Challenges and Opportunities in Virtual Care — Are You In?

In our recent Benchmark Survey Report, we examined some of the trends that are shaping how healthcare organizations are deploying virtual care solutions. We examined the opportunities that exist for new players to get into the game, as well as how those that are already playing can expand their offerings. We also dove into some of the challenges that are being felt throughout the industry – whether in the day-to-day management of currently deployed virtual care platforms or the challenges that are expected by those that have yet to launch any telemedicine services. One thing was clear from our survey however, as virtual care continues to advance, the opportunities that exist in the industry greatly outweigh the challenges.

We’ve Come a Long Way

The truth is virtual care is nowhere near where it was 10 years ago, or even just last year for that matter. For example, our Benchmark Survey indicates that while the industry still leans heavily on video – one of the more traditional modes of careModality Type Deployment, video alone isn’t sufficient to meet the changing needs of today’s patients and providers. Because of this, many are turning to multi-modal care, with 61% of health systems reporting they offer more than one mode of care today. Which of these is gaining the most momentum? Believe it or not, it’s chat, with 44% of health systems saying they expect to include chat in their virtual care launch.

As technology changes, the clinical impact that these platforms provide also improves. Our study shows that virtual care solutions have the power to impact both clinical quality and efficiency. Quality reporting has always been difficult for healthcare providers, but 33% of survey respondents say their technology provider offers a reporting and analytics solution and 30% say their technology provider offers scheduled or ad hoc reporting. At the same time, virtual care is enabling providers to shorten patient visits by as much as 15 minutes – from the current patient visit average which is approximately 16 minutes to between one and five minutes, as reported in our survey. I don’t know about you but the ability to make five or ten times the health impact is an amazing opportunity I would not want to miss out on!

Miles to Go Before We Sleep

As much as virtual care has evolved, there are still hurdles that we need to get over before we can realize the adoption rates that we seek. What’s fascinating however is that the actual challenges providers face in their day-to-day operations are different from those that respondents anticipate they’ll encounter, which include integration, patient utilization, and claim management. Diving into each of these a bit deeper:

  • Program ChallengesIntegration – EMR integration specifically, has long been a pain point for providers and our research shows that this is only growing as an important focus area as virtual care adoption moves into the mainstream. About 21% of survey respondents who have virtual care identify lack of EMR integration as a challenge, even though 42% say their service doesn’t integrate with the EMR at all. That’s in comparison to the fact that nearly 54% of our survey respondents expect EMR integration to be a major challenge.
  • Patient Utilization – There’s still a bit of a “Field of Dreams” assumption to virtual care, despite research from multiple sources, including a 2018 Deloitte study, showing slow adoption. If you don’t believe me, just look at the disparity in the number of respondents in our survey who identified patient utilization as a challenge. Only 31% of those without a virtual care solution, compared to 64% of those with a virtual care service already deployed.
  • Managing Claims – We also saw an under-realization of the challenges associated with managing claims and reimbursement. In fact, only 15% of respondents without a virtual care solution thought that this would be a top challenge, versus the 39% of those with virtual care services who acknowledged this obstacle. The truth is, the healthcare revenue cycle has many parts, making it difficult to manage. Increased integration of virtual care solutions with EMRs and other legacy systems are important and can help make your life a lot easier.

What Lies Ahead

As patients, providers and as those with a stake in the virtual care industry, we should feel encouraged by the opportunities we have at our fingertips. Our survey shows that nearly 100% of health systems expect utilization to increase in the next 12 months – and that’s great news for everyone! So where should we focus our efforts and what can we expect? Undoubtedly, there are many applications for virtual care, but there’s a growing desire for it to be used for more complex conditions, with a big focus on behavioral health. However, to realize this in an effective way, we need increased collaboration between the technology companies that are creating the virtual care solutions and the health systems that are deploying them.

Regardless, the fact that we’re seeing such confidence from health systems when it comes to expanding their virtual care offerings in the coming year, signals to us that the industry is ripe for incredible growth. And it’s about time! Virtual care has long suffered from slow adoption rates, brought on by patients who were hesitant about leaving their trusted physicians and providers who were weary of expected financial and technological barriers. But virtual care doesn’t have to be scary and as our survey shows, many organizations have skewed ideas about the challenges that actually exist in the industry. To overcome this perception, we must educate patients and providers about the opportunities associated with virtual care, while continuing to focus on improving the patient experience. Though technology vendors may provide the platform, I believe, it’s with health systems, who are in a unique position to confidently vouch for the integrity of virtual care, and effectively market the service to truly increase adoption expand access to quality health care.

Interested in learning more about the On-Demand Virtual Care Benchmark Report?

We called out our key business, technology, and clinical findings, discussed what they mean for virtual care in 2019, and hosted an open discussion about the research in our latest webinar: Top Virtual Care Trends for 2019.

Get my Webinar

Under the Hood: Developing and Maintaining Clinical Content for Virtual Care

One of the big compliments we receive from customers is around the strength of our proprietary clinical content that forms the foundation of our virtual care platform. This means a lot to our team. As individuals and as an organization, we maintain a rigorous focus on clinical quality, and that comes through in our algorithms and clinical protocols.

What you don’t necessarily get to see is the amount of work and expertise that goes into developing, maintaining and improving our clinical content. We have a full team of clinicians and informatics specialists devoted exclusively to creating and maintaining our protocols and clinical content – and their contribution to the Zipnosis platform is worth talking about.

Starting off with Clinical Content Development

When we launched the Zipnosis platform, we knew that the only way the technology would work is if it was backed by unassailable clinical content. Remember, this was 2008, and nothing like the Zipnosis platform had been available before. Store-and-forward virtual care was still considered the providence of provider-to-provider care, specifically in imaging for radiology, dermatology, pathology, etc. It definitely wasn’t considered a means for collecting patient-generated symptom and health history information for diagnosis and treatment of common, low-acuity conditions.

Our original clinical content was something truly brand new in the outpatient healthcare space. We started with an enormous quantity of clinical guidelines for in-person care and painstakingly translated them into a few targeted protocols for virtual care.

From those humble beginnings, we expanded our protocol library to support diagnosing and treating more than 90 conditions. Each one required not only research into the standard of care, but a reframing of what care delivery for that particular patient complaint means without lowering the standard.

Clinical Content: Care and Feeding

Considering the extensive amount of work that goes into developing clinical protocols, you may be surprised to learn that protocol maintenance and improvement is where our clinical content team truly shines. The truth is, once a protocol is built, that’s not the end of the work it requires. Like a pet, clinical content supporting virtual care requires constant care and feeding.

At Zipnosis we have a rigorous maintenance process that includes annual content reviews, during which our content team delves into the latest research to ensure that our protocols meet the standard of care and can offer the same or greater guideline adherence as in-person care.

We also closely monitor alerts and updates from the CDC, departments of health, and the FDA to ensure that the treatment recommendations are in line with the latest guidelines. These alerts don’t always align with our protocol review schedule, so we also update protocols on an ad hoc basis when guidelines change.

Clinical Content Beyond the Standard of Care

Our clinical content is the foundation on which the entire Zipnosis platform rests. That means its importance to the quality of care providers deliver through Zipnosis is critical, but it also means that clinical content has a major impact on patient experience.

We dig into how protocols are utilized by patients and consult with our customers to identify opportunities for enhancing our content. This is a more intensive process than our annual clinical reviews, looking at how patients experience the content.

    • Is the language clear, conversational and understandable?

 

    • Are we effectively conveying empathy?

 

    • How many questions do patients have to answer at maximum and minimum? Can we reduce the number of questions?

 

    • Where are patients being referred out of the online system and into our customers’ brick-and-mortar clinics?

 

  • Do the patient education information and questions match health literacy targets?

A full protocol enhancement project takes 10 weeks, and involves the clinical content team as well as people throughout Zipnosis – and even our customers. We perform a deep dive into how patients are interacting with the content, and make modifications – sometimes minor tweaks, sometimes major overhauls – to ensure patients are having a positive experience. And, through it all, we maintain that laser focus on the standard of care.

What’s Next for Zipnosis Content

As we expand the platform into new areas like surgical care and behavioral health, our clinical team just keeps blazing new trails. And, with our Clinical Quality Advisory Council’s assistance and input, our team is even better able to monitor and report on adherence to clinical guidelines. Keep your eyes peeled – there’s always more on the horizon.

About the Authors

Dr. Lisa Ide

Lisa Ide, MD, MPH

Dr. Lisa Ide is the Chief Medical Officer at Zipnosis, where she works to ensure the Zipnosis platform meets our customers’ clinical needs. She is a veteran physician with more than 25 years of experience. Dr. Ide specializes in occupational medicine, and brings the same commitment to patient safety and quality to her work at Zipnosis as she does when treating patients at the Center for Victims of Torture.

Kevin Smith - Zipnosis Chief Clinical Officer

Kevin L. Smith, DNP, FNP, FAANP

Kevin Smith, Chief Medical Information Officer at Zipnosis, has been a leader in innovative care delivery since 1999. In both clinical practice and his doctoral studies, he has focused on innovative applications of technology, clinical decision support, and analytics to drive clinical quality improvement. Dr. Smith is adjunct faculty at the University of Minnesota School of Nursing, a Fellow of the American Association of Nurse Practitioners, and a member of the American Telemedicine Association, HIMSS, AMIA, and the National Speakers Association.

Virtual Care and the EMR: The High Cost of Free

Do you remember the healthcare world pre-EMR? Healthcare organizations from large IDNs to individual practices were swamped by stacks of paper. There were rooms filled with files, cabinets bursting with the medical histories of every patient that sought care at a given clinic.

Pre-EMR medical files

Then came computers and along with them, electronic medical record systems (aka, the EMR). And everything changed. Digitized patient records didn’t take up any space. Health systems, physician groups, and clinics were freed from the morass of paper they’d been buried in for years. And over time, the EMR evolved to be more than just a digital record storage solution. From patient portals to revenue cycle support and scheduling, EMR vendors expanded their offerings to support a wide variety of health system needs.

It’s no wonder then, that when health systems begin looking at a virtual care solution, the telemedicine module/functionality in their EMRs is often the first place they look. Many EMRs automatically include this online care delivery with the software. In fact, the main argument in favor of health systems using their EMR’s virtual care solution is that they’re already paying for the technology, so adding virtual care would essentially be free. But is it really?

Imagine this: Your health system is moving forward with launching virtual care. After reviewing your options, your team decided to build within your EMR. Like most health systems, you want to maximize your EMR investment – plus the promise of “free” virtual care technology is too good to pass up. Then you get started…

What Does “Free” Cost?

Technology

Turning on the telemedicine module in your EMR to offer virtual care is much more complicated than just flipping a switch. You will need to dedicate time and personnel to creating your virtual care service: developing the user experience and interface, creating and mapping the appropriate fields in your EMR, and ensuring the necessary integrations with scheduling, billing, etc. are in place and working properly. This means either diverting resources from other projects, adding to your technology team’s workload, or hiring – on contract or full-time.

The Cost:

  • Simply adding development to your technology team’s workload is the most cost-effective option, but it does cost the organization. Pushing off other projects incurs costs, and adding to the workload can stress employees causing an increase in absenteeism and even turnover.
  • Contracting with a certified consultant can run to hundreds per hour, and you may still need to dedicate person-hours toward development.
  • Hiring – whether contract or full-time – incurs costs in recruitment, training, and compensation.

Clinical Content

The technology side is just the first cost hurdle. Your virtual care service also needs high-quality clinical content, including patient-facing questions, algorithms, and clinical decision support – none of which is included in the EMR’s technology. Same as the technology, you have three choices for creating your clinical content: dedicate internal resources, purchase the clinical content, or hire a clinical informatics specialist – either on contract or full-time.

The Cost:

  • Even if you have a clinician with a background in informatics, finding internal resources means diverting clinical expertise away from patients. The cost of inexperience in this area could be even higher, with poorly-constructed algorithms producing the potential for quality concerns.
  • Purchasing content will, of course, incur the cost of the content, but it may also require additional time and energy from your technology and clinical team to customize it to your unique needs.
  • Hiring, again, means recruitment, training, and compensation costs.

Ongoing Investments

Building internally through your EMR means an ongoing resource commitment. You will need to regularly allocate resources for:

  • Technical support
  • Managing software updates
  • Clinical content management and updates
  • Service and technology enhancements (e.g., additional conditions, specialties, and services)

Opportunity Cost

Right now, health systems across the country – and likely in your market – are launching virtual care. According to a recent KaufmanHall study, 56% of health systems stated that developing virtual access points is a high priority, and 23% have a virtual care solution in place today. On top of which, telemedicine companies are growing their service capabilities and becoming more like complete online health systems than one-off urgent care centers. While you’re finding an EMR vendor-certified consultant, hiring IT and clinical staff to support virtual care, and actually building out all the individual, customized components of your service, these competitors are already marketing to and perhaps serving your patients.

Protecting patient relationships and retaining patients isn’t the only consideration. On the flip side, with virtual care proven to add patients to health systems, the time spent in building virtual care internally means the potential for losing new revenue. A recent white paper by Kurt Waltenbaugh, CEO of Carrot Health (and yours truly) found that approximately 25% of new patients from virtual care went on to have in-person care appointments within a health system. With the average annual revenue per new patient close to $3,000, this can add up to significant lost opportunity.

Finally, building your virtual care service within your EMR makes it much more difficult to change EMR vendors. You may not want to consider it right now, but if something occurs that causes you to change EMRs and you’ve built your virtual care, you lose your virtual care service, and all the time and money invested in building it.

Adding it all up

Back to our imaginary scenario: You’ve gone through your technology build, and you begin adding up all the costs associated with creating your virtual care service. All told, your free virtual care technology ended up taking more than a year and costing several hundred thousand dollars to build. During that time, your two biggest competitors launched online care services, and now have contracts with the major health plans and employers in your area. What’s more, your urgent care centers and clinics have seen a decrease in patients, as those services siphon visits away from your health system.

Having spent the past decade supporting health systems, I understand the temptation of the word “free.” Healthcare organizations are consistently asked to do more with fewer resources, and budgets are under heightened scrutiny. But look closely at any option billed as “free” – it may end up costing you more in the long run.

About the Author

Jon Pearce is co-founder and CEO of Zipnosis. As a healthcare entrepreneur with experience in med-tech start-ups and as a venture analyst, he is focused on leveraging the power of technology to improve the way health systems engage with and treat their patients.

The Digital Healthcare Revenue Question: Are You Blockbuster or Netflix?

When people ask me my Big Hairy Audacious Goal (BHAG) for Zipnosis, I reply: “To make the transactional cost of healthcare $0.00.” The looks I get range from quizzical to quizzical and concerned. After all, people are used to the current payment model and don’t see how Zipnosis will be able to stay in business without transactional revenue. Of course, this isn’t going to happen overnight – but the healthcare of the future is going to be paid for differently than it is today.

Remember, for a minute, Blockbuster – the prime example of a company on the wrong side of the payment and technology equation. In the Blockbuster era, renting a movie was transactional. You went to the video store, chose your movies, and paid at the counter. Until there was Netflix. Even before the advent of streaming, Netflix erased the transaction from renting movies. By selling movie rentals on a monthly subscription model, they broke the transactional payment mold and helped seal Blockbuster’s fate. The same is occurring, albeit more slowly, in healthcare.

For me, this is the most important change in the industry today – not the technology we’re developing, but the ability to help shift the pricing and reimbursement discussion away from fee-for-service and closer to value-based care delivery. And that’s really the difference between the current state (telemedicine) and the future state (virtual care) – the shift from transactions to value. This shows up in two key ways: technology and payment structure.

Transactions vs. Value: Technology

The healthcare industry has been testing out uses for Telemedicine Patient and Clinician on Tablettelemedicine for ages because it is familiar. Telemedicine feels close to our current health system/experience: I sit in front of a computer or on a phone and talk to a healthcare provider instead of in a clinic. The only difference is my location. Telemedicine technology, like video queues, call centers, and nurse line systems, have been architected to support this 1-to-1, transactional experience.

 

But the analog technology telemedicine brings can only scale so far. Just like video stores could only serve so many people, telemedicine has an upper utilization limit. If as an industry and society, we are truly committed to increasing access to care, telemedicine technology becomes a wall at which the number of visits will exceed the infrastructure’s ability to manage them.

The future is more on the Netflix model, where technology and workflow enable significantly higher volume than previously imagined. Another company that successfully harnesses technology to facilitate an unbelievable number of transactions is Amazon. Instead of building a massive call center to meet the needs of their shoppers, Amazon invested in a technology platform that can and does handle far more transactions than humanly possible. There literally are not enough people on the planet to process the transactions Amazon processes.

Similar to both Amazon and Netflix, for healthcare to move beyond transactions, it must adopt new technology platforms – like virtual care. Virtual care is designed to handle a stream of data from many devices and sources. If we want to even contemplate continuous monitoring or predictive care models, we must not just transform the back-end “big data” warehouses, but the last mile of care delivery so its actually available to patients and clinicians. To put a fine point on it, analog telemedicine technology cannot meet this need but digital virtual care platforms do.

Transactions vs. Value: Payment

The transition from fee-for-service to value-based-care is happening in very quantified ways using bundled payments. This is akin to a shift from the Blockbuster model of renting a video – if you want 10 videos you pay $5/video or $50 – to Netflix, where you’re paying a set fee and can consume as much content as you’d like. Netflix can do this because their transactional cost is effectively $0 for you to view the content – even back in the DVD subscription days.

This is where the technology and the payment intersect. You cannot have a scalable value-based care payment system using transactional telemedicine technology. Conversely, transactional fee models are not fit for most virtual care platforms; it’s like asking Netflix to charge you each time you watch The Unbreakable Kimmy Schmidt. They can’t, and why would you?

The Future of Healthcare Revenue

Which brings me back to my BHAG for Zipnosis: driving a $0.00 transactional cost for healthcare. It’s terrifying for a Blockbuster-type payment model, but manna from heaven in a value-based world. It also creates a juicy chicken and egg problem. Do the technology platforms need to be in place before the economics? Or vice versa?

Both value-based care and virtual care technology are here and growing, but I think consumer choice will be what creates the tipping point in the industry. Our research shows that most patients don’t want video visits, and we know that transactional, video-based solutions aren’t the standard of convenience in any other industry. It’s simply not the way the rest of the digital economy works.

The good news is that health systems who have a line of sight into value-based care and are bold enough to install virtual care platforms will be the Netflixes and Amazons of healthcare’s digital age.

Telemedicine Transactions Virtual Care Value
Cost: Pay per visit – high transactional costs Cost: $0.00 transactional cost – pay for value
Back End: Human processing Back End: Platform (technology) processing
Reimbursement Model: Fee-for-service payment Reimbursement Model: Value-based care models
Volume Impact: Value is in single-purpose use Volume Impact: Scalable to meet demand

About the Author

Zipnosis CEO Jon Pearce

Jon Pearce is co-founder and CEO of Zipnosis. As a healthcare entrepreneur with experience in med-tech start-ups and as a venture analyst, he is focused on leveraging the power of technology to improve the way health systems engage with and treat their patients.

The Telemedicine Switch: Taking Healthcare Delivery from Analog to Digital

When telemedicine was born, making a phone call required an operator from one of the Bells to physically switch lines in her circuit board. To buy another “line” literally meant running a phone line from that switching board to your house through the ground and air.

Analog healthcare delivery

Today, we have a “standard” of telemedicine that is still phone calls. Yes, we have video, but if the data from the industry is valid, it’s still #2 to phone calls by a long shot. (And, if you read my other posts you know that video won’t be the standard in healthcare because…well…it’s not the standard in any other industry).

Previously, I noted that it’s important to distinguish between a new healthcare experience in telemedicine and embracing telemedicine as the future. It’s true that most patients have never engaged in telemedicine (though that’s rapidly changing), so the analog still feels fresh. We perceive telemedicine as being state-of-the-art. But it’s not.

This is especially true for regulators and payers who are just now beginning to embrace alternative care models. They are tied to the mode of care that looks most like what care has always been – so a bit of an “innovation bias” still exists in the industry.

Telemedicine 2.0The trouble is that telemedicine’s DNA is the same as Blockbuster’s or Ma Bell’s: it’s analog. It’s tied to physical objects or locations, like cathode ray tubes, cords, carts, and call-centers. Improvements touted in telemedicine are higher definition screens and faster call-back times. Imagine if Steve Jobs had not released the iPhone but instead released a flip phone that simply had a faster speed-dial with a prettier display – that’s “Telemedicine 2.0.”

 

The Digital Age is Here

Unfortunately, Telemedicine’s analog DNA has reached its evolutionary pinnacle. Call-back times and call centers can only scale so far; their flawed unit economics collapse; their data silos crumble.

As digital technologies become more and more commonplace, the old telemedicine models are beginning to show their age.

Virtual Care: The Next (Digital) Frontier

Just like cell phones and WiFi are the natural digital successors to land lines and dial-up modems, we have virtual care as a digital progenitor of telemedicine. Where telemedicine grew out of hard-wired, analog telecommunications, virtual care’s roots are digital, meaning that it has almost no reliance on physical objects. Instead, virtual care is logical, device agnostic, and data-driven. Virtual care connects systems and data by nature, not exception. APIs and SDKs frolic between platforms.

What this means for healthcare cannot be understated.

The transition to virtual care will usher in wide-spread adoption by patients, it will break down data silos that muck up efficient and effective healthcare delivery, and it will uncork pent up economic innovation in the industry. This is certain – how fast this it all happens depends on, well, the switching costs.

Telemedicine = Analog Virtual Care = Digital
  • Equipment: Hardware-specific
  • Equipment: Device-agnostic
  • Connection: Call center
  • Connection: Cloud-based
  • Quality: Proprietary data
  • Quality: Standards-based
  • Integration: One-off interfaces
  • Integration: API & SDK
  • Efficiency: Limited difference from in-person
  • Efficiency: High for patient and provider

About the Author

Zipnosis CEO and virtual healthcare delivery visionary, Jon Pearce

Jon Pearce is co-founder and CEO of Zipnosis. As a healthcare entrepreneur with experience in med-tech start-ups and as a venture analyst, he is focused on leveraging the power of technology to improve the way health systems engage with and treat their patients.

So, How Does Virtual Care Fit into Your Digital Health Strategy?

No one will be shocked to hear that technology is driving the future of care delivery or that staying  current with healthcare technology is increasingly vital to organizational success. But you may be surprised at the role virtual care can play in your digital health strategy.

The Digital Health Ecosystem

Being successful in this brave, new, technology-fueled world means building a digital health ecosystem. Like an ecosystem in the natural world, all components should come together to create a seamless whole. Your digital ecosystem needs to support the overall goals of your healthcare organization, including enhanced patient access, continuity of care through EMR integration, simplifying billing and claims processes, easy patient visit scheduling, and superior patient experience through portal integration.

Having a clear digital health strategy that outlines the technologies you will employ and how they will work in concert to support the continuum of care is critical. It’s easy for health systems to become so focused the individual technology solutions, they can’t see the (digital) forest for the (virtual) trees. Without that strategy, they may not realize there’s a virtual care-shaped hole in their digital health ecosystem.

Virtual Care: The Missing Puzzle Piece

It seems myopic from today’s perspective, but virtual care was traditionally viewed as a siloed point on the care continuum. In the digital age, virtual care is a delivery channel that supports a large breadth of services – from low-acuity conditions to more complex services such as chronic care management, and from primary to specialty care.

Even better, virtual care complements other elements of the digital health ecosystem, making it stronger and more unified. Paired with ePrescribing, virtual care fosters convenient, complete treatment of a variety conditions. It can be used alongside traditional telemedicine video visits to reach more of your patient base. And, virtual care gets both patients and providers comfortable with online care, making it easier to accept digital health technology in higher-acuity situations.

Your Digital Health Strategy

Health systems need to keep pace with changing consumer needs and the shifting demands of the dynamic healthcare industry. According to research firm Gartner, 40% of primary care visits will be virtual by 2018. With direct-to-consumer telemedicine companies vying for patients and growing numbers of health systems launching virtual care solutions to meet growing patient demand, virtual care is a vital piece to your health system’s success and your overall digital health strategy. Are you ready?

Walk Before You Run: Driving Success with a Scalable Virtual Healthcare Business Model

When it’s time to pull the trigger on a new technology investment, particularly one with the potential to revolutionize care delivery in your health system, it’s tempting to shoot for the moon and include all the shiny bells and whistles. Like many large-scale improvements where change management is present, that is not always the best strategy. When developing a virtual healthcare business model, health system leaders need to balance the desire to employ the latest growth strategies with a systematic approach. A phased approach facilitates effective change management and the necessary checkpoints to support success.

Virtual Care Scalable Business Model

 

Change Starts from Within

Health systems frequently start their foray into virtual care by offering the service  internally to their employees. This strategy helps build acceptance and understanding of virtual care. It also helps get employees excited and become more knowledgeable about the service. Once your employees experience virtual care as a patient, they feel more comfortable recommending it to patients later on.

In addition to gaining buy-in from key employees, launching internally provides time to monitor the service and make any needed adjustments to the workflow. This means that when you are ready to expand to a broader population, your service is dialed in and working on all cylinders – for both patients and providers.

Grow With Confidence

After the initial phase, it’s time to grow your virtual care service by expanding your patient population. This may include current patients and/or the broader marketplace, depending on your acquisition and retention strategies as well as your regulatory environment.

This phase is the time to begin scaling your service beyond current patient population targets. Use your organizational strategy and virtual care goals to create a comprehensive growth roadmap.

Your plan may include adding employer and health plan contracts, integrating virtual care technology with internal systems, adding access points, or expanding the number and types of conditions that can be treated.

Whatever your scaling and integration plan includes, a methodical, step-by-step approach will serve you best. This supports analyzing the impact of each new addition and gives you the flexibility to make adjustments and optimize staffing to meet organizational goals.

Hit Your Stride

Being part of the virtual care revolution can be exciting – after all, you’re a pioneer on the forefront of innovative healthcare delivery. And, once you have a fully realized, mature virtual care service, innovation is the next step.

Virtual care is a rapidly evolving industry, and the sky’s the limit to its potential impact to your health system. Leading virtual care technology companies are beginning to expand into serving varied needs along the care continuum. For example, support for longitudinal care, such as chronic care management and post-operative care.

The growth and advance of technology is enabling ever-deeper systems integration, helping to eliminate silos and support greater connectivity throughout health systems. And expanding interoperability of your virtual care software is another way to be on the leading edge of healthcare information technology.

Moreover, by collaborating with your virtual care partner to offer the next generation of online care as a pilot site, beta tester or innovation partner, you give your clinicians and patients a voice in the future of care delivery.

Move at Your Own Pace – This Is Not a Sprint

Steady doesn’t necessarily mean slow. Following a phased plan for your virtual healthcare business model enables you to move as fast as makes sense for your health system. Healthcare leaders gain three main benefits from this strategic approach:

Change management: A systematic approach to launching, growing and optimizing your virtual care service can minimize the challenges that come with implementing a new service line. Effective change management relies on this type of phased approach. Being methodical and gathering information and feedback at every step will help set the stage for virtual care success.
Budget management: Launching a new service line means up-front investment – whether you’re going for traditional telemedicine access points like phone and video, or pushing into new frontiers with virtual care. Starting small, with a clear roadmap for scaling means more effective budget management, including the ability to strategically time capital investments.

Risk reduction: Innovation in healthcare is always a bit of a risk, but by starting small and scaling your virtual care service, you are mitigating the risk that comes with investing in something new. Starting small reduces risk by lowering up-front investment. And, using a documented plan to grow your service enables careful monitoring, which limits the likelihood of making an investment that doesn’t pay off.  

Find out how one leading health system successfully employed a measured approach to launching their virtual care service. Get the case study.

When it Comes to Virtual Care Technology – Think Twice, it’s Alright

More and more, health systems are looking to telemedicine and virtual care technology to improve access by connecting patients with clinicians. It’s no secret that providing care online is critical to remaining competitive and meeting patient demand. With online healthcare hitting the mainstream, health systems are moving faster than ever into the direct to consumer market. Sounds easy, right?

Don’t Get Stuck with Betamax

Let’s take a walk down memory lane to the early 80s. Video was busy killing the radio star, and two competing technologies were vying to be the king of video: VHS and Betamax. Ultimately, VHS won the videotape format wars, and Betamax technology (and tapes) disappeared from store shelves. The people who purchased Beta machines and video libraries were left with a choice: forgo video entirely until the next big technological advance comes along or purchase a whole new system and video library.

There was no real way for consumers in the post-disco era to hedge their bets about video technology. VHS and Beta were both expensive new technologies and were wholly incompatible. Fortunately, health systems moving into online care aren’t in the same boat.

Telemedicine is Today; What’s Tomorrow?

Traditional telemedicine tools, including video consultations, have been around since the 60’s, though they’ve only been available to patients for the past 10 years or so. Those tools definitely have their place. They enable patients and providers to connect in real time and are typically embraced by today’s high-value patients – people over 65 and those with chronic conditions. A recent Deloitte survey showed that those high value patients were significantly more likely to only use digital health tools to connect with their regular healthcare provider. But less than ⅓ of millennials would put the same restrictions around online care.

Similarly, baby boomers and the older members of generation X are more inclined to want a real-time, personal interaction with a healthcare provider. Overall, younger generations are less interested in a personal interaction and more interested in making the whole healthcare experience quicker and more efficient. That means that the high value patients of tomorrow aren’t as interested in video consultations or phone calls with their providers. So, how is a health system supposed to meet the needs of today’s patients and tomorrow’s?

Where do We Go from Here?

The optimal option for health systems looking to make a safe online healthcare bet is combining traditional telemedicine with transformative virtual care technology. This pairing gives health systems and their patients the best of both worlds: personal interaction through a real-time consultation and efficient virtual care. Working together, these access points create a digital “front door,” making it easy for health systems to provide the care individual patients need, when and how they need it.

Just like investing in a Beta machine was a safe bet for 1980 (it was developed by Sony, after all), investing in a traditional telemedicine solution alone is a safe bet today. It means you’ll be able to effectively help today’s patients with today’s needs. But true safety doesn’t lie exclusively in what consumers want right now – the safest choice is preparing for what they’ll want tomorrow, too.

Best Practices Guide to Virtual Care

5 Unexpected Benefits Integration Brings to Your Virtual Care Service

Offering virtual care is a great way to meet market demand and attract new patients. But to get the most out of your virtual care service, integration with your internal IT systems is a must. Benefits of integration, like enhancing the value of your patient portal and ensuring continuity of care, are just the tip of the iceberg. Choosing a virtual care partner who offers advanced integration with your internal IT systems can bring you some surprising advantages.

1.  Enhance patient experience

Patient experience is a major focus in healthcare these days. Health systems are launching virtual care services in an attempt to improve patient experience, but when the virtual care experience is disconnected from other care delivery systems, this goal is hard to attain. Integrating virtual care with your patient portal and EHR, however, can tie a virtual care offering to patient experience objectives.

    • A CCDA integration with your EHR can help make the online adaptive interview more personalized by accessing information from the patient health record, including medication allergies and health history.
  • Offering single sign-on (SSO) from the patient portal to your virtual care service means patients experience a seamless handoff when moving between these systems

2.  Improve patient retention

The healthcare landscape is becoming more competitive, and patients are making healthcare purchasing decisions differently. This combination means that healthcare consumers are increasingly likely to seek care outside of their primary care provider or medical home. Offering virtual care can help attract and retain these patients, and integrating with your patient portal through SSO can foster closer ties with your health system. Integrating with your appointment scheduling system can help prevent patients from seeking care elsewhere by making scheduling follow-up care or other appointments quick and easy.

3.  Seamlessly transition between virtual and in-person care

Systems integration can help marry the virtual visit with in-clinic services. Integrating your virtual care platform with your patient scheduling system, as well as with systems like labs, can help fit virtual care into the overall care continuum. Pairing virtual visits with in-clinic services can also increase the number of conditions your health system can safely treat through your virtual care platform. Start by pairing virtual visits with in-clinic services such as lab testing or imaging, and grow your virtual care service by incorporating follow-up care or referrals. Our ZipTicket® workflow and integration with lab systems brings the virtual visit and in-clinic services together in a process that saves patients time and adds depth to clients’ virtual care services.

4.  Reduce physician time spent on EHR data entry

Let’s face it, your health system has spent good money on your EHR system. But recent studies show it’s eating into patient interactions and physicians’ personal time, and that EHR-related data entry is a major cause of physician burnout. Effective integration, however, can reduce time spent entering data into the EHR. A standard EHR integration with a store-and-forward virtual care platform like Zipnosis can map information from the virtual visit directly to the EMR, eliminating the need for double documentation. Advanced integrations can take things even further. HL7 and other EHR integration options can create patient records in the EHR, eliminating the need to create a new record when the patient comes in for an office visit. And, by pairing EHR integration with certain patient scheduling integrations, your health system can add an adaptive interview to the front end of an office visit. This provides the clinician with a structured clinical note already added to the EHR, giving them more time to interact with the patient and minimizing the amount of data entry necessary per visit.

5.  Get ready for the future

Moving forward, consumer driven data from wearables and the “internet of things” is going to inform health decisions – both from a patient and provider standpoint. The healthcare industry is poised to see numerous benefits from this transition, according to a recent CIO article. However, flexibility and communication are going to be increasingly important to reaping these benefits, particularly as technology moves forward. Effective integration between virtual care and your IT systems can tighten workflows, improve communication and give your health system the foundation to adapt as your patients further embed technology in their lives.

Put integration to work for you

At Zipnosis, we offer advanced integration options to effectively connect your existing systems with our leading-edge virtual care platform. We interoperate effectively with any EHR, and offer advanced options including:

    • HL7 integration, covering use cases for patient registration, transcriptions, billing, results, and more
    • CCDA integration with your EHR provides a more streamlined workflow and personalized adaptive interview
    • Advanced EHR integrations reduce the need for double documentation, since information is securely transferred from one system to another
    • Single sign-on (SSO) – both patient and provider portal options offer a more seamless experience
    • Integration with your patient scheduling system removes barriers to care and ties patients more closely to your health system
  • ZipTicket effectively provides service continuity between virtual visits and in-clinic services, increasing the number and type of conditions your virtual care platform can address

Check out our Best Practices Guide to Virtual Care

Launching Virtual Care: Myth vs. Reality

If you are interested in launching a virtual care service, you are not alone. While market estimates vary, one thing all analysts agree on is that virtual care, also known as telemedicine, is growing rapidly and will continue to do so for the foreseeable future. This growth – past, current and anticipated – has flooded the marketplace with companies that offer telemedicine services, as well as three big myths related to launching a virtual care service.

Myth: We don’t have the clinical capacity to support virtual care.

Reality: You can manage thousands of virtual visits annually with your current staffing.

Outsourcing may initially seem appealing, but with external clinicians serving your patients, you lose control over clinical quality and may experience greater patient leakage. By leveraging marginal capacity through a virtual care platform, you can actually increase the number of patients treatable by your current clinical staff.

Myth: If you build it, patients will come.

Reality: Virtual care is a service, not a technology.

If you build in-house, you’ll have ultimate control. But that comes at a premium cost and with significant time investment. And, you don’t have any guarantees that the tool you build will match patients’ needs and expectations.

Myth: Embedding virtual care in our organization will be too hard.

Reality: Integrating virtual care takes as little as 60 days.

Buying a virtual care platform offers a middle road for cost and control, and the software as a service model makes for a quick launch. By starting small, securing organizational buy-in and scaling appropriately, you can grow your service to meet additional patient needs and maximize clinical efficiency.

Balancing the costs and rewards of your options can be challenging. How is a health system to decide what model of virtual care is best for them?

Start by checking out our ebook To Outsource, to Build or to Buy? for valuable information that will help get you started on the path best suited to your health system.

Killing the Video Myth

There’s a pervasive myth in the telemedicine space that video might be necessary for effective virtual treatment of patients – for any condition. Proponents argue that there’s no way clinicians can fully understand a patient and provide a diagnosis without a face-to-face interaction, even if that interaction is digital. This is simply not true.

Virtual care using adaptive online interview technology gives clinicians the ability to effectively diagnose and treat patients without a video encounter. How effectively? A Zipnosis review of more than 1,700 virtual encounters for sinusitis found that clinicians provided guideline-adherent care in 95.4 percent of cases.

Sometimes called asynchronous visits or “store-and-forward,” adaptive online interviews offer the patient benefits of convenience and access, while providing high levels of clinical quality, efficient diagnoses and a streamlined provider workflow.

What is an Adaptive Online Interview, really?

Maybe it’s best to start by stating what an adaptive interview isn’t. An adaptive online interview isn’t an online questionnaire like the Epic toolkit provides. Rather, it is a powerful expert system that uses branching logic to intelligently interview a patient about their symptoms. This smart approach asks patients only relevant questions determined by demographic information and previous responses, just like an interview with a provider during an inpatient visit.

Zipnosis Online Adaptive Interview

Adaptive online interview (also called structured asynchronous or store-and-forward) collects patient data and sends electronically to the provider.

What’s so Great About the Adaptive Online Interview?

On the Zipnosis platform, we leverage the adaptive online interview to gather patient-entered information in a structured and efficient way. Our adaptive online interview asks the same questions a clinician would ask during  in-person visit – but never forgets a question. The information collected is packaged into a comprehensive clinical note and sent to the clinician for diagnosis and treatment. The result is a totally digital diagnosis and treatment process. Unlike any other platform on the market, Zipnosis unlocks immense benefits:

Time savings: On average, patients complete their adaptive online interview in a fraction of the time taken by an in-person visit. No travel time, no waiting rooms – just convenient access anywhere, anytime.

Clinical quality: The adaptive online interview is grounded in clinical best practices, and the Zipnosis platform leverages patient responses and clinical guidelines to offer clinical decision support, including curated diagnosis and treatment pathways. This helps clinicians provide high quality, guideline-adherent care.

Clinical efficiency: On average, providers trained on the Zipnosis platform can review the provided clinical note and make a diagnosis and treatment recommendation in approximately 2 minutes. And patients typically receive diagnosis and treatment recommendations within an hour of completing their virtual visit.

Provider experience: Providers appreciate the comprehensive information provided, the ease of use and the ability to focus their time on patients with more complex needs, while still offering high quality care for common conditions.

Reporting and analytics: The adaptive online interview model captures a great deal of visit and program data. Using our Statnosis™ reporting and analytics tool, health systems can follow trends related to conditions treated, visit timing, guideline adherence, and triaged patients. All data is de-identified and HIPAA compliant.

But Don’t I Need Video?

Short answer: maybe. But the efficiencies of virtual care are best realized when tasks are shifted from the clinician to the patient. Leading health systems understand this and leverage the adaptive online interview in concert with video to reap the benefits of clinical quality and efficiency while meeting patient or regulatory needs. And with Zipnosis’ intelligent video capabilities, you can, in fact, have it all.

Some health systems incorporate video as an additional step to help treat some patients that would otherwise be triaged to physical locations. Others operate in a regulatory environment that requires video; they leverage the adaptive interview on the front end of the encounter to help save time for both clinicians and patients. Still others choose to launch an adaptive online interview platform alongside their existing video telemedicine service as an additional entry point to their system.

As for video alone? Well, our CEO Jon Pearce says it best: “When’s the last time you ordered something from Amazon with a video call?”

So, what you’re saying is…

Whether employed alone or alongside a video or telephone encounter, adaptive online interview technology offers both patients and providers a quicker, more effective diagnosis and treatment option. Adaptive online interview technology is the future of virtual care; welcome to the future.

Shopping the System by Zipnosis

Can Virtual Care Reverse Clerical Burden Induced Physician Burnout?

The healthcare industry is faced with a crisis: physician burnout. An article in the September/October edition of Family Practice Management labeled physician burnout an “epidemic.” And this epidemic is costing health systems in a major way.

Physicians experiencing burnout are less engaged, leading to higher levels of turnover and an increased likelihood of medical errors – both of which can dramatically affect a health system’s bottom line. Moreover, burnout may lead to increased substance abuse, depression and suicide among medical professionals.

While there is no one single cause of burnout, recent research published in Mayo Clinic Proceedings indicates a correlation between use of EHR/EMR systems and physician burnout. Mirroring findings from a report issued in 2013, this new research indicates that things have not improved over the past several years.

The link between EHR/EMR systems and physician burnout is the amount of time spent on administrative or clerical tasks, such as data entry. The more time physicians are required to spend entering data into their EMR, the lower their job satisfaction and the higher their likelihood of burnout.

Traditional Telemedicine Falls Short

Traditional telemedicine, where physicians interact with patients via telephone or video chat, doesn’t lessen the burden of data entry. Physicians must still spend significant time on documenting the encounter. This type of telemedicine service requires a physician be waiting at a computer terminal for a patient to request a virtual visit. Consequently, physicians supporting telemedicine may be tasked with additional clerical or administrative work to fill the time between patient calls.

Far from lessening administrative burden, this may actually put greater strain on clinicians who support a direct-to-video telemedicine service.

Technology May Still be the Answer

While traditional telemedicine doesn’t offer a solution to physicians’ ever-growing list of administrative tasks, technology applications can still offer some respite. QuantidaMD, a community and educational resource for physicians, suggests that mobile health and virtual care might offer a solution to combat burnout. They indicate that technology can empower patients to take control of their health, as well as offering physicians simple means of capturing patient data.

Mobile health (mHealth) and virtual care have the potential to significantly decrease the amount of data entry required of physicians. In a recent whitepaper on mobile technology, Athena Health noted that mobile devices and apps can help optimize clinical workflows and patient care through clinical decision support, enhancing clinical efficiency, and providing tools for engaging patients and supporting population health.

So, How Does that Work in Practice?

At Zipnosis, we view virtual care technology as a means to meet patient needs while making life easier for physicians. We leverage an online adaptive interview, which asks the same questions a clinician would and records patient responses. Clinicians then receive a comprehensive clinical note, along with clinical decision support in the form of curated diagnosis and treatment options. Physicians can diagnose and prescribe treatment for common conditions with just a few taps on their smartphone or tablet.

The best part? All data from the virtual visit is securely transmitted to the health system for inclusion in the EMR, eliminating the need for physicians to spend their time entering information into an EMR. And, we offer health systems deeper integration options, which can further simplify the process and enhance physician experience.

People don’t seek out a career in medicine because they want to spend hours each day on data entry. Rather, they want to solve problems and help patients. At Zipnosis, our goal is to offer innovative access to mainstream medicine, while easing the burden on providers. We’re gratified to find that our obsessive focus on ease of use has created a platform that can help address this growing cause of physician burnout.

A Step in the Right Direction – New AMA Policies Will Benefit Virtual Care Telemedicine

The virtual care and telemedicine industry is evolving quickly. Over the past several years, we’ve seen major shifts in how care is delivered, increased adoption by both health systems and healthcare consumers, and a number of new companies entering the market. And these shifts are just the beginning. It’s vital we remain focused on how to manage what is coming next – because it’s coming quickly.

At their most recent meeting, the American Medical Association (AMA) addressed the telemedicine industry with new ethical guidance on telehealth and telemedicine, recommendations for including telemedicine training in medical school and residency programs, and a promise to advocate for parity laws that require insurance to cover telemedicine and virtual care services.

We believe these guidelines are a step in the right direction, and offer a jumping-off point for moving virtual care telemedicine forward.

Ethical Guidance

These guidelines are aimed at bringing consistency in quality care delivery to virtual care. As noted in our recent industry call to action, there are some serious issues facing our industry – not the least, a huge gap in quality reporting standards.

Key elements of the AMA’s ethical guidance included informing patients  of the limitations of services provided, advising them on how to arrange follow-up care, and encouraging them to inform their primary care doctor when they engage with a telemedicine provider.

What does this mean? Well for one, physicians can leverage the AMA’s guidance to help them determine whether a diagnostic evaluation and prescribing therapy through telemedicine technology is viable and appropriate. It also provides a clear set of industry standards that can help health systems effectively evaluate vendors as they seek to launch a virtual care service. A definite step in the right direction.

Training

Health systems count on undergraduate and graduate schools, as well as residency programs, to ensure new clinicians have the tools and skills necessary to care for patients. Increasingly, this means use of technology, including virtual care and telemedicine solutions. It is a very welcome development that the AMA is now calling  for greater incorporation of technology training in these programs. With greater knowledge and understanding of virtual care, new clinicians will be well positioned to help health systems take the necessary steps to meet patients’ evolving needs.

Insurance Parity

Lack of reimbursement for virtual care and telemedicine services is often listed as one of the prime barriers to greater adoption. We’ve been advocating for parity for years as we seek to help our clients offer virtual care telemedicine to their patients. While more than half of states have laws requiring insurers to reimburse telemedicine-delivered services, the reimbursement landscape is still disjointed.

The AMA’s promise to advocate for insurance parity can help even the playing field and bring greater consistency to reimbursement from state to state. In support of insurance parity, the AMA said it would develop model legislation to achieve parity at the state level and work with state medical boards to draft model state legislation defining telemedicine for inclusion in state-level medical practice laws and regulations.

Going Forward

Virtual care and telemedicine continue to be the future of healthcare delivery. This forward-thinking gives our industry the guidance it needs now, and the long-term support to continue our current trajectory.

From bringing consistency and standardization to quality of care in the telemedicine industry, to giving the next generation of clinicians the tools they need to effectively navigate virtual care, to leveling the playing field to enhance access to virtual care and telemedicine services. We applaud the steps taken by the AMA, and are excited to be part of building the future of the virtual care industry using the foundation they’ve provided. And we hope our industry peers and the AMA will join us in leveraging evidence-based policy in this process.

Do You Have to Sacrifice Clinical Quality for Convenience?

People are busy these days. And making a trip to the doctor either eats into working hours or free time. That’s why patients are demanding alternatives to the ways they access care.

This demand has forced health systems to take a leap of faith and offer telemedicine services. Some of which are based on outsourced clinical support. But can health systems depend on outsourced telemedicine vendors to provide quality care that adheres to national best practices? Can patients be certain the diagnoses and treatments they receive are accurate and clinically adherent?

JAMA Study Finds Guideline Adherence in Live Video Visits Spotty

Capturing quality metrics for the telemedicine space has been tricky. But researchers at the University of California at San Francisco decided to try anyway. They evaluated the care provided by eight telemedicine vendors against national best practices. It should be noted that Zipnosis was not part of the study.

Results of this 2-year study were published in the May edition of JAMA Internal Medicine, and were not encouraging. Over the 599 virtual visits studied, adherence to national best practice protocols for care ranged from 34.4 to 66.1 percent. The variation range increased for treatment of viral pharyngitis and acute rhinosinusitis (sinusitis), with clinicians adhering to guidelines anywhere from 12.8 percent to 82.1 percent of the time.

So, what did all eight of the companies evaluated have in common? All were direct-to-consumer telemedicine providers that exclusively use synchronous – or live – video technology, apparently lacking the use of effective clinical decision support tools to ensure guideline adherence, to treat patients.

Convenience without Compromise

While the results of this study don’t bode well for outsourced and direct-to-consumer telemedicine vendors that rely primarily on video, high quality virtual care is within reach. An internal review of more than 1,700 asynchronous patient encounters through two major health systems for treatment of acute sinusitis on the Zipnosis platform had contrasting results to the JAMA study – a guideline adherence rate of 95 percent.

The backbone of this success is the adaptive online interview embedded within the Zipnosis platform, which guides patients through a structured interview grounded in evidence-based national best practices. Once the interview is complete, clinicians receive a comprehensive clinical note and are then guided through curated diagnosis and treatment options based on patient inputs – the final diagnosis is issued by a local provider, not an outsourced clinician.

The whole process leaves little room for error; harried clinicians won’t miss a question and organically designed clinical decision support means patients get the right care quickly and consistently. Best of all, since Zipnosis’ partners use their own clinicians, they can directly monitor and improve clinical quality without the hassle of working through a 3rd party clinical team.

Patients are demanding more convenient access to healthcare. The data is clear: Traditional, direct-to-consumer, outsourced telemedicine services that address patient convenience face challenges in the area of clinical quality. In the absence of a better alternative, this would be fine. But it is time to stop compromising and expect virtual care to improve access and quality at the same time. At least, that’s what we believe and are proving here at Zipnosis.  

The String Theory of Telemedicine

Like a tangled ball of string, telemedicine can endlessly fascinate. It can improve care access – anyone from anywhere can see a physician. It can reduce care costs – how expensive can it be to Skype your doctor? It can be used to diagnose and treat your health problems – everything from your sinus infection to your Type I diabetes. It can even be used to talk doc-to-doc – care coordination solved. What can’t telemedicine do!?

The boundless enthusiasm reminds me of the great Monty Python skit about an advertiser brainstorming a marketing campaign to sell 122,000 miles of string in three-inch pieces. It’s waterproof! Rust proof! Low calorie! It can tie up very small parcels! It kills 99 percent of known household pests! It’s got a million uses!!!

 

The Quest for the Holy Grail

In reality, the implementation of a successful telemedicine strategy is a lot more tangled than that – think string theory in Quantum Physics not ball of string and cuddly kitten. What we perceive as promising answers to critical healthcare problems actually lead to other universes with new challenges to contemplate. It’s easy to get lost in the complexity, as practical applications with solid ROI remain elusive.

Telemedicine has been a tantalizing goal for about 60 years, ever since scientists in the space program first debated ways to diagnose and treat astronauts. Since then, not much has changed in the thinking behind the idea, so why the excitement now? Information technology, of course, is the new space program. Picture quality and bandwidth have advanced light years. We can FaceTime with Grandma whenever we want so why can’t we televisit with the family pediatrician? If Netflix can predict what we want to watch and how, why can’t a hospital help us avoid the ER when we know our child has strep?

Marketing claims made within the industry are propagating those easy parallels without being straightforward about the complexities or actual benefits. It’s got a million uses!!! Lacking a practical business model, video-only telemedicine services don’t come close to meeting the everyday needs of patients and the efficiency and financial challenges of clinicians and providers. Pushing video as a stand-alone solution is like selling three-inch pieces of string and promising the world.

What’s missing is a clear understanding of value.

 

And Now For Something Completely Different

Telemedicine, like any other healthcare service, is not a cure-all but a commodity. It has its uses but it’s a tool to be leveraged not an answer in and of itself.

Patients don’t care about access; they value convenience and ease. How convenient would it be to shop on Amazon by video conference?

Clinicians don’t want to spend time engaging patients on-screen the same way they do in person. They want quick, digitized interactions that focus on care and decrease hassle, data entry, and time wastage.

Provider organizations don’t want an IT strategy that drives up user numbers without bolstering revenue. They want channels to new customers, a more competitive value proposition for current patients and clinicians, and meaningful gains in cost reduction and workflow efficiency.

So why let video-only rule?

Adaptive online interviews allow patients to make health queries and enter information when it’s convenient for them, not for providers or clinicians – think in-between meetings or in the minivan, not in the waiting room.

Evidence-based algorithms can determine when it’s necessary for a patient to see a clinician in person, or when an e-scrip or video consultation are better options.

Text alerts and EMR messages can let busy clinicians know when a patient is ready for a video visit and give them all the patient information they need exactly when they need it.

Video, in other words, should just be one part of a larger platform of solutions that creates actual value for patients and clinicians while driving solid ROI for providers.

The next time yet another telemedicine startup describes its video solutions, ask about the whole ball of yarn, not just the three-inch piece.

Whom do you trust: Online symptom checkers or real clinicians?

Jul 17, 2015 – A headline from NPR this week gave me pause: “Online Symptom Checkers Can’t Replace the Real-Life Doc Just yet.” How do patients use symptom checker apps and do these apps fit within the broad landscape of telemedicine?

The article discussed research about the efficacy of these applications, “Researchers tested 23 online symptom checkers and found that the correct diagnosis was provided first on a list of potential illnesses only about a third of the time. That means symptom checkers are spitting out wrong diagnoses two-thirds of the time.”

The fundamental problem with this is that the researchers (and perhaps patients as well) are mistakenly equating the notion of checking symptoms with arriving at a diagnosis – something symptom checkers were simply not designed to do. Symptom checker apps may provide helpful information to a patient, but they are not designed to provide a diagnosis or care – and they are not telemedicine.

Unlike simple symptom checkers, a virtual care (telemedicine) visit offers patients both a means to review their symptoms as well as a way to potentially receive both a diagnosis and treatment plan that is based on medical evidence and provided by a trained clinician.

A  Zipnosis virtual visit starts with the patient’s concerns about what might be wrong. From there, the application leads the patient through a series of questions about symptoms and past history. The flow of questions adapts based on the information the patient provides. Once the interview is complete, a summary is reviewed by a real clinician practicing at a local health system. The key is that it is a real live clinician, not the software, who makes the diagnosis and recommends a treatment plan.

The entire process is grounded in evidence-based medicine and complies with national best-practice guidelines.  If at any point the patient provides information indicating a serious illness, Zipnosis will determine that virtual care is not appropriate and direct the patient to the most appropriate level of care. For example, if a patient believes she/he has a sinus infection and also indicates a fever of 103, the Zipnosis platform will stop the virtual visit and recommend an appropriate in-person site, such as the health system’s urgent care clinic.

Symptom checkers may have their place. Like Wikipedia, they bring together a wide range of information for quick review. They may help someone make a decision to wait or to seek help from a clinician. However, as with Wikipedia, the information offered is best evaluated with a very large  grain of salt.

For patients who have questions about the significance of their symptoms, virtual care visits go beyond just checking symptoms to provide real care by trusted clinicians.

Dr. Rebecca Hafner-Fogarty
Chief Medical Officer
Zipnosis