihypertensive for three years does not need a fresh diagnostic odyssey to continue it, they need a prescription before they run out. A working adult who recognises a recurring, familiar problem does not always need a physical examination to be helped safely. Forcing every such encounter through the narrow door of an in-person appointment does not raise the standard of care, it raises the rate at which people abandon it.

Continuity is where this matters most. Chronic conditions are managed in refills, and a missed refill is not a clerical event but a gap in treatment with real physiological consequences. Lowering the barrier to that refill is not a luxury. It is, quietly, one of the highest-yield interventions available.

What changed in Europe

The pandemic did not invent telemedicine, but it normalised it, and it accelerated the infrastructure underneath it. Poland is a useful case study. Electronic prescriptions became the national standard in 2020, and today essentially every prescription is issued digitally, retrievable by the patient through a government health account and dispensable at any pharmacy with a code. The clinical encounter and the prescription were decoupled from a single physical location without being decoupled from a licensed prescriber.

That distinction is the whole argument. A responsible online prescription service is not a vending machine. It is a licensed physician, working within the same legal and ethical framework as any clinic, using a different channel to reach the patient. The technology is mundane. The consequence, that a patient who would otherwise have gone without is now seen, is not.

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‘Breaking Down Interstate Barriers to Telehealth Delivery’ Tops ATA’s Priorities for 2023

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by JESSICA DAMASSA, WTF HEALTH

Just one week before the ATA EDGE Policy Conference (12/7-12/9 Washington DC) we get a SNEAK PEEK at what’s topping the agenda – and the American Telemedicine Association (ATA)’s list of priorities for 2023 – to ensure that digital health and virtual care providers avoid the ‘telehealth cliff’ that could send us back to pre-pandemic scaling issues of both practice and reimbursement.

Kyle Zebley, SVP of Public Policy at the ATA and Executive Director of ATA Action (the ATA’s affiliate advocacy organization) gives us the skinny on where policies currently stand at the federal and state level and, more importantly, what’s in jeopardy of changing soon. The list is long – everything from interstate practice to originating site stipulations, in-person visit requirements (especially for tele-mental health visits), and a number of favorable reimbursement policies that made telehealth a covered benefit at federally qualified health centers, rural health clinics, and under some high-deductible health plans. And, these are just to name a few…

Right now, the pandemic’s public health emergency is still in effect until mid-January, and, though it is expected to be renewed, the renewal will only get us into the second quarter of 2023. Kyle gives us the in-depth details on what ATA is advocating for and how they’re doing it. Of particular interest is the work being done to preserve clinicians’ ability to deliver cross-state care. The details here are fascinating. Kyle explains the nuances of tactics like licensure compacts and common sense exceptions that are being explored to permanently extend cross-state telehealth care, as well as the role the federal government can play in helping these policies along by incentivizing states to adopt these them through a “carrot-and-stick approach.”

The time to get involved is now, Health Tech! Get your start by watching this in-depth chat with Kyle to get caught up on where things stand, then check out ATA’s site for information on what you can do to support these on-going efforts to keep virtual care a growing vehicle for healthcare delivery.

* Special thanks to Wheel, sponsor of this special monthly WTF Health series on the policies that are changing telehealth and virtual care. Wheel is the health tech company powering the virtual care industry, provides companies with everything they need to launch and scale virtual care services — including the regulatory infrastructure to deliver high quality and compliant care. Learn more at www.wheel.com.

ATA’s CEO Ann Mond Johnson Takes on the “Telehealth Cliff”

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By JESSICA DaMASSA, WTF HEALTH

The BIG takeaway from ATA’s Annual Meeting is best bottom-lined by ATA’s big boss, CEO Ann Mond Johnson, in this interview: “From an overall perspective, we just don’t want to go over that ‘telehealth cliff.’”

ATA, the re-branded American Telemedicine Association, has not only evolved along with virtual care through the pandemic, but has also been critical in redefining telehealth as modality for healthcare and re-framing access to it as a bipartisan issue that everyone in DC can get behind.

Ann talks through the high-level changes she’s witnessed for telehealth adoption over the past two years and gives us her predictions for what’s going to happen next – particularly when it comes to the business of virtual care, consumer demand, and, most importantly, regulations and reimbursement. Lots happening thanks to ATA’s new affiliated trade organization, ATA Action, which is lobbying to ensure that the waivers that enabled the acceleration of telehealth during the Covid-19 public health emergency become permanent. The time is NOW for health tech co’s to get involved! Tune in to find out how.

Get Ready for (Healthcare) Microgrids

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BY KIM BELLARD

We depend on it.  Indeed, our daily lives are unimaginable without it.  The trouble is, it’s become unreliable.  Lives have been lost because it wasn’t performing when it needed to be.  It’s built around large facilities that are often decades old.  Parts of it don’t communicate/coordinate well with others.  Its workforce is aging and burnt out.  There is no person or agency charged with ensuring its resiliency. It badly needs to be rethought for the 21st century. 

Oh, you thought I was talking about our nation’s power grid?  I was talking about our healthcare system.  

The parallels are striking, and concerning.  They’re huge industries, based on early 20th century approaches, and beset by 21st-century challenges to which they may not be easily adaptable.  If we don’t manage their evolution to the 21st century right, we’re dead.  Literally.  

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Behind the Mask

By HANS DUVEFELT

Today I saw a patient I have known for years. He suddenly pulled his mask down and said, “I’d like to know what you think I should do about this”.

On his nose was an 8 mm (1/3”) brownish-red flat spot with a crack or scrape through it.

“How long have you had it?”, I asked.

“Oh, a while now” he answered. That is about the least helpful time measurement I know of. I asked him to pin it down a bit more precisely. He settled for about a year. I prescribed a cream and made a two week follow-up appointment for either cryo or a biopsy. It’s probably just an excoriated, premalignant, actinic keratosis.

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Did Covid and Telemedicine Finally Make the Physical Exam Obsolete?

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By HANS DUVEFELT

Left to my own devices, I would be selective about when and how much of a physical exam I do: either not at all or very detailed for just those things that can help me make the diagnosis. I have no patience for boilerplate normal exams. Any doctor who uses the term PERRLA (pupils equal, round, reactive to light and accommodation) is probably faking it. First, most of the time this isn’t actually tested completely and, second, even if it’s done correctly, it has no relevance in the majority of chart notes I have found it in. I have actually seen it in office note templates for urinary tract infections!

It is well known that the history makes the diagnosis in the vast majority of cases. But that task – or art, actually – is sometimes relegated to support staff or forced into unnatural click boxes. Because reimbursement until very recently was tied to how many items were asked about and examined, there was a loss of the story, or narrative, of the patient’s illness. And you could get more brownie points by including things that were extremely peripheral to the clinical problem at hand.

EMRs make it easy to produce long office notes with lots of reimbursement and quality scoring points of uncertain clinical value and accuracy.

Specifically, the physical exam has in many instances become a corrupted, fraudulent, one-click travesty of the art and professionalism we swore an oath to hold high when we graduated from medical school.

The pandemic and the rush toward telemedicine made it clear to most people that medical diagnosis, advice and treatment is entirely possible without physical contact. It was just a matter of getting paid for it, or the healthcare industry would have come to a stop, or at least a crawl.

Now that we have admitted that listening, talking and a certain amount of looking or observing can be done without being in the same room, it is time for us to be honest about the value of the physical exam.

Our medical education in universities and tertiary medical centers taught us how to handle complex and baffling cases that had eluded diagnosis in the primary care setting: Start from scratch, assume nothing. This is a method we need to use in select clinical situations.

But in everyday practice that is inefficient and unnecessary. Most of what we see is simple stuff and part of our job is to triage, to know when something seemingly ordinary is or has the potential to be more serious.

We need to know how to do a really good and relevant physical exam when the situation requires it. But we also need to know when that would add nothing and only waste our time and effort.

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Remote Patient Monitoring Sets Up Big Tech to Revolutionize Telemedicine and Healthcare

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By JAMES MOELLER

Remote patient monitoring has emerged as the next significant challenge for virtual healthcare and that challenge is creating significant opportunities for many companies largely outside of the traditional healthcare technology marketplace. In particular, it is potentially setting up an opportunity for Big Tech companies like Apple, Google, and Amazon, to revolutionize telemedicine and healthcare similar to what those companies have accomplished in mobile phones, Internet search, and retail.

Next Generation Remote Health Monitoring

Next generation remote healthcare monitoring will likely look much different than anything done before. What is emerging today is the potential for the broad adoption of remote health monitoring devices and systems that leverage consumer wearables, smart home communication systems, and big data to produce holistic views specifically for healthcare providers. The pandemic has thrust telemedicine solutions forward by years if not a decade or more in the short span of three to six months. This is creating an opportunity for remote patient monitoring to provide even better visibility into patients beyond what can be accomplished with basic video conferencing.

But while telemedicine is now becoming more firmly established, remote monitoring seems to still have a long way to go. This is evident in a new report by KLAS Research (a healthcare industry research firm) published on August 27th, where they interviewed 19 executives from 18 healthcare organizations regarding their challenges and solutions during the outbreak of the pandemic. Not surprisingly, telemedicine was the top challenge with 32% of the executives. Overall, though, 84% of the executives indicated that the telemedicine issues were already solved and the remining 16% indicated that the solutions were in progress. However, remote patient monitoring ranked as the second most significant challenge with 26% of the respondents. But furthermore, only 22% of the executives indicated the remote monitoring challenges were solved, with 33% saying it was in progress, and 45% indicating it was completely unsolved. So, a clear opportunity exists.

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Amwell’s Roy Schoenberg: Telehealth Post-Pandemic is “Entrenched Inside” Traditional Health Care

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By JESSICA DaMASSA

There are few better positioned to speculate on what’s next for telehealth than Roy Schoenberg, co-CEO & President, of Amwell. After 15 years, more than $710M in total funding, and probably the best analogies out there for describing telehealth’s potential as a disruptive technology, Roy weighs in on just how unprecedented COVID19 has been for the uptake and evolution of virtual care.

“Historically, people thought, could telehealth be as good as a physical visit? The reality of COVID,” says Roy, “has literally opened the door to the question, can telehealth be better?”

From the near-term “new wave” of telehealth that has already begun to “eclipse the urgent care telehealth” to how Amwell’s clientele of clinicians, healthcare delivery systems, and payers are shifting to accept the idea of the technology as “the start of healthcare,” Roy talks of a future of telehealth that is “entrenched inside the system.” And how Amwell is meant to act as “facilitator.”

“When we start thinking about telehealth as a switchboard — not as a product, but as an infrastructure for the redistribution of healthcare — we’re talking about a completely different experience for us as Americans on what healthcare is available to us and how we can consume it.”

“To me, and I’ll fast forward to the end here, we want to get to the point that telehealth changes our expectation when we grow old as to where we can grow old. We want to be in a place where we can stay at home…where we don’t have to be in the ‘belly of the beast’ to get healthcare.”

How far away is this future that Roy describes, midway through telehealth’s biggest year yet? Is the appetite there among incumbents? And what of those Amwell IPO rumors? How might that kind of funding help rush things along? Tune in to this episode of ‘WTF Health – What’s the Future, Health?’ with Jessica DaMassa to find out.

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Health in 2 Point 00, Episode 131 | Tele-everything! Oscar, Evidation, Lululemon, Calibrate, & more

Today on Health in 2 Point 00, Jess and I talk about Oscar raising $225 million, Evidation Health raising $45 million doing digital clinical trials, Lululemon buying fitness startup Mirror for $500 million, Calibrate raising a $5.1 million seed round bringing telehealth to weight loss and metabolic health, at-home urine analysis startup Healthy.io buying Inui Health for $9 million, and Airvet raising $14 million for veterinary telemedicine. —Matthew Holt

Australia Healthcare Market: Telehealth, Digital Health Expected to Boom Post-Covid19 | WTF Health

By JESSICA DaMASSA, WTF HEALTH

As healthcare systems around the world grapple with the coronavirus, ‘virtual-first healthcare’ is fast becoming the global response of private and public healthcare systems alike. In Australia, the federal government recently committed to investing $500M to built out its country’s ‘virtual-first’ healthcare infrastructure, so we caught up with Louise Schaper, CEO of the Australasian Institute of Digital Health (AIDH), to find out what that means for telehealth, remote monitoring, and digital health companies looking to capitalize on the market opportunity in Australia.

With a population of 25 million people (roughly the number of people in Florida) and a set of newly-minted reimbursement codes that makes telehealth available to all of them via the government-funded public healthcare system, the appetite for investing in new health tech solutions has grown ravenous.

Says Louise, “Anyone who has solutions that are already market-tested and approved, I’d actually expand your networks globally now. There’s not a section of the globe that hasn’t been impacted by [covid19] and we’re all needing to work out how to deliver healthcare differently.”

As in other parts of the world, the government codes reimbursing telehealth and other virtual-first services are temporary (Australia’s are set to expire September 30, 2020), but organizations like the AIDH, the Australian Medical Association, and others are advocating for their permanence and are optimistic.

The prevailing sentiment is that, like in the US, the benefits of virtual care to healthcare consumers and clinicians are going to be difficult for the government to ignore. Add to that the potential of linking virtual care to the Aussie government’s AUD$2 billion dollar build of its MyHealthRecord system — a centralized, cloud-based EMR that holds the healthcare data of 90% of all Australians — and the prospect grows even more appealing.

Join us as we talk through the basics of the Australian healthcare system and get an insider’s look at the demand for digital health, remote monitoring, and telehealth Down Under.

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