Breaking News–Teladoc: while accredited by NCQA, placed on ‘under corrective action’ status (updated)

Breaking News. Teladoc–one of the two giants in telemedicine–has been placed on ‘under corrective action’ status in its latest (15 May) two-year accreditation with the National Committee for Quality Assurance, better known by its initials, NCQA. Their next review is slated for six months (18 Nov).

According to the earliest breaking report on Seeking Alpha, a business and stock market website, the move to ‘corrective action’ status has been brewing for some time. Teladoc was the first telemedicine company to win this coveted status in 2013. Now, of course, all major telemedicine players have this accreditation.

This is the latest mark against the company, which has gone through some recent ‘interesting times’ financially with accounting problems based on booking stock awards (2018), the CFO’s resignation, and lack of replacement. The report by a ‘bear’ on the stock indicates that its large contract with Aetna, among others, is up for renewal.

Exactly what this ‘corrective action’ is related to has not been made public by either NCQA or Teladoc. Comments under the article sourced from a Wells Fargo analyst that the action is arising from a workflow that Teladoc uses for credentialing providers.

A good portion of this article discusses revisions on the Teladoc website and marketing materials which ensues when something like this happens and it is the basis for a superiority or credentialing claim.

NCQA is a non-profit that advocates quality standards and measures for healthcare organizations, health plans, and organizations that provide services to the former. Their standards are widespread in the industry as a means of review and accreditation for providers and hospitals, as well as incorporated into quality metrics used by HHS and CMS. For those who may not be able to access the full article–requires free membership (but you’ll get emails) registration with the Seeking Alpha site–attached is a PDF of the article.

Update: While to the ‘bear’ Teladoc is a glass half empty and cracked, to another Seeking Alpha writer, the glass is more than half full even though the company continues to run substantial losses. Here’s an analysis that is mostly positive, though acknowledging the issues above.

Babylon Health’s expansion plans in Asia-Pacific, Africa spotlighted

Mobihealthnews’ interview with Ali Parsa of Babylon Health illuminates what hasn’t been obvious about the company’s global plans, in our recent focus on their dealings with the NHS. For its basic smartphone app (video consults, appointments, medical records), Babylon last year announced a partnership with one of Asia’s largest health insurers, Prudential [TTA 18 Sept 18], licensing Babylon’s software for its own health apps across 12 countries in Asia for an estimated $100 million over several years. Babylon has also been active in Rwanda and now reaches, according to their information, nearly 30 percent of the population. There’s also a nod to developments with the NHS.

Parsing the highlights in Dr. Parsa’s rather wordy quest towards less ‘sick care’, more ‘prevention over cure’, and making healthcare affordable and accessible to everyone ’round the clock:

  • Asia-Pacific: Working with Tencent, Samsung and Prudential Asia through licensing software is a key component of their business. By adding more users, they refine and add more quality to their services. (Presumably they have more restrictions on the data they send to Tencent than what they obtain in China.)
  • Africa: How do you offer health apps in an economically poor country where only 5 percent of the population has a smartphone? Have an app that works for the 75 percent who have a feature phone. Babyl Rwanda has 2 million users–30 percent of Rwanda’s population–and completes 2,000 consultations a day. Babyl also works with over 450 health clinics and pharmacies. The service may also be expanded across East Africa, and may serve as a model for similar countries in other regions.
  • UK and NHSX: About the new NHS-formed joint organization for digital services, tech, and clinical care, Dr. Parsa believes it is ‘fantastic’ and that “it is trying to bring the benefits of modern technology to every patient and clinician, and aims to combine the best talent from government, the NHS and industry. Its aim, just like ours, is to create the most advanced health and care service in the world, to free up staff time and empower patients.” (Editor’s note:  NHSX will bring together the Department of Health and Social Care, NHS England and NHS Improvement, overseeing NHS Digital. More in Digital Health, Computer Weekly.)

Tyto Care inks deal with Best Buy for retail sales of remote diagnostic device

Tyto Care’s long-planned retail debut of the TytoHome remote diagnostic device has arrived at Best Buy. The telehealth device which incorporates a camera, stethoscope, otoscope, tongue depressor, basal thermometer, and smartphone app can be bought online for $299.99. According to their release, TytoHome will be available at select Minnesota Best Buy stores and will roll out to North Dakota, South Dakota, California and Ohio.

TytoHome has been from the start (late 2016) pitched to parents as a 24/7 service for ill children in that middle-of-the-night sick call to the doctor, but more recently for adults as an adjunct to a virtual visit. The Israel-based company with US offices in NYC partnered with American Well early [TTA 2 Dec 2016]. For Best Buy customers outside of Minnesota, North and South Dakota, TytoHome will connect to doctors via LiveHealth Online, an American Well partner. In those three states, TytoHome will connect to Tyto Care health system partner Sanford Health and their medical providers. Each visit will be $59, possibly less if the service is covered by the person’s or family insurance plan.

Best Buy, of course, has made a large bet on retail health tech with its purchase of GreatCall, well-known for its Jitterbug phones targeted to older adults with its 5-Star PERS, but also prior to the acquisition with GreatCall’s purchases of Lively’s tech for consumer devices and HealthSense in LTC systems. Their current plans are outlined in a recent interview with CEO David Inns.

Suddenly hot, redux: mental health telemedicine in long term care, analytics to help predict rehospitalizations in skilled nursing facilities

The positive side of telemedicine for two areas–Long Term Care (LTCF). Skilled Nursing (SNF). Two types of care facilities that don’t get a lot of excited cocktail party chatter or much respect in the health tech field. Yet the needs are there, the tech attention has returned, and apparently the money has as well.

A major provider of behavioral health services for LTCF, Deer Oaks, is turning to telemedicine (SnapMD) to expand their reach. Already working with 1,400 LTCFs in 27 states in the central to southern US, Deer Oaks has been active since 1992 in providing both psychiatric and psychological services for geriatric and disabled patients.

The problem is coverage and the lack of providers. Psychiatry is itself aging out with few young doctors in the field–as well as the uneven distribution of practitioners. Mental health is a significant concern in the older adult population, including those dealing with depression and dementia.

Deer Oaks is adding telemedicine to expand to facilities in smaller, in rural areas, to extend hours, and to reach people with limited mobility. Facilities receive equipment and training. Two significant challenges they found were the lack of tech expertise in the staff, and importantly, the reliability of Wi-Fi in those areas, which is needed at 500 kbs of bandwidth to work. This expansion fits with CMS’ extension of covered telemedicine in rural areas and FCC’s continuing Connected Care Pilot Program, San Antonio-based Deer Oaks is estimated to have over $18 million in revenue (CrunchBase) and sees their growth in this area, according to an interview in mHealth Intelligence.

Assessing developing conditions in a SNF or LTC patient and preventing readmissions will always get this Editor’s attention, as she started in the field with behavioral telemonitoring for this area.

  • Real Time Medical Systems raised at end of February $9.2 million from SunBridge Capital Management to fund the growth of their analytics software which uses EMR information plus information from clinicians in routine monitoring of resident status to alert for early changes in resident conditions. Appropriate intervention could prevent hospitalization or a more serious development. Real Time currently has 500 SNFs and 30 hospitals, for a total of about 60,000 covered residents.
  • Skilled Nursing News also notes that Call9, an emergency medicine provider that embeds first responders at SNFs to provide onsite care and reduce unnecessary transfers to ERs, has raised a stunning $34 million and is concentrating on both SNF and assisted living. It is connected with several major payers and Medicare Advantage plans.
  • More conservatively, Third Eye Health, which provides post-acute emergency telemedicine to 220 SNFs, recently raised $7 million. All these companies have claimed readmission reductions of 40 to as high as 70 percent, and savings from services such as these may be billions.

None of which gets buzzy panels at HIMSS, Health 2.0, or CES, or viral videos on the news as the plight of Mr. Quintana did [TTA 13 Mar, below] but provides a badly needed advance in care services–and savings–for LTCs/SNFs and badly needed and better care for their patient residents.

A telemedicine ‘robot’ delivers end of life news to patient: is there an ethical problem here, Kaiser Permanente?

Bad, bad press for in-hospital telemedicine. A 78 year-old man is in the ICU in a Kaiser Permanente hospital in Fremont, California. He has end-stage chronic lung disease and is accompanied by his granddaughter. A nurse wheels in an InTouch Telemedicine ‘robot’ (brand is clearly visible on the videos; KP is one of their marquee customers). The mobile monitor screen is connected to a live doctor on audio/video for a virtual consult. The doctor is delivering terminal news: that not much can be done for Mr. Quintana other than to keep him comfortable in the hospital on a morphine drip, and that he would likely be unable to return home to hospice care.

Granddaughter Annalisia Wilharm videoed the consult. The screen is high above the bed, the doctor is wearing headphones, and is looking down. The doctor’s voice is accented and hard to understand through the speakers–is the volume low because it’s set low or due to privacy regulations? In any case, the doctor is asked time and again to repeat himself by the granddaughter as the patient cannot hear or understand the doctor. Another factor apparent on the video to this Editor is that the patient is on a ventilator–and ventilators make noise that mask other sounds.

Mr. Quintana passed away in the hospital last Tuesday 5 March, after a two-day stay.

The video has gone viral here in the US, with the family going to local press first (KTVU). The story was picked up in regional Northern California coverage and blew up into national coverage from USA Today (edited video complete with emotive background music), Fox News (San Jose Mercury News video), and picked up in media as diverse as the Gateway Pundit–if you want to get a feel for vox populi, see the comments.

Kaiser Permanente has apologized in guarded terms: “We offer our sincere condolences,” said Kaiser Permanente Senior Vice-President Michelle Gaskill-Hames. “We use video technology as an appropriate enhancement to the care team, and a way to bring additional consultative expertise to the bedside.” Also: “The use of the term ‘robot’ is inaccurate and inappropriate,” she exclaimed. “This secure video technology is a live conversation with a physician using tele-video technology, and always with a nurse or other physician in the room to explain the purpose and function of the technology. It does not, and did not, replace ongoing in-person evaluations and conversations with a patient and family members.” The family also was well aware of Mr. Quintana’s status but is equally upset at his treatment at this critical time.

Despite all this exclaiming, this Editor, an advocate of innovations in telemedicine and telehealth since 2006, finds fault with Kaiser Permanente’s deploying a telemedicine consult in this situation on the following grounds:

  • End-of-life news this serious needs to be delivered by a human. Period.
  • Despite Ms. Gaskill-Hames’s statement, the video consult was not intermediated by a human. There is someone in scrubs behind the InTouch mobile monitor, but there is no standing by the monitor nor any effort to interpret what the doctor is saying. Explaining the technology is not explaining what the patient and family can do.
  • The patient had difficulty understanding the doctor’s voice, either through hearing or language comprehension. A ventilator could be blocking or masking the audio. Even so, the audio, depending on the source, is muddy, and the video worse than you get on a smartphone. 
  • The monitor is at the foot of the bed, not close to the patient. The patient may not be able to see the monitor at that distance due to poor vision.
  • It doesn’t take much thought to believe there may be an issue of cultural inappropriateness.
  • There is no patient advocate or a chaplain present. Whether one visited later is not known.
  • Another open question: why was additional comfort care and a ventilator not available at home if Mr. Quintana was truly terminal? Did this man die needlessly in an ICU?

The popular takeaway about Kaiser, the VA, and other health systems which are deploying telemedicine by their patients is that robots are replacing doctors. We may know better, but that is what the consumer press runs with–an emotional video that, BTW, breaks patient-doctor confidentiality by showing the (unnamed, but not for long) doctor giving medical instructions to Mr. Quintana.

It is not the telemedicine technology, it is how it is being used. In this case, with insensitivity. The blame will be laid, in this shallow time, at the feet of the ‘robot’. Rightly, blame should also be laid at the feet of the increasingly ‘robotic’ practices of major health systems.

There will certainly be more to this story.

A view at some variance, but winding up in the same place, is expressed by Dr. Jayne in HIStalk.

RSM’s Medical apps: mainstreaming innovation with Matt Hancock

This event on 4 April run by the Royal Society of Medicine’s Digital Health Section continues the successful series started by this editor (now no longer involved) seven years ago. It will examine the growing role that apps are playing in healthcare delivery.

Join colleagues to hear renowned speakers, including the Secretary of State for Health and Social Care, Matt Hancock, discuss the current and future part apps can play in the NHS and broader healthcare industry. We will hear Wendy Clarke, executive director at NHS Digital talk about the new NHS app. As apps move from concept to pilot to practice, demonstrating efficacy becomes increasingly important, so will be looking at how we can best assess clinical effectiveness. It is well recognised that poorly designed software can hamper rather than enhance healthcare. Matt Edgar Head of design for NHS Digital will talk of the importance of good design in medical apps, and how it can improve patient and clinician experience. The use of cutting edge technology in healthcare necessarily opens new regulatory and legal issues. We are pleased to have our legal counsel, Julian Hitchcock back to share his experience with this, with a particular focus on the use of artificial intelligence in healthcare. We will also be examining the importance of interoperability, as medical apps become more mainstream, and how to make this happen. We have some presentations, too, from new and established medical start-ups, showcasing the transformative effects these new technologies can have. Finally, we will take a look at what the future may hold with futurologist Lewis Richards, Chief Digital Officer of Servest.

Aims:

This meeting aims to: 

  • Encourage clinicians to consider medical apps when deciding on an appropriate intervention
  • Aid understanding of the medicolegal issues around medical app use
  • Reduce the fear, uncertainty and doubt about the use of medical apps

Objectives:

By the end of this meeting, delegates will be able to,

  • Have an understanding of the current state of the art of medical apps
  • Explain the latest position on regulation and endorsement of medical apps
  • Have an appreciation of how to assess the clinical effectiveness of medical apps. 

Book here – best to book soon too, as currently the RSM has not allocated the largest lecture theatre to the event so it will almost certainly sell out.

News roundup: Current Health’s Class II, Healthware Italy’s €10 million boost, the low state of Latin America telemedicine, weekend reading on digital health in health systems

Scottish startup gains FDA Class II clearance, pilots with Mount Sinai Brooklyn. Edinburgh’s Current Health has received FDA Class II clearance for its AI-enabled remote patient monitoring wearable monitors. The single arm-worn wearable sends data every two seconds on oxygen saturation, respiration rate, pulse rate, temperature, activity, and posture. Algorithms analyze the data and alert clinicians to patient status and deterioration. The Mount Sinai pilot follows on Dartford and Gravesham NHS Trust for a post-discharge monitoring program, with a 22 percent reduction in home visits plus fewer hospital readmissions and emergency department visits. Current Health is the renamed snap40. Mobihealthnews, BusinessWire release

Healthware, a Salerno, Italy-based consultancy group primarily concentrated in marketing and sales, has received a €10 million investment from Fondo Italiano d’Investimento SGR (FII Tech Growth). The investment will be used over the next two years has received to expand Healthware’s business transformation for life sciences companies and product development and services for digital health start-ups which improve health outcomes through new technologies. Release.  Hat tip to Healthware’s Antonietta Pannella

Telemedicine adoption in hospitals ranges from 65 to below 30 percent in Latin America. A study published this week in Health Affairs Global Health Policy (paywalled) looks at the different rates of hospital-based telemedicine adoption in nine Latin America countries. Leading is Chile with the aforementioned 65 percent; Argentina, Costa Rica, Mexico and Peru with less than a 30 percent. In the middle: Panama (35 percent), Uruguay and Guatemala in the 40 percent range. Despite supportive official policies in many of these countries, “Efforts to implement telemedicine are isolated and scattered, often left to the public sector or taking the form of insulated projects that are not sustained” or scaled up nationally and regionally. Mobihealthnews

For weekend reading. Intersecting with the Latin America story above is this. This Editor missed the October issue of Global Health: Science and Practice published out of Johns Hopkins, but here it is. The focus of the six articles is digital health integration into health systems in the US and internationally. Hat tip to Alain B. Labrique via Twitter

The wind may finally be at the back of telehealth distribution and payment (US)

Medicare Advantage may lead, but Medicaid and regular Medicare are not far behind. The Centers for Medicare & Medicaid Services (CMS) has announced in two proposed rules changes expansion of telehealth access for both privately issued Medicare Advantage (MA) plans (26 Oct) and state-run Medicaid and CHIP (Children’s Health Insurance Plan) (14 Nov) plan members. This may mean greater acceptance by providers because they will be paid for these services.

For MA, the proposal would, starting in 2020 as part of government funded basic benefits, eliminate geographic restrictions (rural telehealth) and allow members in urban areas to access telehealth services. It would also broaden present location restrictions, allowing MA members to receive telehealth from home versus traveling to a health care facility. The most intriguing wording is here: “Plans would also have greater flexibility to offer clinically-appropriate telehealth benefits that are not otherwise available to Medicare beneficiaries.” which very well could mean remote patient monitoring in conjunction with visits. MA plans have always had more latitude to offer telehealth benefits to members, which are about 1/3 of Medicare-eligibles (over 65). Over 11 percent growth is forecast and it is highly competitive though dominated by United Healthcare and Aetna–over 600 new plans are entering the market next year. Enrollments close on 7 Dec for 2019. CMS.gov release, mHealth Intelligence, Healthcare Finance News.

For Medicaid and CHIP, which states use to extend insurance to low-income individuals and families via private plans, states would be able to, under an approved rule, to more flexibly determine what criteria determine telehealth access. Currently, states use proximity factors–distance from provider and time. The proposed criteria under 10. Network Adequacy (pages 15-16) recommends that time and distance be deleted and instead “adding a more flexible requirement that states set a quantitative minimum access standard (later listed) for specified health care providers and LTSS (long term services and supports) providers”. The reasons why are the limited supply of providers and the functional limitations of the LTSS population. Also notable was language in section 8 discussing access to provider directories via smartphone, as 64 percent of the population with incomes less than $30,000 own a smartphone and use it to access health information.  CMS proposed rule, POLITICO Morning eHealth

This adds to the momentum of the Medicare Physician Fee Schedule published on 1 Nov that added even more:

  • Virtual brief patient checkins and evaluation of patient-recorded photos and video to payments
  • CMS is also finalizing separate payments for three new codes covering chronic care remote physiologic monitoring that unbundle 99091 (CPT codes 99453, 99454, and 99457) and interprofessional internet consultation (CPT codes 99451, 99452, 99446, 99447, 99448, and 99449).
  • Two new codes covering telehealth for prolonged preventive services
  • Finalizing the addition of renal dialysis facilities and the homes of ESRD beneficiaries receiving home dialysis as originating sites
  • After 1 July, the home will be permitted as a permissible originating site for telehealth services furnished for purposes of treatment of a substance use disorder or a co-occurring mental health disorder. CMS.gov fact sheet 

The importance of this is that more digital health covered by Medicare and government payments in public/private programs such as Medicaid and MA lead private insurers to pay doctors for these services, who will then be willing to pay vendors for providing them. For the telehealth and telemedicine companies that have weathered the storms and lean times of the past decade, there may be light at the end of the tunnel that is not an oncoming train.

Accrediting telehealth and remote patient monitoring providers (US)

Another organization has a go at it. ClearHealth Quality Institute (CHQI) of Annapolis, Maryland, an independent health care accrediting body, is developing two new telemedicine accreditation modules that cover Telemedicine Outcomes and Remote Patient Monitoring. The CHQI has formed a committee to develop standards in these areas to add them to current accreditation modules in telemedicine delivery: Consumer-to-Provider (C2P), Provider-to Consumer (P2C), and Provider-to-Provider (P2P). 

The need for clinical training and accreditation was recognized in August’s National Quality Forum report, Creating a Framework to Support Measure Development for Telehealth. Four domains of measurement were identified in the NQF report for telemedicine and telehealth organizations: 1) access to care, 2) cost effectiveness, 3) experience, and 4) effectiveness.

CHQI started in the insurance accreditation and compliance areas, expanding to telehealth recently. It is the only telemedicine accreditation program recognized by the American Telemedicine Association (ATA) and with major telemedicine providers such as American Well, Doctor On Demand, and MDLive.

Our Readers will remember that back in 2014, then Intel-GE Care Innovations in conjunction with the Jefferson College of Population Health had started the Validation Institute to accredit both individuals and companies. By last July, Care Innovations had sold it off to the Health Value Institute and had some time back concentrated on companies only. ClearHealth release, PatientEngagementHIT

France officially enters the telemedicine world

By ministerial decree for the 2018 social security financing law, France starts deploying telemedicine both for doctor-patient consults (teleconsultation) and ‘telexpertise’ (between health professionals) starting on 15 September. The latter will be defined in stages by 2020.  For instance, from 2019 it will be deployed for long-term conditions (ALD), rare disease patients in sub-dense areas or in long-term care homes or inmates. “In this context, they agree to define the scope of these acts and their rates as well as their methods of implementation and billing.”

The rest of the teleprofessional deployment calendar will be defined before the year 2020. The full bill is printed here (in French, of course) Agir-Telemedecine.org

Telemedicine changing Texas rural health and emergency medicine

The expanded use of telemedicine in Texas–controversial and delayed by the state medical society, despite its use in distance medicine and prisons–is slowly starting to change rural health in the state. SB1107 passed the Texas legislature in 2017, removing the previous requirement for an in-person medical consultation. Texas, like many Western states, has an acute shortage of primary care doctors in 184 of 254 counties, according to the state health service.

Where telemedicine fills that gap is in areas such as emergency rooms in rural hospitals. In Van Horn, population 2,000, with the next hospital 90 miles away, telemedicine enables the ER  to operate two trauma rooms and for the state, have a doctor there well within 30 minutes away which is the state requirement for a basic-level trauma facility. The ER connects with an office building in Sioux Falls, SD to a nurse and doctor on immediate call to help oversee care via the Avera eCare telemedicine system.

Universities have also worked to diversify telemedicine use in other settings. Texas Tech University Health Sciences Center has pioneered its use in ambulances and schools. The regional TexLa Telehealth Resource Center helps anyone looking to start a telemedicine project. By 2020, the University of Texas will have telemedicine fully implemented on campus. Houston Chronicle

A mHealth refutation of ‘Why Telemedicine is a Bust’

Worth your time over a long coffee is David Doherty’s lengthy analysis of a recent article published on the CNBC website on the ‘failure’ to date of what was supposed to revolutionize healthcare, the telemedicine ‘video visit’. Mr. Doherty counters point-by-point that the concept of telemedicine is already out of date–that the future of healthcare is with mobile devices, such as the EKG-taking KardiaMobile. He points to the distrust of large telemedicine companies such as Doctor on Demand and American Well as being heavily wedded to health insurers (the prevalent business model), selling/trading patient information, and breaking the individual doctor-patient relationship.

Mr. Doherty sees the future of telemedicine enabling individual doctors to better serve their patients on several levels–video consults, monitoring, and via high-quality apps–seamlessly.  But the insurer-employer-practice model is hard to break indeed, as American Well, Teladoc, and Doctor on Demand–all of which started with a DTC model–found out. And reimbursement is improved, but discouraging. mHealth Insight

International acquisition roundup: Doro and Welbeing; Teladoc and Advance Medical

Two international telecare/telehealth/telemedicine M&A deals made the news this last week.

Sweden’s Doro AB acquired Welbeing, headquartered in Eastbourne UK. Welbeing (formally Wealden and Eastbourne Lifeline) is a telecare provider of home-based personal alarms which supports about 75,000 residents in local systems. Their revenue in last fiscal year (ending 9/17) was £7.6 million (SEK 90m). Doro operates in the UK and about 40 countries, with a core business in mobile phones specially designed for older adults. Their Doro Care solutions provide digital telecare and social services for older adults and the disabled in the home. Doro is paying SEK 130 million (£11.1 million) for the acquisition of Welbeing, equal to eight times estimated EBITDA for the financial year 2017/2018, with 85 percent cash and 15 percent in Doro shares with a bonus based on financial performance. Release 

Making a few headlines in the US is telemedicine leader Teladoc’s purchase of Barcelona’s Advance Medical for a hefty $352 million, giving Teladoc a major international footprint especially valuable for its corporate clients and major payers. Advance Medical provides complete telemedicine services in 125 countries in over 20 languages. Even more valuable is their knowledge of local healthcare delivery systems, global expert medical opinion, and chronic care. The acquisition also gives Teladoc an international network of offices and a significant entreé with international health insurance companies. Mobihealthnews, Seeking Alpha (Teladoc investor slideshow)

VA’s ‘Anywhere to Anywhere’ telehealth initiative finalizes

VA Secretaries may come and go (or never get there), but their initiatives stay. With much fanfare last year, then-Secretary David Shulkin announced the ‘Anywhere to Anywhere’ telehealth and telemedicine program [TTA 3 Aug]. This program will use VA practitioners to provide virtual patient care across state lines when a veteran cannot make it to a VA hospital or clinic. The Department of Veterans Affairs published the proposed rule last October [TTA 3 Oct 17] with the Final Rule published in the Federal Register on 11 May.

Technically, it preempts state and local regulations around telehealth. “VA is exercising Federal preemption of conflicting State laws relating to the practice of healthcare providers; laws, rules, regulations, or other requirements are preempted to the extent such State laws conflict with the ability of VA health care providers to engage in the practice of telehealth while acting within the scope of their VA employment.”

It was widely supported by ATA, the American Association of Family Physicians, American Medical Informatics Association, Federal Trade Commission, the College of Healthcare Information Management Executives (CHIME), and many other industry organizations. It also enjoys wide Congressional support.

There is plenty of room for growth. Only 1 percent of VA’s veterans used Home Telehealth, while 12 percent used other forms of telehealth. They will be doing so with few suppliers: Medtronic, 1Vision/AMC Health, and Care Innovations. Iron Bow/Vivify Health was found to not have tablets which met the US production qualification. This Editor wonders how the current three suppliers will fare.

This telehealth program will be located in the apparently newly named Veterans Health Administration Office of Connected Care. mHealthIntelligence.com

A tipping point in consumer acceptance of health apps, AI, and virtual care? Accenture thinks so.

Accenture’s 2018 Consumer Survey on Digital Health indicates that the tipping point may be here, sort of. Some key findings:

  • Consumers had high rates of favorable acceptance and likeliness to use AI-enabled clinical services: home-based diagnostics (66 percent of respondents), virtual health assistants (61 percent), and virtual nurses to monitor health conditions, medications and vital signs at home (55 percent), which may be good news for the future of telehealth services.
  • The 2,301 respondents already are using mobile and tablet health apps (48 percent). 44 percent are using patient portals for to fetch their health records, primarily to get information on lab and blood-test results (67 percent), to view physician notes regarding medical visits (55 percent), and their prescription history (41 percent).
  • Wearables are being used by 33 percent and favorably viewed by over 70 percent as beneficial in understanding their health condition (75 percent), engaging with their health (73 percent), and monitoring the health of a loved one (73 percent). 

Virtual care seems to be leading the way over wearables and remote patient monitoring–and after-hours care, patient follow-up, and patient education are leading virtual care.

  • 25 percent had received virtual care services in the previous year, up from 21 percent in last year’s survey. 16 percent are taking part in remote health consultations, compared with 12 percent in 2016. 14 percent are participating in remote monitoring, up from 9 percent in 2016.
  • 47 percent state that given a choice, they would prefer a more immediate virtual medical appointment over a delayed in-person appointment.
  • For after-hours care, 73 percent said they would use virtual care for after-hours (nights and weekend) appointments.
  • 71 percent said they would use virtual care for taking a class on a specific medical condition. 65 percent would use virtual care for a follow-up appointment after an in-person visit.
  • Most respondents said they would also use virtual care for a range of additional services, including discussing specific health concerns with medical professionals (73 percent), in-home follow-up after a hospital stay (62 percent), participating in a family member’s medical appointment (59 percent), and being examined for a non-emergency condition (57 percent).

Accenture release and report.

Telemedicine’s still-sluggish adoption in health systems revealed in survey of health system executives

Sage Growth Partners, a Baltimore Maryland-based healthcare research and strategy firm, released a study surveying US C-level executives and service line leaders at a variety of larger health systems (integrated delivery networks (IDNs), academic medical centers (AMCs), community hospitals, and specialty hospitals) on their telemedicine use. It combined initial/exploratory qualitative interviews (total N=65) with online quantitative surveys (completed N=98) taken 2nd Quarter 2017.

Have we reached a tipping point? The findings indicated that just over 50 percent (56 percent) had developed in-house telemedicine systems or were already working with vendor/s on implementing telemedicine in their organizations. The study’s definition of telemedicine was broad, inclusive of any technology and programs that connect providers and patients not physically at the same location when care is provided. 

But many of the findings are dismaying:

  • Budgets–limited at best. Most (66 percent) had budgets under $250,000 per year 34 percent committed over $250,000 with most under $100,000, but three-quarters believe those budgets will increase next year. 
  • What it’s used for: Emergency use (29 percent), remote patient home monitoring (21 percent, and non-emergency cases (20 percent). 
  • How many vendors do they want to deal with?: One is quite enough–54 percent prefer a single telemedicine solution across the continuum of care (however defined), with 31 percent accepting two solutions. 
  • Has it changed the ‘standard of care’?: Yes for stroke, according to 70 percent surveyed. 75 percent believe it will potentially change the standard of care for behavioral health/psychiatry, followed by neurology (53 percent), primary care (52 percent), and cardiology (48 percent).
  • What about direct-to-consumer telemedicine?: The top must-haves are EMR integration, appointment scheduling, and store-and-forward messaging (60+ percent). What’s surprisingly not so desired: store-and-forward of images (47.9 percent–so much for home wound management) and vitals capture (45.9 percent–so much for connecting devices to telemedicine).

Perhaps it’s this Editor looking at the ‘glass half-full’ with a ‘Gimlet Eye’, but here we are in February 2018 still having this discussion at the executive and service line levels. The progress has been glacial at best on starvation budgets, yet telemedicine vendors are multiplying. What is also not promising: these executives’ preference for enterprise solutions which preclude small, innovative companies from getting past the pilot or trial phase. Another barrier: the insistence upon EMR (EHR) integration, which sounds appropriate except that Cerner and EPIC are ‘walled gardens’. Defining Telemedicine’s Role: The View from the C-Suite (PDF, free download from Sage). Also Clinical Innovation + Technology and Global Healthcare