While telehealth virtual office visits flatten, overall up 300-fold; FCC finalizes COVID-19 telehealth funding program (US)

July 22, 2020 | by

As expected, the trend of telehealth visits versus in-person is flattening as primary care offices and urgent care clinics reopen. Yet the overall trend is up through May–a dizzying 300-fold, as tracked by the new Epic Health Research Network (EHRN–yes, that Epic). Their analysis compares 15 March-8 May 2020 to the same dates in 2019 using data from 22 health systems in 17 states which cover seven million patients. It also constructs a visit diagnosis profile comparison, which leads with hypertension, hyperlipidemia, pain, and diabetes–with the 2020 addition of — unsurprisingly — anxiety.

POLITICO Future Pulse analyzed EHRN data into July (which was not located in a cross-check by this Editor) and came up with its usual ‘the cup has a hole in it’ observation: “TELEHEALTH BOOM BUST”. But that is absolutely in line with the Commonwealth Fund/Phreesia/Harvard study which as we noted tailed off as a percentage of total visits by 46 percent [TTA 1 July]. But even POLITICO’s gloomy headline can’t conceal that telehealth in the 37 healthcare systems surveyed was a flatline up to March and leveled off to slightly below the 2 million visit peak around 15 April. 

Where POLITICO’s gloom ‘n’ doom is useful is in the caution of why telehealth has fallen off, other than the obvious of offices reopening. There’s the post-mortem experience of smaller practices which paints an unflattering picture of unreadiness, rocky starts, and unaffordability:

  • Skype and FaceTime are not permanent solutions, as not HIPAA-compliant
  • New telehealth software can cost money. However, this Editor also knows from her business experience that population health software often has a HIPAA-compliant telehealth module which is relatively simple to use and is usually free.
  • It’s the training that costs, more in time than money. If the practice is in a value-based care model, that is done by market staff either from the management services organization (MSO) or the software provider.
  • Reimbursement. Even with CMS loosening requirements and coding, it moved so quickly that providers haven’t been reimbursed properly.
  • Equipment and broadband access. Patients, especially older patients, don’t all have smartphones or tablets. Not everyone has Wi-Fi or enough data–or that patient lives in a 2-bar area. Some practices aren’t on EHRs either.
  • Without RPM, accurate device integration, and an integrated tracking platform, F2F telehealth can only be a virtual visit without monitoring data.

Perhaps not wanting to paint a totally doomy picture (advertising sponsorship, perhaps?), the interview with Ed Lee, the head of Kaiser Permanente’s telehealth program, confirmed that the past few months were extraordinary for them, even with a decent telehealth base. “We were seeing somewhere around 18 percent of telehealth [visits] pre-covid. Around the height of it, we’re seeing 80 percent.” They also have pilots in place to put technology in the homes of those who need it, and realize its limitations.

Speaking of limitations, the Federal Communications Commission (FCC) COVID-19 Telehealth Program, authorized by the CARES Act, is over and out. The final tranche consisted of 25 applications for the remaining $10.73 million, with a final total of 539 funding applications up to the authorized $200 million. Applicants came from 47 states, Washington, DC, and Guam. FCC release. To no one’s surprise, 40 Congresscritters want to extend it as a ‘bold step’ but are first demanding that Chair Ajit Pai do handsprings and provide all sorts of information on the reimbursement program which does not provide upfront money but reimburses eligible expenditures. That will take a few months. You’d think they’d read a few things on the FCC website first. mHealth Intelligence

The telehealth ‘entrepreneur’ whose $5 million funding bought stays at the Ritz and portfolios at Bottega Veneta

February 6, 2019 | by

This curious and cautionary tale should be better known. A young entrepreneur named Keisha L. Williams from Ashburn, Virginia had an attractive proposition. She needed immediate funding to bring to the US an Austrian telehealth system described as “software that would allow doctors to remotely examine and talk with patients.” Ms. Williams had degrees in both law and electrical engineering, so credibility. She also had a story. The software was in ‘escrow’ in Austria. There were taxes and fees that had to be paid immediately. And she had family situations, financial and medical emergencies. In other words, she had a ‘great line of ‘stuff’ on the technology, urgency, and personally, a few tugs on the heartstrings.

Ms. Williams told this story enough times over four years, and to enough people who believed her–more than 50, who invested over $5.4 million.

What happened? 95% of the money was spent on over the top vacations to Bora Bora, Italy, the Bahamas, and Jamaica, plus the occasional yacht with ‘hand and foot services’ and shopping at top-end retail such as Bottega Veneta and Vuitton. $500,000 alone was spent on her girlfriend. About $300,000 was spent on the software.

The rest of the story involves 14 Federal fraud charges, four accomplices, and unwitting, likely vulnerable people who were talked into giving over their savings. Late in January, she was sentenced to 15.5 years in Federal prison.

Many of our Readers have started companies or worked with entrepreneurs who have a great story and need money. The stories touch our hearts–and sometimes our checkbooks. Apparently, Ms. Williams raised the money without exposing herself to anyone in the industry or private investors who would ask remotely leading questions. To us, this technology sounds hardly sexy–it’s telemedicine virtual visit software with maybe some remote patient monitoring thrown in. Yet to 50 people, who are now poorer or who were involved with the fraudulent scheme — it sounded really special. (The name is also common–there are quite a few people on LinkedIn with the same name, which may make life difficult for them.)

With the rising tide of telehealth, if your cousin or uncle has heard of a great way to visit your doctor over the phone and asks you if you’ve heard about it, you might want to ask Uncle to pass the pie as you switch the conversation to being on guard for fraudulent schemes. Washington Post (read the comments), Daily Mail, Seattle Post-Intelligencer, press releases 17 Oct and 18 Jan from the US Attorney’s office, Eastern District of Virginia

Babylon Health’s ‘GP at hand’ not at hand for NHS England–yet. When will technology be? Is Carillion’s collapse a spanner in the works?

January 16, 2018 | by

NHS England won’t be rolling out the Babylon Health ‘GP at hand’ service anytime soon, despite some success in their London test with five GP practices [TTA 12 Jan]. Digital Health cites an October study by Hammersmith and Fulham CCG (Fulham being one of the test practices) that to this Editor expresses both excitement at an innovative approach but with the same easy-to-see drawback:

The GP at Hand service model represents an innovative approach to general practice that poses a number of challenges to existing NHS policy and legislation. The approach to patient registration – where a potentially large volume of patients are encouraged to register at a physical site that could be a significant distance from both their home and work address, arguably represents a distortion of the original intentions of the Choice of GP policy. (Page 12)

There are also concerns about complex needs plus other special needs patients (inequality of service), controlled drug policy, and the capacity of Babylon Health to expand the service. Since the October report, a Babylon spokesperson told Digital Health that “Commissioners have comprehensively signed off our roll-out plan and we look forward to working with them to expand GP at Hand across the country.” 

Re capitation, why ‘GP at hand’ use is tied into a mandatory change of GP practices has left this Editor puzzled. In the US, telemedicine visits, especially the ‘I’ve got the flu and can’t move’ type or to specialists (dermatology) are often (not always) separate from whomever your primary care physician is. Yes, centralizing the records winds up being mostly in the hands of US patients unless the PCP is copied or it is part of a payer/corporate health program, but this may be the only way that virtual visits can be rolled out in any volume. In the UK, is there a workaround where the patient’s electronic record can be accessed by a separate telemedicine doctor?

Another tech head-shaker: 45 percent of GPs want technology-enabled remote working. 48 percent expressed that flexible working and working from home would enable doctors to provide more personalized care. Allowing remote working to support out-of-hours care could not only free up time for thousands of patient appointments but also level out doctor capacity disparities between regions. The survey here of 100 GPs was conducted by a cloud-communications provider, Sesui. Digital Health. This is a special need that isn’t present in the US except in closed systems like the VA, which is finally addressing the problem. The wide use of clinical connectivity apps enables US doctors to split time from hospital to multiple practices–so much so on multiple devices, that app security is a concern. 

Another head-shaker. 48 percent of missed NHS hospital appointments are due to letter-related problems, such as the letter arriving too late (17 percent), not being received (17 percent) or being lost (8 percent). 68 percent prefer to manage their appointments online or via smartphone. This preference has real financial impact as the NHS estimates that 8 million appointments were missed in 2016-2017, at a cost of £1bn. Now this survey of 2,000 adults was sponsored by Healthcare Communications, a provider to 100 NHS trusts with patient communications technology, so there’s a dog in the hunt. However, they developed for Barnsley Hospital NHS Foundation Trust a digital letter technology that is claimed to reduce outpatient postal letters by 40 percent. Considering my dentist sends me three emails plus separate text messages before my twice-yearly exam…. Release (PDF).

Roy Lilley’s daily newsletter today also engages the Tech Question and the “IT desert” present in much of the daily life of the NHS. Trusts are addressing it, junior doctors are WhatsApping, and generally, clinicians are hot-wiring the system in order to get anything done. It is much like the US about five to seven years ago where US HHS had huge HIPAA concerns (more…)

NHS Scotland launches Attend Anywhere video consult trial

December 14, 2016 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/12/VC_Infographics_WaitingAreaOverview01_600pxwide.png” thumb_width=”200″ /]Announced earlier this month by Shona Robison, Cabinet Secretary for Health and Sport, Scottish Government at the Scottish Digital Health & Care Week and Conference is the pilot of the Attend Anywhere virtual doctor visits. The consults are through a patient’s computer, smartphone or tablet using a Google Chrome web browser. The patient logs in to the website, waits in a private video room, the provider is notified that the patient is in the queue, and when the doctor is available, the video visit will start. (See illustration at left)

Initially, the service will target video call access to up to 50 health care providers including primary care, specialist services, speech and language therapy as well as pharmacy prescription reviews. According to Attend Anywhere, the service is available now to Scots in both rural and metropolitan areas. The service was developed as part of a collaboration between NHS Scotland’s Technology Enabled Care (TEC) Programme, Melbourne Australia-based video consulting specialists Attend Anywhere, and Healthdirect Australia, supported by NHS 24 Scottish Centre for Telehealth and Telecare. The press release links to a video of the consults in use in western New South Wales, including a care home. Scottish Centre demonstration site, Scottish Digital Health Week page.  Hat tip to Chris Ryan of Attend Anywhere Australia for the original articles and corrections. His LinkedIn post here shows the Scottish Centre’s table at the conference.

The difficulty in differentiating telemedicine and telehealth

June 15, 2016 | by

Our Editors have always tried to cleanly define the differences between telemedicine, telehealth and telecare, even as they blur in industry use. (See our Definitions sidebar for the latter two.) But telemedicine, at least on this side of the Atlantic, has lost linguistic ground to telehealth, which has become the umbrella term that eHealth wanted to be only two or three years ago. Similarly, digital health, connected health and mHealth have lost ground to health tech, since most devices now connect and incorporate mobility. And there are sub-genres, such as wearables, fitness trackers and aging tech.

Poor telehealth grows ever fuzzier emanations and penumbra! Now bearing the burden of virtual visits between doctor and patient, doctor-to-doctor professional consults, video conferencing (synchronous and asynchronous), remote patient monitoring of vital signs and qualitative information (ditto), and distance health monitoring to treat patients, it also begins to embrace its data: outcome-based analytics, population health and care modeling. Eric Wicklund accumulates a pile of studies from initial-heavy organizations: WHO, HIMSS, HHS, Center for Connected Health Policy (CCHP), ATA, TRC Network. All of which shows, perhaps contrary to Mr Wicklund’s intentions, how confusing simple concepts have become. mHealth Intelligence

Are virtual visits consistent and effective? JAMA-published study raises doubts.

May 13, 2016 | by

A medical/health policy team from University of California-San Francisco (UCSF) studied virtual telemedicine visits and found a “significant variation in quality.” Over a year, 67 trained standardized patients over 599 visits presented their symptoms to the eight largest telemedicine (video and phone) providers (not named in the abstract). Their illnesses were common and acute: ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain and recurrent female urinary tract infection. Based on their metrics, histories and physical exams were completed only 70 percent of the time; key management decisions adhered to accepted guidelines 54 percent of the time. Rates of guideline-adherent care (best practices) ranged from 206 visits (34.4 percent) to 396 visits (66.1 percent) across the eight websites. Wide variations were also found in diagnosis of pharyngitis and acute rhinosinusitis, with clinicians adhering to guidelines anywhere from 12.8 percent to 82.1 percent of the time. JAMA Internal Medicine, May issue, published online 4 April: Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits (abstract only without subscription)

The type of telemedicine they studied were the typical live, real-time video appointments. Another ‘virtual care platform’ provider, Zipnosis, offers a contrasting way. They claim that the live simulacrum of the in-person appointment is lacking, and what’s needed is an asynchronous approach–‘store-and-forward’ information in what they call an “online structured, adaptive interview” integrated with health systems’ services.

In preview information released to press and as a letter to JAMA just prior to the start of the American Telemedicine Association’s (ATA) annual meeting, Zipnosis offered its own, far more positive study. Their review of 1,760 patient encounters (more…)

Teen inventor develops video communicator, med dispenser debuting at ATA 2015

May 5, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/05/dispenser.jpg” thumb_width=”150″ /]Teen inventors come up with interesting designs and apps at science fairs and codeathons, but it’s unusual when a 15 year old brings to market an assistive technology product targeted to remote caregiving and socialization of much older people. This is the case with iC Loved Ones, a smartphone/tablet + independently controlled med dispenser for remote caring. A desktop PC, smartphone or tablet loaded with the iC Loved Ones app remotely controls the dispenser, delivering medications in pre-loaded dishes. A separate smartphone or tablet, which can be positioned anywhere in the home on the provided stand, is used for video chat and virtual visits. The auto-answer setup (more…)

Telemedicine’s boffo year? Some confirmation. (US)

January 16, 2015 | by

Big bets were made on telemedicine (video doctor-patient consults) in 2014. This Editor closed her 18 December article with ‘telemedicine providers received a $200 million+ vote of confidence from tough-minded investors. We’ll see if 2015 results fulfill these whale-at-Monte-Carlo wagers.’ Here may be the start of a tipping point. New York State’s new law requiring insurer reimbursement for telehealth services went into effect 1 January, making NY the 22nd state to require payers to pay up for virtual visits. Permitted providers are physicians, dentists (!), physician assistants, psychologists and social workers. This provider list is considerably broader than Medicare’s new rules applying telehealth for patients with two or more chronic conditions, which is tied to physicians’ offices and contracted third parties. Also cheering the industry are that Indiana, Iowa and Tennessee are holding hearings on potential legislation, with Missouri at the legislative bill stage. (more…)

Dr Topol’s prescription for The Future of Medicine, analyzed

January 12, 2015 | by

The Future of Medicine Is in Your Smartphone sounds like a preface to his latest book, ‘The Patient Will See You Now’, but it is quite consistent with Dr Topol’s talks of late [TTA 5 Dec]. The article is at once optimistic–yes, we love the picture–yet somewhat unreal. When we walk around and kick the tires…

First, it flies in the face of the increasing control of healthcare providers by government as to outcomes and the shift for good or ill to ‘outcomes-based medicine’. Second, ‘doctorless patients’ may need fewer services, not more, and why should these individuals, who represent the high-info elite at least initially, be penalized by having to pay the extremely high premiums dictated by government-approved health insurance (in the US, ACA-compliant insurance a/k/a Obamacare)–or face the US tax penalties for not enrolling in same? Third, those liberating mass market smartwatches and fitness trackers aren’t clinical quality yet–fine directionally, but real clinical diagnosis (more…)

Google testing telemedicine program via Helpouts

October 16, 2014 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/10/google-doctor-video-chat1.jpg” thumb_width=”150″ /]If Sergey and Larry don’t get your data one way…they will another. Google has quietly devised another use for Helpouts, its languishing live video help service. In given (but not disclosed) markets, you may be searching for information on a medical condition, and get the option to connect to a live doctor for a virtual visit. It was enough under the radar that it was stumbled upon; a developer searched via Google for ‘knee pain’ and found this (left), posted it to Reddit and it was later confirmed by Engadget. The cost is free (for now). According to iHealthBeat, via Modern Healthcare (subscription required), Scripps Health and One Medical Group are the reported participants. The Washington Post adds that not every medical-related query (more…)

Verizon’s ‘white label’ telemedicine service debuts

June 30, 2014 | by | 2 Comments

Verizon is evidently sticking with its strategy of enterprise marketing when it comes to digital health. The Verizon Virtual Visits service released last week enables a video chat with a clinician via smartphone app (3G/4G OK as well as Wi-Fi; the full mobile enablement Verizon states as a key differentiator versus competitors such as American Well, MDLive and Teladoc) or alternatively, web portal. Prior to the average 30 minute chat, the service verifies eligibility and co-pay information, presents patients’ self-reported histories, symptoms, medication allergies and other information, then collects the co-pay; at the close if needed, an e-prescription via SureScripts is sent to the patient’s pharmacies. Verizon presents this as as a ‘white label’ service for groups such as health systems, insurers and health plans who will determine their unique co-pay and clinician mix. Clinicians can be contracted through Verizon’s provider network or, in a health system, their own or an in-house/contract mix. Neither clients nor third-party medical provider(s) have been announced yet, but VentureBeat states that the clients will be publicized in the next few months, which is deflating. Information Week, The IHCC. Verizon release.

Babylon app for booking GP visits debuts (UK)

May 1, 2014 | by

Making news out of Tuesday’s Wired Health UK 2014 at the Royal College of General Practitioners (RCGP) in London is Babylon. From the app (iPhone, Android), appointments with a GP or specialist can be booked 12 hours a day, six days a week, with one of the almost 100 part time salaried and on call doctors in Babylon’s system or a BUPA (private healthcare/insurance system) physician. Also bookable through the app are diagnostic kits and blood tests;  X-rays or scans would be at a partner facility. Have a question or want to check your symptoms? The app directs your text and pictures to a doctor or nurse. Need a prescription? Delivered to your home or a nearby pharmacy. Record storage is on your phone. All for £7.99/month for basic service or £24 per consult–both low prices that seem to be introductory (a/k/a not profitable) or for light users. Babylon is registered with the Care Quality Commission, an independent healthcare regulator, and has designated body status from NHS London.

Founder Ali Parsa, a former Goldman Sachs banker who previously founded Circle, approvingly says that booking an appointment is as simple as ‘booking a Hailo cab’ (in NYC, Uber). This is a more complete model than a ZocDoc or Vitals (US appointment services) with testing and a symptom checker, but it does not seem to have a video consult (more…)