Tuesday, July 28, 2015

Uncertain Health in an Insecure World – 50

“Digital House Call”

As early as 1925, “diagnosis by radio” was predicted in Science and Invention magazine. I recall watching the 1959 television series, The Flying Doctor, inspired by the Royal Flying Doctor Service of Australia. Dr. Greg Graham (played by Richard Denning) flew into the remote outback, serving the medical needs of inhabitants and Aboriginal peoples.

Given the option, most patients would rather be seen face-to-face by their physician. But population growth in the developing world and chronic physician shortages in developed countries mean there are tens of millions who simply cannot see a doctor in the flesh. 

That is uncertain health. That is an insecure world.  

The telehealth era began at the Medical College of Georgia in 1993. As the immediate past dean, I am proud that the electronic house call was invented there by Dr. Jay Sanders. The U.S. Institute of Medicine released a definition and made recommendations in 1996. It has since evolved into the standard of care for healthcare access by millions. Governments around the world are actively pursuing efforts to get people onto the telehealth grid (like Inuits, below).

Telehealth (a.k.a. telemedicine, e-health or e-medicine) is the all-inclusive term for virtual care delivery at a distance.  Communications take place between physician and patient or between physician and consultant, either in real-time or asynchronously using “anytime” store & forward capabilities. Only real-time care meets U.S. Medicare’s narrow definition of reimbursable telehealth services.

At the just completed 2015 Global Telehealth Conference in Toronto, the theme was “serving the underserved”. Scientific papers from >25 countries showed that telehealth technology is continuing to make a difference in global healthcare. Telehealth is widely utilized for stroke management in a hub & spoke model, with systems like the Mayo Clinic at the center of the wheel. In novel ways, telehealth is now the basis for virtual tumor boards, diabetes population management and retinal scanning (above), and off-site ICU patient monitoring. Ebola patient Dr. Richard Sacra (below), in quarantine in Nebraska and physically separated from family and doctors for bio-containment purposes, was cared for using the Vidyo telehealth platform! 

The global telehealth market will double in the next five years at a robust CAGR of 18.9% through 2019. This sector is receiving intense VC interest and major vendor investments, including big plays by McKesson, GE, Seimans, and Philips Healthcare. IHS Inc. predicts that the U.S. telehealth market will grow by 50% per year to US$1.9B in 2018.

Much of the impetus for such rapid growth comes from U.S. healthcare reform requirements for universal access and pressure to expand population health management. Increasingly, U.S. states are authorizing payments for telehealth services in public programs and for privately insured patients in 24 states and the District of Columbia. More than 50% of U.S. hospitals now use some form of telehealth platform. Deloitte predicted that in 2014, 75 million of the 600 million G.P. visits in the U.S. and Canada would be e-visits. 
One wonders how this well-aging, fixed platform telehealth tortoise will keep pace with the newer, more nimble digital health, AI, IoT and robotic hares. Increasingly, the tools of telehealth are digital and portable – laptop webcams, video-enabled smartphones and tablets.

Several large employers such as Booz & Co., Home Depot and Westinghouse Electric now offer telehealth consultations to their employees. Walgreens Boots Alliance, Inc. is now collaborating with MDLIVE to expand their digital telehealth offerings in pharmacies located states like Colorado and Washington. In 2015, Walgreens Boots and MDLIVE jointly launched a mobile app for iOS and Android devices to connect customers 24/7 with board-certified doctors. Walgreens just announced that this service will be available in 25 states by the end of 2015.

Is there anything that telehealth cannot do?

Dr. Peter Antall, CEO of Online Care Group, warns that telehealth should not “disintermediate care from one’s medical home, particularly their primary care.” In June, the pro-doctor American Medical Association (AMA) tabled its ethical guideline for telehealth services due to delegates’ concerns about AMA guidelines requiring an initial face-to-face patient-doctor visit. Previously, AMA had required that telehealth doctors be licensed in the patient’s state.

There’s little risk of people living near doctors becoming telehealth shut-ins.

Telehealth brings certainty to an insecure world,

We in The Square don’t want doctor disintermediation, especially when the human touch is part of healing. But technology is progress, and by bringing care everywhere, telehealth is the next best thing.

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