Tag: Telemedicine

Health in 2 Point 00, Episode 61

Dec 7, 2018

On Episode 61 of Health in 2 Point 00, Jess and I are still in Tokyo—but this time we’re reporting from a famous whiskey bar. In this episode, Jess asks me about the most important takeaways from Health 2.0 Asia-Japan and the growing health tech market there. We also have two special guest stars today: Yuuri Ueda, the director of Health 2.0 Asia-Japan, tells us how loosening government regulations are opening up opportunities for more and more startups to break into telemedicine, and Fred Trotter explains how Japanese startups can learn from the U.S. in terms of data security and privacy. All this in (exactly) two minutes.

There’s so much more from Health 2.0 Asia-Japan that you all need to see, so keep an eye out on THCB for my three-point takeaway from the conference and be sure to watch Jess’s WTF Health interviews to hear from amazing people in the Asian health tech community —Matthew Holt.

WTF Health | Teladoc’s Gorevic: “We’re feeling A-quisitive”

Jun 5, 2018

By JESSICA DAMASSA

WTF Health – ‘What’s the Future’ Health? is a new interview series about the future of the health industry and how we love to hate WTF is wrong with it right now. Can’t get enough? Check out more interviews at www.wtf.health.

I guess he warned us that Teladoc was feeling ‘A-quisitive’ — the question now is are they done? A few weeks ago I spoke with Jason Gorevic, Teladoc’s CEO at the new HLTH Conference about consolidation in the telehealth space and what’s next for the virtual care giant.

Although he was mum on the company’s $352M mega-buy of Advance Medical, there was a shopping list of other solutions that seem to have caught Teladoc’s eye — everything from tech that turns Alexa into a telemed access point to NLP plug-ins and any number of shiny devices that make remote monitoring easier, less expensive, and more effective.

Perhaps an indicator of where they’ll look next as they continue to sweep up market share? Listen in on some of the details about their CVS partnership (VIRTUAL Minute Clinic, anyone?) and the VERY interesting talks he’s having with the country’s largest payers on redefining benefit designs to push virtual care first.

Can Interactive Group Therapy Boost Productivity in Medicine?

Apr 27, 2017

By DEVON HERRICK

Imagine attending private lectures and taking all your college exams in your professors’ offices individually, one-on-one. Your instructors lecture you, then pepper you with questions, grading your answers and recording your scores. This is not unlike traditional physician visits. Contrast this to attending classroom lectures and taking online multiple choice exams where a computer algorithm or Scantron tallies your answers and calculates your grade. Classroom instruction with standardized testing is much more efficient that private tutoring. Hundreds of students can learn and take their online exams simultaneously. What if medical productivity could be similarly improved?

Inefficient Physician Communication. When you visit your doctor you are engaging in what’s known as synchronous communication. You queue up in a waiting room and later both you and your doctor meet one-on-one in an exam room (at the same time). You may spend five minutes talking to a nurse and then 10 minutes talking to a doctor. A survey found with waiting and travel time, the whole process takes patients about three hours, on average. Furthermore, many doctors see only about 20 to 25 patients a day. The amount of information conveyed during an office visit is limited — as is the amount of information patients retain. Doctors also must take notes and update medical records during the exam. Fiddling with electronic health records further reduces the amount of useful information exchanged during a 10-minute encounter while your doctor hunts for pull-down menus. The way medicine is practiced is inherently labor intensive, not to mention inconvenient for patients.

Synchronous telemedicine is where you call your doctor or he/she calls back and you talk one-on-one. That may be a little more convenient for patients, but it’s still labor intensive. Asynchronous telemedicine is like email (or snail mail for that matter). You email your doctor or call your doctor and leave a message. Your doctor replies via email or by leaving voicemail. Asynchronous communication doesn’t require both parties to be present at the same time to communicate, but the information flow back and forth can be slow and inhibited compared to talking.

Research Bites Dog

Apr 3, 2016• 8

By JOSEPH KVEDAR, MD

Screen Shot 2016-04-03 at 10.42.56 AM We live in a headline/hyperlinked world. A couple of years back, I learned through happenstance that my most popular blog posts all had catchy titles. I’m pretty confident that people who read this blog do more than scan the titles, but there is so much information coming at us these days, it’s often difficult to get much beyond the headline. Another phenomenon of information overload is that we naturally apply heuristics or short cuts in our thinking to avoid dealing with a high degree of complexity. Let’s face it: it’s work to think!

In this context, I thought it would be worth talking about two recent headlines that seem to be set backs for the inexorable forward march of connected health. These come in the form of peer reviewed studies, so our instinct is to pay close attention.

In fact, one comes from an undisputed leader in the field, Dr. Eric Topol. His group recently published a paper where they examined the utility of a series of medical/health tracking devices as tools for health improvement in a cohort of folks with chronic illness. In our parlance, they put a feedback loop into these patients’ lives. It’s hard to say for sure from the study description, but it sounds like the intervention was mostly about giving patients insights from their own data. I don’t see much in the paper about coaching, motivation, etc.

If it is true that the interactivity/coaching/motivation component was light, that may explain the lackluster results. We find that the feedback loops alone are relatively weak motivators. It is also possible that, because the sample included a mix of chronic illnesses, it would be harder to see a positive effect. One principle of clinical trial design is to try to minimize all variables between the comparison groups, except the intervention. Having a group with varying diseases makes it harder to say for sure that any effects (or lack of effects) were due to the intervention itself.

Dr. Topol is an experienced researcher and academician. When they designed the study, I am confident they had the right intentions in mind. My guess is they felt like they were studying the effect of mobile health and wearable technology on health (more on that at the end of the post). But you can see that, in retrospect, the likelihood of teasing out a positive effect was relatively low.

Telemedicine: Competition and Coopitition

Apr 3, 2016

By ALAN PITT, MD

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In 1985 I had the good fortune to study in Sweden. I made many good friends and loved the natural beauty. I also learned a lot about healthcare in what is essentially a socialist country.

Sweden was (and is) by no means perfect. Progressive taxation had disincentivized hard work leading to something of a brain drain. Many of the physicians I met were looking to emigrate. On the flip side, Swedish healthcare was accessible and high quality. The government viewed healthcare as a responsibility and right rather than an option. The relatively small and homogeneous population (8 million in 1985) allowed central planning. On the campus of the Karolinska Institute, their version of the NIH, there were regional specialty hospitals: a hospital for the heart, the G.I. tract, the nervous system, etc.

This contrasts with American healthcare where hospitals offer specialty services on nearly every corner. Here in Phoenix, a patient with cancer can choose from Banner / MD Anderson, Mayo Clinic, Dignity Health / UA Cancer Center, and Cancer Treatment Centers of America, along with several other institutes. How did such choice come about? As a nation, we hold certain truths to be self-evident. Near the top of the list, we believe competition is a good thing. In just about every business open markets lead to higher quality goods and services and ever decreasing prices. Right? So how come on almost every measure Swedish healthcare trumps the American system? Sweden spends half as much per capita

[JL1] but on average its citizens live four years longer.

Value-based Telemedicine

Sep 2, 2015• 5

By BLAKE McKINNEY, MD

When a family member was a new mom she called me concerned about her 7-day old baby’s breathing.I almost sent them to the ER. Then she asked me if we could FaceTime. What I saw was a warm, pink, dry baby looking around, looking quite well to me. I was able to tell that she had no labored breathing, no retractions or nasal flaring. She just had a little stuffy nose. I had been answering questions, treating minor ailments and triaging the acutely ill for several years via text, but it was in that moment that I knew the iPhone and other smartphone devices would fundamentally and forever change the way physicians can deliver our services.

Fast forward to next year. An estimated 2 billion people will have smartphones across the world in 2016. Industries are being transformed radically by the widespread uptake of these devices. Healthcare will be no different and will continue to move toward more virtual care enabled by smartphones. As the example above demonstrates, it makes sense for both care and economics.Virtual care and telemedicine worldwide is expected to be a $34 B market by 2020 according to Mordor’s Market Intelligence, with the US accounting for 40% of that, nearing $15 Billion in the next five years. Several early stage tele-medicine companies have raised many millions of dollars in the last several months.

Payment reforms are driving the market toward value-based care and will only accelerate the use of telemedicine via smartphone. Many new forms of payment for medical services are emerging that are not tied to the legacy fee-for-service reimbursement model. Patients are paying more out of pocket and therefore have increasingly aligned interests with payers to reduce costs while achieving better overall health. These changes are, in turn, driving the empowered healthcare consumers’ demand for a better experience and convenience.

How Technology is Driving the Next Wave of Telemedicine

Apr 9, 2015• 2

By RYAN BECKLAND

The growth in business cases for new models of healthcare delivery and integration of digital health technology is reaching the point of convergence — creating powerful synergies where there was once only data silos and skepticism.

We have not quite achieved this synergy yet, but opportunities emerging in 2015 will move the industry much closer to the long-awaited initiatives in connected, value-based care.

Individuals are constantly hyper-connected to a variety of technology networks and devices. Wearables will continue to enter the market, but their features and focus will go well beyond fitness. Even the devices entering the market now are more sophisticated than ever before. Some are now equipped with tools like muscle activity tracking, EEG, breath monitoring, and UV light measurement.

It will be fascinating to watch how consumer electronics, wearables, and clinical devices continue to merge and take new forms. Some particularly interesting examples will be in the categories of digital tattoos, implantable devices, and smart lenses.

As the adoption of wearables continues to grow, we will continue to see more value placed on accessing digital health data by healthcare and wellness organizations. This will be especially important as healthcare shifts towards value-based models of care. The need to gain access to the actionable data on connected devices will only grow as innovation creates more complex technologies in the market.

From Google to New Reimbursement Models, Digital Health Trends for 2015

Mar 10, 2015

By RYAN BECKLAND

There is no question that 2014 was an exciting and eventful year for digital health. Even with all of the advancements and innovations in 2014, this year promises to be even better. The growth in business cases for new models of healthcare delivery and integration of digital health technology is reaching the point of convergence — creating powerful synergies where there was once only data silos and skepticism.

Maybe we have not quite achieved this synergy yet, but the trends emerging in 2015 will move the industry much closer to the long-awaited initiatives in connected, value-based care.. To understand the convergence that is taking place in digital health, we need to examine the key emerging trends in technology, healthcare and business.

Technology

Connecting to Smart Clinical Devices

Technology has advanced to the point that we are constantly hyper-connected to a variety of networks and devices. We have handheld diagnostic tools on our person continuously generating an astounding amount of data.

The types of health devices that are connectable and disseminating data are rapidly changing. Tools are emerging like flash thermometers that do not require physical touch, which diminish contamination risks, and smart EpiPen casings that automatically alert medical professionals during an allergic reaction.

These devices are not only becoming less expensive, but they are also starting to be reimbursable by insurers. Thus, over time these devices will replace traditional, non-connected products. Clinical devices are increasingly designed as Bluetooth-enabled, allowing for the real time collection of patient data, and providing better access and outcomes for patients.

RingMD: The Newest Entrant in the US TeleMedicine Market

Jan 5, 2015• 2

By Prerna Anand

At 22 years old, Justin Fulcher looks like an average, newly graduated, young entrepreneur. But don’t be mistaken by his humble appearance. He is the Founder and CEO of RingMD, one of the fastest growing patient-provider communication platform, granting quality and affordable health care to people worldwide.

Founded in 2012 in Singapore, RingMD is a mobile based platform that connects patients with doctors via video or phone. Users input their symptoms, chose the format for the call, provide a mode of transaction, and get access to a list of providers based on location, price, ratings, insurance coverage, availability etc. Provider profiles have detailed biography, and feature dynamic pricing, making it an active health care marketplace. Patients can upload files in real time to share with the consulting doctor, and their EMR history is shown in a split screen on the provider side. Doctor notes are shareable, in both text and video formats.

RingMD has been an active telehealth provider in Singapore, Hong Kong, and other Asian countries, and is now ready to enter the US market. Mr. Fulcher visited Health 2.0 headquarters recently and shared his story with us.

Following is an excerpt from the interview:Continue reading…

Throwing the EHR Under the Bus …

Oct 19, 2014• 59

By JOHN IRVINE

Given what is now known about how the case of Thomas Eric Duncan at Texas Health Presbyterian was handled, the attempt to blame the hospital’s electronic health record for the missed diagnosis sounds pretty lame.

But people are still doing it:

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Critics of electronic medical records have found a case they will be talking about for years.

Consider this argument from Ross Koppel and Suzanne Gordon:

While it is too early to determine what precisely happened in this case, it is not too early to consider the critical issues it highlights. One is our health care system’s reliance on computerized technology that is too often unfriendly to clinicians, especially those who work in stressful situations like a crowded emergency room. Then there are physicians’ long-standing failure to pay attention to nurses’ notes. Finally, there is the fact that hospitals often discourage nurses from assertively challenging physicians.

Long promised as the panacea for patient safety errors, electronic health records, in fact, have fragmented information, too often making critical data difficult to find. Often, doctors or nurses must log out of the system they are on and log into another system just to access data needed to treat their patients (with, of course, additional passwords required). Worse, data is frequently labeled in odd ways. For example, the results of a potassium test might be found under “potassium,” “serum potassium level,” “blood tests” or “lab reports.” Frequently, nurses and doctors will see different screen presentations of similar data, making it difficult to collaborate.

Continue reading…