Telehealth – Healthcare IT’s new land of opportunity

From a consumer’s standpoint, a healthcare transaction means a real-time conversation with a physician.

Commentary - After years of debate, healthcare reform is evolving from policy to reality—and already beginning to influence the behaviors of patients and healthcare providers around the country. In the effort to make healthcare more accessible and affordable, one would expect the role of enabling technologies to be front and center. All too often, however, when it comes to healthcare, technology gets a bit part.

Despite the rise in demand for new delivery models, web-based healthcare tools have lagged behind other industries. Today, consumers can easily go online to plan travel, do their banking and buy or sell goods and services. These online consumer tools share several key attributes: they are available when and where you are, offer choices, provide immediate service, and most importantly, focus on “transactions”—purchasing plane tickets, making a hotel reservation, transferring funds or buying a new laptop.

In contrast, nearly all existing healthcare websites focus on sharing information alone. Consumers can click a variety of links to find more information about various ailments, or maybe even email a question to a healthcare “expert” and get a response a day or two later. While this is valuable, ultimately a person with a medical problem wants to connect with a physician and execute a “transaction” in a prompt manner. From a consumer’s standpoint, a healthcare transaction means a real-time conversation in which a physician reviews your health history, evaluates your health status and helps determine the best course of action—be it tests, a referral to a specialist, or a prescription.

Until recently, this type of transaction was only offered in physician offices and hospitals. Enter a collection of technologies known as “telehealth.” Simply defined, telehealth technologies enable the delivery of medical care using telecommunications, including phone, email, Internet and other channels. In past years, the application of telehealth was interpreted narrowly to mean the use of technology to overcome physical distance. Now, it means that a patient can go online and see a qualified physician—including her own physician—rather than having to make an appointment, wait, drive to the office, and wait some more, taking hours away from work and family.

As a result, many in the industry are acknowledging that telehealth can be part of the solution for healthcare reform. In his recent State of the Union Address, President Obama called out telehealth’s promise. By advocating “a patient who can have face-to-face video chats with her doctor,” he acknowledged that telehealth is evolving from option to a necessity for healthcare providers and consumers.

Just two months later, it became clear that others in the government had reached a similar conclusion. The Centers for Medicare & Medicaid Services (CMS) released proposed new rules to define how doctors, hospitals and other stakeholders will provide more coordinated care for Medicare patients through so-called Accountable Care Organizations. Those outside of the industry may never have the pleasure of perusing the many hundreds of pages of rules. But, suffice it to say, that telehealth technologies are a key pillar of making this vision a reality. The path to improving healthcare included the need to “define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures and coordinate care through the use of telehealth, remote patient monitoring and other technologies.”

In other words, telehealth solutions can do for healthcare what other Web-based technologies have achieved in retail, finance, and other areas—bring diverse networks together for the benefit of consumers, more accessibly than ever before. For example, telehealth can enable seamless care coordination across a range of specialty providers where many gaps are present today. They can allow a team of care providers to collaborate—in real time—on a patient’s behalf to improve care, remove potential communication gaps and drive down costs.

As with any disruption to the norm , there are valid risks to be aware of. Even with its increasingly high-definition audiovisual capabilities, telehealth does not allow for a hands-on exam. It thus requires physicians to exercise different clinical judgment on the care they render. And since the Internet is open for everyone, it can become a platform for imposters and poor-quality providers to disseminate their wares.

But these types of challenges have been seen and conquered before. Amazon was criticized for taking the joy out of in-store book buying. Expedia eliminated the friendly agent from the travel agency down the street. Online banking and retail were feared to be leaky and insecure. Online grocery shopping did not allow the buyer to physically examine the produce and e-books turned the page on turning pages altogether. And yet they all prevailed somehow, and reached a point where they became an accepted part of our lives. This was done not by the persistence of the entrepreneurs but by their adaptation.

Telehealth is no different. It is not a replacement for the relationship between a patient and her doctor but it is ideal for a defined scope of medical care. Telehealth needs to be portrayed clearly as such to remove ambiguity and unrealistic expectations. It needs the capability to validate that the people who use it are who they claim to be and that the providers in it are licensed, audited and held accountable to the quality of care they deliver by their state medical boards, as they are in their practices today. Prescriptions could be limited to known safe lists and, as with any other modern computer-based system, measures should be in place to constantly look for abusers, intruders and other forms of mayhem. All of the above is doable and has been done before.

Telecommunications have changed almost every dimension of our lives within one generation, and telehealth is its application in healthcare. In order for it to take hold, telehealth must continue to deliver the positive transformation that has accompanied the move of other consumer activities online.

Roy Schoenberg, MD, MPH serves as American Well Systems’ President and CEO and is the inventor of the American Well concept. Today, Roy directs the company’s product development as well as the rest of the company’s Operations divisions. Schoenberg holds an MD from the Hebrew University Medical School and an MPH in Healthcare Management from Harvard University.