TTA’s scorching week: events, tenders, app experts, diabetes telehealth, and When We’re 64!

 We enter Summer–and some scorching temps on both sides of the Atlantic. How to scorch your company during an EHR/HIT transition. A not-so-scorching diabetes telehealth study result. Events, tenders, app experts are hot, and We Sing A Song of Telemedicine When We’re 64–and still hot!

R2G’s annual mHealth App Survey is closing–and register now for The King’s Fund Digital Health meeting on July 11!

Tender Alert: Scotland Excel, Leeds, London/Manchester, Thurrock (Four from our Eye on Tenders–and most close 17 July)
Study doubts benefit of basic blood glucose self-monitoring for non-insulin T2 diabetes (Not encouraging for the Diabetes Monitoring Gold Rush)
Some London events and an opportunity to monetise your expertise (Editor Charles invites app reviewers, and three events are up)
Mismanaging a healthcare IT transition: what’s the cost? (Expensive by any metric, especially the customer and long term ones)
Singing a song–-of telemedicine (after you, McCartney!) (Congratulations to Paul on his 75th, not his 64th!, from a contributor)

June is all about change again at GE and GreatCall. A Nightingale is singing that tenders are up. Ericsson’s big study on 5G closing the gap. Telemedicine grows ever-larger and more accepted, even for bad news. Misbehaving robots and self-driving cars. And more!

Telemedicine may be appropriate for delivering ‘bad news’: study (More research needed)
UK Telehealthcare TECS MarketPlace event 4 July in Yorkshire, plus (Telehealthcare Awareness Week is end of June)
GE’s change at the top puts a healthcare head first (Many changes coming to The Blue Meatball)
Ericsson report: will 5G close the healthcare gap from hospitals into the home? (Major study from unexpected source)
Tenders closing quickly: Cornwall/Isles of Scilly, Blackpool (Blackpool is still open)
76% of health systems to adopt consumer telemedicine by 2018: Teladoc survey (But its use is changing)
The Nightingale-H2020 project for wireless acute care (UK/EU) (Major initiative, get on it before tender)
Behave, Robot! DARPA researchers teaching them some manners. (Rules for those Overrunning Robots and those Self-Driving Cars)
GreatCall’s acquisition: a big vote for older adult-centered healthcare tech (Private equity sees gold in the old)
Tech that assists those with speech impairments, telemedicine for mapping public health (Solving specific, important problems)
Wearable haptic/Braille guidance system for the visually impaired (MIT CSAIL innovation)

It’s all about change: the big EHR change at VA, change at the top at Tunstall Americas, and state telemedicine policy.

VA says goodbye to VistA, hello to Cerner for new EHR–and possible impacts (Big changes will take years)
Tunstall Americas has a new president/CEO (updated) (More details on this quiet change)
Texas gets its telemedicine on: governor signs off on full direct-to-consumer access (A change that leads the way for other states)

Previous articles of continued interest

Add hospital-acquired infections to your list, Google Ventures! (What kills 450,000 or more annually–in US alone)
DNA ‘Snapshot’ facial modeling–and predicting future Alzheimer’s risk (Out of Law & Order)
The King’s Fund Digital Health & Care Congress coming up fast! (London) (Register now for July!)

Breathe, exhale: a future bracelet that may predict asthma attacks through breath (Real research vs. the fakes)

In-home video monitoring acceptable to 90 percent of dementia carers: Age NI study (Feelings change in the Selfie Age)
Want to attract Google Ventures to your health tech? Look to these seven areas. (Won’t be easy)
Winston Churchill Memorial Trust – 2018 Travelling Fellowships (Global research grants for UK citizens)
International Conference on Rural and Elderly Health Informatics (Togo, W. Africa) (IREHI, 14-17 December–workshop papers due 25 July)

Successful Aging 2030: how far we haven’t come, how far we have to go (Over a coffee, Editor Donna’s full report from d.health Summit 2017)

The stop-start of health tech in the NHS continues (UK) (Hurry up and wait)

Thinking about a location for your health tech startup? Consider…’virtual’ Estonia! (A Baltic welcome to business–and you don’t have to leave home)

Blue Cedar releases new security for health apps, built into the app (A way around a roadblock)


 

 

Make your plans, if you have not already, to attend The King’s Fund’s annual Digital Health meeting in London. NHS England’s “Next steps on the five year forward view” outlines the plan to harness technology and innovation over the next two years. But what’s really happening on the ground? Find out in two full days of conference, networking, and exhibition. For more information and to register, click on the advert above or here


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Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

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Telemedicine may be appropriate for delivering ‘bad news’: study

A study of a pilot telemedicine program, JeffConnect, administered by Thomas Jefferson University in Philadelphia during 2015 with 32 patients who received free primary care services via doctor-patient video consults (called telehealth here) has some interesting directional findings. The first was high overall satisfaction among the 19 respondents interviewed, including caregivers, with minimal wait times and far more convenience from home or work, aside from some difficulty in connecting. The second, and the most surprising, was this:

Patients had different perspectives on whether they prefer to hear bad news in a video call. Some said they preferred it, thinking that they could get the news earlier and be in a comfortable location with supportive people. One participant explained, “If it was something earth-shattering, you could cry in your own bedroom and not have to worry, I mean driving from downtown and you’re upset or what-not…” Others preferred to receive serious news in person, explaining, “If the doctor were telling me I have a fatal disease or a disease that could be fatal, and I have to go into immediate serious care, probably better in-person.” Several patients stated no clear preference between the 2 options.

This subject warrants more investigation with a larger cohort. Annals of Family Medicine. Also mHealth Intelligence.

GE’s change at the top puts a healthcare head first

This Monday morning’s Big News was the stepping down, after 16 years, of GE‘s CEO Jeff Immelt effective August 1, and the rise of GE Healthcare’s head, John Flannery. The focus of most articles naturally was the fate of GE. Mr. Immelt may have steered the company through a severe recession starting in 2008, but he managed to lose about a third of the company’s value in the process. Expect some changes to be made in Boston. “I’m going to do a fast but deliberate, methodical review of the whole company,” Flannery told Reuters in an interview. “The board has encouraged me to come in and look at it afresh.” In an earlier call with investors, he said the review would have “no constraint.”

Mr. Flannery is a 30-year GE veteran, head of Healthcare since 2014, and previously head of GE India, its equity business in Latin America and GE Capital in Argentina and Chile. According to Fortune, GEHC is 15 percent of GE’s total business and in recent years has been smartly up in revenue. They have partnered recently with UCSF on predictive analytics, Boston Children’s Hospital on a pediatric brain scan database, and Johns Hopkins of a more efficient hospital bed allocation process. Also is an example of telemedicine remote diagnosis using a GE Health portable ECG device connected to the Tricog smartphone app to take a reading in India which was diagnosed in San Diego.

Usually healthcare CEOs become CEOs of other healthcare companies–witness the rise of one of Mr. Flannery’s predecessors, GE veteran Omar Ishrak, as CEO of Medtronic.  Fortune’s healthcare reporter interviewed Mr. Flannery two weeks ago–more of this interview will be published according to the author. (But hasn’t as of June 21!)

76% of health systems to adopt consumer telemedicine by 2018: Teladoc survey

We normally don’t feature corporate or sponsored surveys, but are making an exception here as it demonstrates two trends: that hospital systems can’t fight consumer telehealth** anymore, and that the future mix of usage is starting to change. Teladoc’s/Becker’s Healthcare Hospital & Health Systems 2016 Consumer Telehealth Benchmark Survey projects that by 2018, 76 percent of health systems will adopt consumer telehealth (vs. site-to-site), double from 2016, and that most who have it will be expanding offerings. As a benchmark survey, it tracks services offered or plan to offer, organizational priorities, and goals.

An interesting part is how the mix of services under telehealth is evolving. Presently, the top three among current users are urgent care, primary care, and psychiatry/mental health. For new users, their priorities are ED/urgent care (45 percent), readmission prevention (42 percent), primary care, including internal medicine and pediatrics (42 percent), chronic condition management (41 percent). Nearly one in five (18 percent) plan to include cardiology services.

As implemented by health systems, telehealth has run into problems that were totally predictable and will provoke the ‘Duh?’ response from our Readers. From the report:

  1. They didn’t measure patient or physician satisfaction with their telehealth programs, even though improving patient satisfaction is a leading motivator for offering telehealth services.
  2. Gaining physician buy-in was cited by 78 percent of respondents, and rated as the #1 lesson learned
  3. The second most important? The importance of aligning telehealth initiatives with organizational goals (75 percent). (more…)

Tech that assists those with speech impairments, telemedicine for mapping public health

This year’s trend to develop technologies that solve specific but important problems, such as improving navigation for the visually impaired, [TTA 8 June] continues:

  • Voice-controlled assistance systems are becoming commonplace, from improved interactive voice response (IVR) to Siri, Echo, and Alexa. Their limitation is that their recognition systems understand only standard, not impaired or even heavily accented speech. For those with the latter, a Tel Aviv-based startup called Voiceitt has developed Talkitt, an app that learns an individual’s speech based on basic, everyday spoken (or typed input) phrases and after a training period, converts them into normal audio speech or text messages on a tablet or smartphone. This aids with everyday life as well as devices like Echo and Alexa. Voiceitt is out of the Dreamit Health accelerator and was just seed funded with $2 million. This Editor notes from the TechCrunch article that it’s described as ‘the thin edge of the wedge’ and ‘a market with need’. It will be introduced this year to health systems and schools to assist those with speech impairments due to health conditions. Hat tip to Editor Emeritus Steve Hards
  • Diagnosing degenerative diseases such as diabetic retinopathy, which is preventable but if untreated eventually blinds the patient, is doubly difficult when the patient is in a rural, economically disadvantaged, predominantly minority, and medically underserved area of the US. Ophthalmologist Seema Garg has been on a quest since 2009 to have this recognized as a public health threat. The North Carolina Diabetic Retinopathy Telemedicine Network out of University of North Carolina-Chapel Hill, headed by Dr. Garg, collaborated with five NC clinics to recruit patients with diabetes. Her team then trained primary care staff to take digital retinal photographs transmitted over a secure network to be examined for symptoms. The public health study used Geographic Information Systems (GIS)-mapping for patient accessibility to ophthalmologists, demographics, and risk factors such as higher A1C levels, minority race, older age, kidney disease, and stroke. JAMA Ophthalmology, Futurity  Hat tip to Toni Bunting of TASK Ltd. (and former TTA Ireland editor)

Texas gets its telemedicine on: governor signs off on full direct-to-consumer access

The telemedicine stars at night–and day–are big and bright, deep in the heart of Texas. Over the weekend, Governor Greg Abbott signed into law Senate Bill 1107 which ended the requirement that a physician-patient relationship had to be established offline before a telemedicine visit could take place. MedCityNews  The Texas House earlier this month passed House Bill 2697 permitting direct-to-consumer virtual doctor visits, followed by the concurrent bill SB 1107 in the Senate. JD Supra (Jones Day), Modern Healthcare

The new legislation allows for previously prohibited initial care via telemedicine (versus in person), asynchronous “store-and-forward” typically used for data and images or other such audiovisual technology so long as it complies with rules that ensure safety and quality. The bill’s terms were negotiated between the Texas Medical Association, the Texas eHealth Alliance, and Teladoc. It also effectively ends the long-running, six-year standoff between Teladoc and the Texas State Medical Board, and the shutout of other providers such as American Well.

Both rivals cheered the good news on, which was timed beautifully for Teladoc’s 1st Quarter earnings call on May 9, adding to record-high visits, plus healthy revenue and membership increases. While it has many internationally known medical centers, Texas is a huge state and is notoriously short of primary care physicians, with 71.4 primary care physicians per 100,000 people and 46th among all the states for primary care physicians per capita.

There is one aspect of the bill that ensures further legal challenge, which is the language prohibiting the use of telemedicine to prescribe abortion-inducing medication as it does in 20 other states. Mobihealthnews. Further background in March article

CBO finds as budget neutral telehealth in Senate CHRONIC Care Act

Sneaking under the holiday week wire, when Congress high-tails it for home, the Congressional Budget Office (CBO) reviewed the telemedicine and telehealth provisions in the US Senate’s pending CHRONIC Care Act and found last week that they do not increase or decrease Medicare spending overall. Formally S.870 – Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017–and sponsored by Sen. Orrin Hatch of Utah, this means that this bill developed by the Senate Finance Committee’s bipartisan Chronic Care Working Group has passed a key spending acceptability test, and is another step further towards passage. CHRONIC removes many of the qualifiers that Medicare hedged around telehealth and telemedicine, with most restricting reimbursement to rural areas. There are four areas where the Act removes barriers:

  1. Nationwide coverage for Telestroke
  2. Home remote patient monitoring for Dialysis Therapy
  3. Enhanced telehealth coverage for ACOs–this expands the provisions in the Next Generation ACO program to ACOs participating in the Medicare Shared Savings Program (MSSP) Stages II, III and the few left in Pioneer, so that telehealth will be reimbursed regardless of geographic location and in the home.
  4. Increased flexibility for telehealth coverage under Medicare Advantage plans

There’s a long way to go, but this is an important step forward to an equal playing field for telehealth services. National Law Review’s summary

ATA 2017 dispatch: Devices and doom

click to enlargeBruce Judson, our guest ATA 2017/Telehealth 2.0 reporter, is a bestselling author of books on business and technology issues in the evolving digital era. This is the third and final article this week he’s written from the ATA floor. Mr. Judson writes frequently for The Huffington Post. More on about him may be found in our review of his critique of the RAND telehealth study [25 Mar].

This Editor agrees with his POV that drowning doctors in more and more data, whether previously accessible or not, isn’t a way forward to a successful business model. The current data is overwhelming–and not interoperable with EHRs. More and more data, looking for a home….

Orlando, April 26. Yesterday, I set aside several hours to walk by the booths of the 200+ exhibitors at the ATA show. As I slowly walked the Exhibit Hall, I was struck by the large number of in-home telehealth patient monitoring devices. (Names are omitted to protect the innocent.)

Colleagues had similar reactions. When I asked about exhibitors, the most common response was “I had no idea there were so many new telehealth monitoring devices that are FDA approved or in the process of obtaining approval.”

As I wandered from booth to booth, I was also struck by the failure of so many, if not most, monitoring device manufacturers to focus on the practical uses of their truly revolutionary technologies. At each monitoring device booth, I asked the same question, “How will the data be used?”  All too often, the answer was, “We provide daily patient data for physicians that have never been accessible before, and doctors receive daily graphs.”

My follow-up questions were always, “You believe busy doctors will look at data on their large patient population each day? Why don’t you provide alerts?” Again, there was a frequent answer, which was some variation of “Yes, now doctors can see daily events which will lead to extraordinary improvements in health outcomes, and we don’t want to create alert fatigue” (false positives that suggest a problem where one does not exist).

In my view, monitoring devices without suites of robust predictive analytics will fail. Doctors are already too busy, and anything that adds to their workload is immediately suspect. Moreover, we still live in a fee for service world, and now we are talking about new, uncompensated work.

As Jonathan Linkous said to me on the first day of the ATA show, “the technology is a tool to provide the service,” not the service itself. Patient monitoring device firms must realize they are offering a service. To succeed, their services must provide actionable analysis, not more and more data. If alerts are ready for prime time, then doctors will value the devices: They can rely on the associated algorithms to indicate when an intervention (also to be compensated) is needed.

Moreover, I strongly suspect doctors would prefer a few false alerts, with algorithms biased toward safety and results that can be quickly checked via the underlying data, as compared to wading through charts looking for anomalies.

A fundamental question for anyone is “what business are you really in?” To succeed, many of the ATA exhibitors need to reorient themselves from the business of providing great technology to the business of providing great service enabled by technology.

Mr. Judson’s first article, a discussion with ATA’s Jonathan Linkous on business models for telehealth is here. The second article on Mercy Health’s catalyzing telehealth innovation at the hospital level is here.

ATA2017 dispatch: Catalyzing telehealth innovation in hospitals

Bruce Judson, our guest ATA 2017/Telehealth 2.0 reporter, is a bestselling author of books on business and technology issues in the evolving digital era. This is the second article this week from the ATA floor. Mr. Judson writes frequently for The Huffington Post. More on about him may be found in our review of his critique of the RAND telehealth study [25 Mar]. His discussion with ATA’s Jonathan Linkous on business models for telehealth is here.

Orlando, April 25. At the ATA show, I stopped at Mercy’s booth, and spoke with Keela Davis, who is Mercy’s Executive Director, Innovation and Product Development. In the booth, was a large, inspirational display of Mercy Virtual’s high-tech, widely-reported $54 millionhospital without beds.” The facility is the nerve center for Mercy Virtual’s telemedicine programs, which include TeleICU (remote monitoring of ICUs by Mercy specialists) as well as multiple other remote services for patients in hospitals and at home.

A great deal has been written about Mercy’s groundbreaking service and large investment in this facility. I asked Davis what led to the decision to build “the hospital without beds.” She said that first, a lot of experience in telehealth proceeded the investment decision. Undoubtedly this experience was required to simply decide what should be built in a facility designed for the technology that exists today and that will undoubtedly accommodate new technologies as they arise. Second, she also said, that it reflected “a visionary” decision on the part of Mercy’s leadership to make this commitment. Now, in her words, the facility has become “a symbol of our work.”

As a student of innovation, our discussion was notable on several fronts:

First, Davis noted that now that the facility exists it serves as a catalyst for innovation. Mercy is actively considering, as might be expected, a range of new telehealth services. While Davis was quick to point out that the facility was not the only source of telehealth innovation at Mercy, she did indicate it’s the hub for innovative ideas and discussions. Organizations build on their experience, their successes, and the demonstrated commitment of management to move forward with good ideas. Mercy’s facility now provides the tangible place that facilitates ongoing growth. In short, after conquering the first level of innovation, Mercy is poised to march forward with new, groundbreaking services.

Mercy’s facility is also a warning to organizations that see the telehealth future, but hesitate to act. As Mercy gains experience, it will have a team that understands the many, complex aspects of assessing and bringing new services to market. Plus, many of the underlying capital and investment requirements associated with creating these services have already happened. In short, it will soon be difficult for other healthcare entities eyeing services in the same arenas to match Mercy’s innovation machine.

ATA 2017 dispatch: The future is about business models and the consumer

Bruce Judson, our guest ATA 2017/Telehealth 2.0 reporter, is a bestselling author of books on business and technology issues in the evolving digital era. This is the first of several articles this week. Mr. Judson writes frequently for The Huffington Post. More on about him may be found in our review of his critique of the RAND telehealth study [25 Mar].

Orlando, April 24. Yesterday, the annual convention of the American Telemedicine Association (ATA) moved into full swing. At noon, Jonathan Linkous, ATA’s CEO, took a few minutes to talk with me. During our wide-ranging discussion, three notable themes emerged:

First and perhaps most important, Mr. Linkous believes that the future development of telehealth now stands with establishing viable business models. In his view, the speed of growth of the industry now depends on how the many participants in the healthcare system develop business models that lead to appropriate investments. He noted that this contrasts with the general focus on the evolving technology. Of course, the technology will continue to evolve and major advancements will occur for the foreseeable future. But, Mr. Linkous strongly believes that “the technology is here today.” In short, it’s now about how the technology is used and deployed. New advances will be incorporated into services and infrastructure as they occur. But, the past, telehealth is now moving into mainstream investment discussions. In his view, the leaders of every health organization are now assessing the role telehealth will play in the services they offer, and the investments they need to make now.  Now, it’s about making it work. We are no longer waiting for the technology to be viable.

Second, Mr. Linkous commented on the hype surrounding the industry. He was frank in recognizing that, as with all exciting, transformative industries, the hype cycle is in full swing. One telling comment: “Unlike the past, the industry now has real revenues,” with rapidly growing businesses. In short, we may not be past the hype, but the industry is quickly moving to fulfill realistic expectations.

Finally, Mr. Linkous concluded that the future growth of the telehealth industry would largely depend on the consumer. He cited a variety of factors: the growth of value-based care, the emerging influence of millennials who are comfortable with technology, and the overall consumerization of medicine.

Many industry participants have described themselves to me as B2B businesses. Undoubtedly, they are. It’s hard to refute Linkous’s conclusion: Ultimately, the growth of the industry, like the evolution of healthcare itself, will depend on consumer choices.

A analysis–and challenging takedown–of the RAND telehealth cost study (updated)

A must read on telemedicine and telehealth cost. One of our Readers, Bruce Judson, commented on our earlier coverage of RAND Health’s new study published in Health Affairs [TTA 8 Mar] finding that telemedicine virtual visits (here called telehealth) drove up utilization of care by 88 percent and cost by $45 per year for respiratory illnesses that typically resolved on their own.

He has written his own analysis based on the full study. Telehealth Costs: RAND’s Questionable Rant (Huffington Post), considers the full study and compares it to a 2014 RAND study by the same authors. Mr Judson notes inconsistencies in sampling and definitions; the illogical attachment of a waiting period cost (77 minutes=$30) to a telehealth visit (perhaps to level it with an office visit?); the misinterpretation of results; small sample size; and the fact that the CalPERS sample is ancient (2011-13), representative of a time when telemedicine (here provided by Teladoc) was a new notion. There are inconsistencies with an earlier RAND study based on the same data! (He does not count in costs outside the study such as lost time at work or the cost of spreading infection to co-workers.)

Mr Judson, after many years in publishing, digital marketing and strategy (from when it was called ‘new media’), and currently an advisor to a UK firm investing in IoT, has cast his lot with us in health tech, heading a firm in the Hudson Valley of NY, Telehealthworks, which markets an employer telemedicine and wellness program called freshbenies. While he discloses that he’s not a disinterested observer or researcher, he has that in common with most of our Readers, who are very interested in determining the truth about costs and savings. He gives many reasons to be skeptical of the RAND findings.

Dubai launches RoboDoc based telemedicine service

Almost exactly 14 months to the day since the press release announcing a pilot of a click to enlargetelemedicine service, the first patient is said to have undergone treatment using the Dubai Health Authority’s RoboDoc telemedicine system according to Middle East North Africa Financial Network. The patient was based in Hatta Hospital and the respiratory specialists were based at Rashid Hospital Trauma Centre according to the report. RoboDoc units, from InTouch Health,  have also been installed at two primary care centres in Dubai.

In a previous TTA article this editor expressed surprise that telehealth would be of interest to Dubai which is only 1600 square miles in area. Having considered the details of the implementation the interest is partially explained by the fact that Hatta is an outpost separated from the rest of Dubai, 135 km (84 miles) from Rashid Hospital.

However, the other two centres at which the RoboDoc devices have been installed, Al Bashar Health Centre (15 miles from Rashid Hospital) and Nad Al Hammar Health Centre (7 miles from Rashid) (more…)

Is telemedicine attractive to hypochondriacs?

An article in MIT Technology Review takes a sideways look at telemedicine and asks if telemedicine is providing an easy route for people suffering from excessive anxiety about their health. The author, Christina Farr, suggests that the ease of contacting a doctor using telemedicine services in comparison to having to visit a doctor’s office and the ability use either insurance or direct payments makes these services more attractive to hypochondriacs (lately called those with somatic symptom disorder).
Views on the subject are quoted from the chief medical affairs officer at MDLive, Deborah Mulligan, and a board member of Doctor on Demand, Bob Kocher. While the first is able to relate an anecdote where a case of excessive anxiety disorder was identified and successfully referred to cognitive behavioral therapy, the latter says he isn’t aware of any patients with health anxiety regularly using the Doctor on Demand app.

Read the full article here.

West Virginia considers expanding prescription medication via telemedicine

The West Virginia legislature has been considering a new bill to expand the range of medications that may be prescribed in a telemedicine encounter. The bill was passed by the House of Representatives last week and sent to the Senate for consideration.

The House Bill 2509 proposes to amend the West Virginia Medical Practice Act to enable physicians to prescribe certain controlled substances when using telemedicine technologies. According to Mobihealthnews this would specifically include medication for mental and behavioral health, although bill itself does not refer to these conditions. A note at the end of the bill states “The purpose of this bill is to permit a physician to prescribe certain controlled substances when using telemedicine technologies.”

It seems that the legislation in the US dealing with telemedicine is fragmented and becoming more so. There was the issue of whether health insurance companies would cover telemedicine consultations, then the issue of medicare and medicaid covering the telemedicine consultations, then the state medical boards refusing cross border telemedicine and now issues on individual medications that can or can’t be prescribed. This will make it increasingly difficult for those practitioners who decide to enter the telemedicine arena.It is not a sustainable approach to pass a new law on every issue relating to telemedicine. Telemedicine is merely medicine practiced via a different route and regulation and standardisation of processes associated with telemedicine should be divested to a suitably established agency overseen by the legislature, similar to how the medical boards operate. In fact, this could easily be an additional responsibility given to the medical boards.

Telemedicine may drive up medical utilization, increase cost for respiratory illness: RAND Health

click to enlargeIs convenience the culprit? Researchers from RAND Corporation’s Health program conducted a three-year study of telemedicine (here called telehealth) usage by employees of CalPERS for respiratory illness and came to a surprising conclusion. From the study abstract: “12 percent of direct-to-consumer telehealth visits replaced visits to other providers, and 88 percent represented new utilization. Net annual spending on acute respiratory illness increased $45 per telehealth user.”

The study examined 2011-2013 claims information for over 300,000 people insured through the California California Public Employees’ Retirement System, which despite the name provides health benefits to active state employees as well as retirees. It targeted common acute respiratory infections (sinus infections, bronchitis and related) to determine patterns of provider utilization and the change after the introduction of telehealth. Of that group, 981 used the Teladoc system for video consults, adopted by CalPERS in 2012.

The objective of the study was to determine whether the telehealth visits were new care or substituted for other types of care such as doctor, clinic, or ED visits. Even though the telehealth services were far cheaper–about 50 percent lower than a physician office visit and less than 5 percent the cost of a visit to the ED–they did not make up for the calculated 88 percent rise in utilization.

Similar results were reported by RAND in last year’s research on retail clinics, which estimated that 58 percent of visits for low-severity illnesses were new and not shifted from EDs or doctor’s offices. What is in common? Convenience. Convenience opens up greater use. If you have a store down the street, you may pop in daily versus once-weekly.

Updated: Some further insights from Mobihealthnews were that the study stated that telehealth visits may be more likely to result in additional costs, such as follow-up appointments, testing or prescriptions. In other words, the telehealth visit starts off less expensive, but the standard of care in follow-up adds to that initial cost.

The RAND recommendation is thus not a surprise: make more telemedicine visits a shift from office or ED to restrict telemedicine growth. Raise the cost of co-pays for the service to reduce demand. On the ‘high side’, encourage ED ‘frequent flyers’ to use telehealth services instead. Pass the painkillers. Health Affairs (abstract only; paid access required for full study), RAND Health press release.

Analysis: instead of self-doctoring, and suffering at home and in the workplace, the small group of CalPERS policyholders in the study actually used their new benefit to check their health–as intended! The additional cost is not staggering; (more…)

Idaho legislature begins repeal of telemedicine abortion ban

An agreement reached in the U.S. District Court in Idaho in click to enlargeJanuary this year overturned Idaho’s ban of prescription of abortion-inducing drugs during a telemedicine consultation (see our previous article).

The settlement of the case before Chief District Judge B. Lynn Winmill, brought by Planned Parenthood of the Great Northwest and the Hawaiian Islands, required the Idaho legislature to repeal the laws that made such prescriptions over telemedicine consultations illegal. The repeals have to be carried out by the end of the 2017 session, else Judge Winmill will declare the laws unconstitutional and unenforceable, according to Mobi Health News .

Idaho legislature has accordingly started the process of removing the single line from the Telehealth Access Act which bans the prescription of abortion inducing drugs and repealing the law requiring the doctor to be physically present at the consultation when prescribing the drugs. This is to be achieved via the new House Bill 250, sponsored by the State Affairs Committee, named simply An Act relating to Abortion. The bill was introduced last Friday.

The wording of the bill emphasises the the view that the state believes that abortions induced by medicines prescribed via telemedicine consultations constitute “substandard medical care and that women and girls undergoing abortion deserve and require a higher level of professional medical care”. Planned Parenthood has said that it objects to this statement that telemedicine provides substandard care according to Boise Weekly.

The bill has made rapid progress having had its second reading yesterday and is currently filed for the third reading.