Why Healthcare Needs To Focus On Best Of Breed Rather Than A Single System

Focus

Imagine having to only use one particular tool to run your life consistently, while this may sound bizarre it almost shackles the healthcare industry. Granted we can get into talking about scale and needs however in this post I would like to talk more about how we can, and should be, utilizing best of breed software, vendors and technology for everything we do in healthcare. 

It pays homage to the old ad-age “No one gets fired for hiring _____.” However while big-likes-big this way of thinking is also the fastest way that gets you in-trouble, makes you vulnerable to disruption and does not allow you to be nimble.

While the effect may not be felt right away, it will be, just think of Kodak, BlackBerry and Sears just to name a few companies.

Unrealistic value proposition

One product that does everything, if someone came and told you that today you would tell them that is unrealistic, not only because historically this has been proven true but also because it is.

The stark reality is it is a very unrealistic value proposition that one single tool will do everything you need. Generally you will always find that one tool does one or two things really good, regardless of all its other claims of what it does; and furthermore if that one tool does not do the one job it is supposed to do well then it does not matter how many other jobs it does well.

As an analogy think of the iPhone, when it came out it came out to solve a problem. The PDA market was largely saturated but they most failed to either be a phone really well or be a PDA really well. BlackBerry almost had it right with everything but the iPhone focused on the consumer in all of us.

New technologies

It is hard enough to keep up the pace with changing technology and even if you don’t want to be on the bleeding edge there is a constant change in technology that will cause you to rethink every tool you have. 

Often times though in healthcare we are stuck to one tool that does many things and are initial reaction is “we already have XYZ” which does that. What we fail to realize is what the differences are between the tools.

An iPhone is the same as an Android, after all they are both phones right? Yet there is a stark difference between the two and we as healthcare executives need to apply that same methodology when we look at new technologies.

Staying Nimble

Why is any of this important? It is only important if you want to move forward rather than be maintaining the position you are in and fending for it while others are either passing by or trying to take over your position.

 Staying nimble will allow you to innovate and make micro moves that make macro waves.

Why Your Operations Team Needs To Spend Time On Innovation

Innovation Spend

One of the biggest challenges in healthcare, actually with almost any business, is working with and relating to others; which we happily call leadership.

Some leadership challenges are created because of external factors, interpersonal relating and company dynamics. However some leadership challenges are self-created.

Case in point is operations and innovations. Often a team that is focused on day-to-day operations is the last team you would tap in order to spend on innovations. Instead companies bring in other teams, which creates a massive divide between operations and innovations even though they can help fuel innovation faster than it would on its own if properly aligned and led.

Innovation-Divide

They know the existing challenges

You should always involve your operations team in innovation, and give them time to actually work on those innovations. In the software development a popular method is 20% time whereby a developer will spend 20% of their time on innovative and new projects to help keep their skills sharp but also help propel their team and company forward.

This is key as the same team operating the day-to-day to keep your trains running on time really understands the challenges they face and often have thoughts about how they can be addressed. But even if they don’t, being able to articulate the challenge to a team that can innovate is extremely important, it is half the battle of coming up for a solution.

They have ideas to fix it

More often than not your operations team has solutions, even more astonishing they probably have already developed work arounds for those challenges they have and are either just unaware they can be resolved, don’t have time to resolve them or feel that they will not be heard if they voice those challenges.

Make no mistake though a work around is NOT a fix or a solution; it may be a great stop-gap temporarily but long term you leave the organization exposed.

These work arounds though are helpful to any team innovating and more often than none can lead to a solution that not only solves that challenge but sheds light on the real challenge at hand.

They have access to the tools

One of the largest areas where innovation teams clash with operations is getting access to tools, data and applications they need. Often the operating team will push back stating they require a project plan, and what if something goes wrong, or if they accidentally mess things up.

At first these concerns can be seen as a way to sabotage a project however a different perspective is that they are truly concerned about the challenges they have. If a system already has stability issues, or if they have had challenges with it in the past and they know all the work arounds and fixes for it however this new incoming team has no knowledge of that.

This comes back to leadership and how the groups came together, this can be avoided if both teams know what each is working on, and both involved, then they will move as a united team.

They know what success looks like

This is perhaps the most important part of the entire article. Your operations team knows exactly what success looks like and can help articulate that to both your senior management, internal teams and even the innovation team.

In order to actually achieve this you must lead your team properly through the transition, and involve them in innovation from day one.

Why Healthcare Should Look To Other Industries For Answers

Similar

True or false? There are no two similar snow flakes. (keep reading to find the answer)

Healthcare is a rewarding field to work in, our work directly effects lives and families. It is very easy to trace your work in healthcare and see how it improves others lives.

However when it comes to technology we often try to think that our own solutions are unique and can’t be addressed by any other means. While it is true we have very unique circumstances in healthcare from how we use data to how we input it to the uniqueness of each client and system, the reality is we can learn from other industries to solve 90% of our own technology shortcomings, the last 10% is what make healthcare rewarding.

Similaritiesa-1

It has been done before

The fact of the matter is most challenges in healthcare IT have been seen before in other industries and those industries came out with solutions to address them. Here are just a few examples:

  • Interfaces: In healthcare we got more interfaces than you can shake a stick at, and the other industries have responded with APIs, yes they don’t solve for every data type but it solves for a standard structure we can work with, that is half the battle
  • Data Storage: We have lots of data, especially lab data, and in other industries the answer for this created Hadoop and a file store meant to handle large amounts of data (think Facebook)
  • Software: In healthcare we still largely rely on one or two systems to run our workflows, in other industries this has ben decentralized and they are able to use the best of breed software for each scenario while still keeping data in sync, all the systems work in harmony together
  • Architecture: In healthcare we still rely on a point to point rather than a Service Oriented Architecture which promotes the ability to be able to scale software and data as well as make it readily available much faster

Learning from others mistakes

The best part about looking to other industries is not really about finding solutions it is more actually about finding out what their mistakes were.

See we are unique in healthcare and we will have different things to overcome than say another industry but the mistakes are more valuable than the success they had.

The mistakes can help us see our own pitfalls as we design and build systems so that five years later we are not stuck by our own decisions.

This allows us to make solutions that address challenges and not solutions trying to find challenges.

Creative ideas to solve simple challenges

Some of the most heavily relied on technologies today (think: Hadoop, React, Cassandra, Node, etc..) were actually built to solve real-world challenges. In the business world sometimes we end up building software and then find a challenge it solves; however for software engineers this is rarely the case.

You see software engineers 99% of the time build software to ADDRESS a challenge, not because they are trying to find one. Which leads almost every innovation to creating a solution that addresses those challenges.

For instance Oracle database was sold on a business level before it was engineered however engineering had to create relational databases to solve their own challenge.

This leaves a trail of creative ideas that we can learn from.

We are not unique and where we are

The answer to our trivia question earlier is: False. In 1988 Nancy Knight (USA), a scientist at the National Center for Atmosphere Research in Boulder, Colorado, USA, found two similar snowflakes.

If snowflakes can have identical then perhaps in healthcare there are similarities and lessons we can learn from other industries. Not just in software but also in business and operations.

We often diminish engineers in healthcare as not understanding our business and tell them to first shadow doctors and work in the system before trying to come up with solutions; the same should also hold true for doctors and those who work in healthcare, this is not the only way to solve a challenge, we must look into other industries.

Your Analytics Software Is Creating Another Silo

Data Silo

In healthcare the current hottest trend we see is analytics software that seems to have the promise to do it all. Often times Integration Engines, HIEs and Population Health Management is also thrown into the mix to confuse things even more. Regardless of which you are looking at, we are going to call these “Analytics” software.

Don’t get us wrong we are not against any analytics software, however we are against the case for yet another silo to be created, but this can be managed!

The Value of Analytics

Analytics comes in many flavors, and this post is in no means meant as a comprehensive cover of such. You have everything from Machine Learning, AI to specific needs such as SEPSIS or HEIDS measures.

The value for analytics is broad and will largely depend on your needs as well as outcomes you are looking to resolve, which is exactly what it is intended for.

The Shortcoming

However that being said there are a few challenges with analytics as they stand today and ideally you want to avoid making these mistakes as they cost time and money down the road. The major shortcomings are:

  • Since there are so many options and each one takes a major integration effort to address, its hard to pick the right analytics software
  • All of them create another silo for your data, but they have to in order to provide value to your organization

Mind The Silo

In order for analytics to function most data needs to be transformed into whatever the solution requires in order to produce the results you need. This creates a silo for your data because the data goes in as one format and only to be stuck in another, the output is merely the process of that system.

This may sound okay, where it is not okay is that then we try to use that data for other things. Such as connecting an HL7 interface, or passing along data; which many of these systems will tell you they can do.

On the surface this all works well, however as you dig down to creating near-real-time data exchanges or try to do high volume transactions you will begin to run into a lot of issues, and in the process you have created yet another dead end silo for your data.

How A Platform Helps

This is where a platform that helps direct your data in near-real-time really can show its true benefit. First and foremost it solves for the issue of which to choose. You can easily pilot 2 or 3 software systems at the same time without adding resource needs as the platform can easily manage and direct data to each system using proper security controls.

While you are still creating another data silo, you are not dependent on that one. Meaning the software can do what it does best then you can take that output and put it back into the platform to provide a full view of your data.

Interoperability — a problem or a solution in healthcare? Maybe it’s both

Imagine that you, your doctor, your data and the clinic’s software are all connected and communicating in perfect harmony. That’s interoperability at its best. But interoperability is complicated. While it has the ability to streamline healthcare when functioning correctly, it remains one of the industry’s biggest hurdles to overcome. I’ll try to explain why.

What it is

If we want to get technical, however, interoperability is defined as “the ability of computer systems or software to exchange and make use of information.” There are two important parts here — 1) to exchange, and 2) to make use of.

Let’s look at the exchange part first. The issue of data exchanges is so paramount in certain industries, including healthcare, that there are actually boards and foundations created and dedicated fully to matters surrounding it, including the upholding of standards. But what’s fascinating about healthcare is that in this industry a consensus has yet to be reached regarding what those standards should be — and the standards that do exist can be left for interpretation of what can be implemented.

Why this matters to you

Let me put it in a way we can all relate to. Let’s say you get sick (hopefully that doesn’t happen to you) and have to go to the doctor. You fill out a lot of paperwork, then spend time in a room with the doctor and probably a computer, where he or she documents everything. And you don’t get a copy of any of the information, it just goes somewhere. Next, maybe you need to see a specialist as a follow-up to this visit. This second doctor asks you to fill out all the same information and report everything that happened at your last doctor’s appointment. So either you have to try to remember all the details, or perhaps they call your first doctor to get the information, which can take time.

Can you imagine if this were how ATMs worked? It would look something like this: You go to your bank and make a deposit. Then you go to an ATM to get money and it asks you to sign up for a bank account. Then a representative has to call your other bank to get verification before you can get your hands on your money — and you can consider yourself lucky if they can do it on the spot. Can you imagine doing this for every single ATM transaction?

Parents with chronically sick children have figured out the workaround to this. Maybe you’ve seen or even been one of those parents who resolves to carrying around a binder containing their child’s medical information. They’re trying to keep all the records organized and at the ready, so they can share them with doctors at a moment’s notice. How did it come to this? To answer that question, we must first look back.

The first medical records

In the beginning, there were manila folders. (Ah, the age before computers …) In some ways, that system was simpler than what we have today, but in other ways, it’s far more complicated, insecure, unsearchable and unusable.

Prior to 1900, there were actually no medical standards for keeping records about patients. And with the rise of hospitals and medical education in the second half of the 19th century, we began seeing official medical records as hospitals started keeping ledgers. By 1960 or so, computers were playing a role in the medical field, standardizing the storing and sharing of medical records.

What really changed things was U.S. Congress’ new Health Insurance Portability and Accountability Act (HIPAA) (1996), which required standards for electronic medical records (well, sort of). And of course, no one can forget Obamacare, which launched in 2010 and introduced new reporting requirements.

Great, so we have standards now, right? Well, not exactly. You see, those laws aren’t about standards, they’re about reporting.

The challenges

So we transitioned from manila folders to software. But all the software did was make the folders and information inside them electronic. I don’t want to downplay the value of these systems, however, the simple fact is that today that software is all about recording, reporting and billing. The next challenge will be to ensure the information is input in a way that is totally standardized and reliable.

That challenge involves more than just elements related to human error, including:

Software innovation: When you make a product you ultimately need to create a competitive edge; the way that was done 50 years ago is different than the way we would like to see it done today. It used to be OK to create things that ultimately created “black boxes” of sorts. Now I won’t say that was the intention of the software makers, just the time in history — after all, you were often the only player or one of a few players. However, today we are all about a sharing economy and working with each other — think Airbnb, Uber and Postmates.

Standards: There has been no adoption of any single standard — and most standards have variations in them and are left for interpretation of the user to do it as they see fit — the farthest and most standard two that are used and have consistency are HL7 and CCDA — unfortunately it requires more work than a simple login to get your records and each vendor has to integrate each interface (the way data is sent) separately.

No driving force: Unfortunately, the only driving force behind standardization today is the need to report information to the government which is used for cost efficiency and payments as well as in today’s world Population Health.

Consumers: We, as consumers, have yet to push the industry, mostly because we’re barely involved in our own health. This needs to change and is arguably the largest area of improvement we need to make.

Regulation: The regulations that have been put in place for information standardization include a “pass/fail” check when a software vendor is making the product — but no one follows up on the product during implementation. This often results in cases in which software is implemented at a hospital and it can pass the standards check, yet the functionality of it is not effective outside the four walls — for instance ask your doctor next time to send a “direct message” to another email, most have no idea how to do it or if their software can do it. Another area we need to focus on is ownership — more on this later in the article.

Time: Standards such as HL7 often require that a team work together to map that data. So imagine having five people multiplied by 100 applications to connect — you would need 500 people to pull this off. And since that isn’t realistic, these projects take time and run in a waterfall effect (meaning one after the other).

The evolution of solutions

There have been many solutions proposed to address this issue and all of them have succeeded in some ways and yet also failed to make a greater impact. The good news is, we need these trials and errors in order to discover what works for healthcare. Some of the more well-known solutions are:

Direct: A protocol that allows the exchange of “secure” information. Think of it like encrypted email with a file in it that’s in a standard format (although, again, “standard” here is left for interpretation). The idea is that the direct message sends a CCDA.

CCDA: A file format that has to have a particular structure, and usually does, however each interface can have some things that are non standard or inconsistent depending on what each vendor sends in the CCDA.

HIE: A health information exchange into which data is added and then transformed so that it’s uniform; an HIA is used to share data across a particular population or given region.

FHIR: A protocol that wraps an existing standard (right now that’s HL7 ) into a more modern standard REST API so that developers can build applications that help you access and use your data. FHIR has the potential to solve at least the data sharing and access for patients — however there is a question of ownership (see Ownership later in article) AND the fact that a machine technically can’t access your records according to laws.

Interfaces: There are standard interfaces like ADT, CCDA and HL7 that can share data, however, each feed again is unique, is time-consuming to connect and is left for interpretation.

We’re sharing data!

Now all this being said, I want to make sure everyone understands we’re actually sharing data, quite a bit actually. In fact, Epic — one of the world’s largest EMR software providers — is often blamed with not being able to share data or work well with others and yet Epic shares a lot of data and even displays it on their website loud and clear for everyone to see.

There are also many efforts to put together a common HIE and other data repositories . Some companies’ visions for this are about a shared society of information and others are about a common HIE being the single source of truth.

What does all of this mean?

Times change but we haven’t changed the way things work — this is why I argue it’s not about disruption, it’s about transformation. Just like we invest in personal growth, so must industries invest in the growth of their companies. What got us here in healthcare will not get us to the next step in healthcare and to get there we must create a more unified way of sharing information that is fast, secure and reliable.

In my view, the answer to this will require multiple different forces to work together in order to move this forward and make a change:

Vendors/Developers: First, vendors of products in healthcare must start working with new standards and adopting new technologies to integrate and work with data rather than conforming to the old ways of working.

Government: The government must set guidelines to help companies ensure they reach this goal, for instance, with Meaningful Use 2 we saw the requirement for APIs, which is a more modern way to connect data.

Health Systems: Rather than focusing on making sure just reporting gets done, it’s our job in healthcare to work to start pushing innovation and building systems that are built to scale for the new healthcare era.

Consumers: We play a big role here — we need to ask questions, ask for our data and be more involved in our health. They can’t ignore us, as we are ultimately the end user.

Agreement: What I mean by this is that we don’t all agree on words, for instance if you ask someone what population health means or interoperability means you will get different answers. If you were to ask a bank what it means to transfer funds every single one would have the same answer.

The last hurdle: the product life cycle

All right, so say we figure all of this out — we can just launch it, right? Well, kind of.

Unfortunately, most companies have a long product life cycle, which means that we could see it take 1 year just to get developed and another 2 to 3 years before all their clients are on the particular version that allows for this.

This then puts pressure on vendors to reduce their product life cycle and provide more frequent updates. Compare that to Facebook, Google or Uber and that number shrinks to every 2 weeks on average.

A word on the next evolution of Obamacare

I won’t get into all the specifics here — there’s only one thing I want to highlight: If/when and how Obamacare gets replaced, there are a few things we can count on that are positive impacts on our society, which is that almost all the bills I’ve read have a few positive similarities.

State borders: They would like to see that your medical coverage is not tied to a state or employer but rather tied to you (this is how it works in Germany as well). Your insurance can stay with you and be “portable.”

High deductible plans: We’ll continue to see the use of this and this means we have to be more careful of what we do and how we spend.

Now why are these two relevant? For starters, if we start removing state borders then we also must allow data sharing to work much better, faster and more instant, or at least allow the patient to be the center of care.

The second part about high deductible plans is also vital as it means we need to — as consumers — get more involved in our health, which will drive care and lower costs for both us and the system.

Telehealth is great. So why isn’t it everywhere already?

Telehealth

A lot of people don’t know this but Hart got its start in telehealth. Well, actually, we started with medication adherence and the more we worked with clients, the more we discovered how important remote patient monitoring (RPM) is to medication adherence.

RPM is one form of telehealth by which devices are sent to a patient’s home to monitor chronic conditions. This is especially useful in a post-hospital situation to maintain quality of care and reduce the chances of the patient ending up back in the hospital.

At its core, that’s what telehealth really is — and should be — about: Providing convenience, delivering excellent quality of care, minimize a patient’s need for unplanned hospital visits and just generally making it easier to improve a person’s overall health.

So if telehealth is so great, why isn’t it everywhere already?

I can answer that question and others for you. But before we dive into the conversations currently surrounding telehealth, let’s add some context.

“Tele-what?”

When “tele-” is used to describe something, it means there are electronic means involved so that two or more parties can accomplish something without having to be in the same room.

When you see “tele-” used with “health” or “care,” it means care provided over electronic means so that the two people — usually a clinician and/or patient, or in some cases, multiple clinicians — can interact without meeting face to face. The idea is that telehealth can allow providers, hospitals and health technology companies like Hart to extend tools and resources to patients; and it can allow patients to receive more instantaneous answers to their health questions.

I’ll give you some examples to help clarify. Let’s look at a few forms of telecare that exist today.

Telehealth is used to broadly describe health information services, education and care services delivered electronically. It’s a term that umbrellas everything that happens under it.

Telemedicine is often confused with telehealth, or the two are wrongly used interchangeably. But telemedicine is more defined in that it specifically refers to using telecommunications technology to provide remote clinical services to patients. Examples include digitally transmitting medical images, doing remote diagnostics (like RPM) and/or video consults (think FaceTime). These interactions may be with your primary care physician; in other cases, they may be with a remote team that will ultimately keep your doctor in loop.

Teletherapy is the practice of therapy done via telemedicine, for example, personal therapy, family therapy or even addiction therapy.

Telecare involves a team of doctors, nurses and others taking care of patients remotely. This allows a patient to maintain his or her independence and quality of care while staying at home.

Just a heads up that I’ll be using “telehealth” throughout the rest of this post to keep things simple. But it’s good for you to have some knowledge of the subtle differences between the related terms.

“How is this technology used?”

Because this technology has such a broad application across so many areas in healthcare, it can offer greater convenience and faster care to everyone. Here are some specific examples.

Remote Care

Arguably the most exciting area is our ability to extend care to people we were not able to reach before. Imagine having doctors providing care to patients in other countries, remote areas or even disaster areas. This significantly improves the care someone receives and can actually help eliminate the need to travel long distances just to receive care.

Remote Patient Monitoring

As I mentioned, Hart began in the RPM area. A great service that allows a care team to remotely take care of a patient after he or she has been discharged from a hospital, RPM enables the patient to enjoy the comforts of home, safely. Plus research has shown patients may heal better and faster when they are surrounded by familiar settings and, in particular, their loved ones.

Consults

Another major way this technology is being used is to provide consultation between specialists and caregivers. For example, maybe your doctor wants a specialist’s opinion on one of your medical images in order to make an intelligent diagnosis. Instead of referring you to the specialist and making you do a lot of back and forth with additional appointments and paperwork, your doctor could use telehealth to get instant feedback, saving everyone time and money.

Employers

I’ve already written about companies establishing on-site clinics for their employees. Sometimes those clinics are criticized by people who point out that remote employees or out-of-town family members are left out. But telehealth allows those individuals to visit with the very same doctors and care team as the on-site employees do. Interacting with familiar faces can be important to retention since many patients perceive these individuals to be more fully involved in their care.

I’m sure you can see and think of many other areas in which we can use these types of services. We’re seeing their numbers grow rapidly and I enjoy learning about new telehealth services that are springing up all the time.

“What are the benefits?”

All of this sounds great but in my opinion there are benefits to telehealth beyond just the ability for tele-visits. Nothing is more important than getting the right answer quickly from your doctor, however, there are other things to consider here that offer amazing value to us as patients, and of course, there’s also value for the physician.

Convenience

No one can argue how convenient telehealth services are. Compare the traditional method of trying to make a doctor appointment to just picking up your smartphone. In the latter scenario, you can access your doctor’s office so much faster. Or if you use voice commands to your Echo or your Google Home device, then your access is even faster still. It might take 5 to 20 minutes to get a member of your care team up on your screen.

Teladoc, a leading provider of telehealth (that just surpassed 2 million telehealth visits), advertises an average wait time of 22 minutes. All things considered, that’s not bad. That’s how long it takes most of us just to schedule an appointment with our primary doctor over the phone. That’s 20-some minutes not to be seen but just to be scheduled.

Engagement

If you have a telehealth app on your smartphone, you now have a way for a care team to communicate with you. That’s a great opportunity for engagement, whether it’s before or after your visit — maybe even right after your appointment while you’re waiting for a call back. And in the event you’re an RPM patient, you actually have a device that’s collecting information 24/7 from the medical devices you’re using. All of these are touch points that are ripe for engagement and can allow your care team to better facilitate your overall health.

Prevention

The best part about telehealth services is that they’re not just for those who are sick. There are many times when we need to go see the doctor for simple things that could be accomplished via telehealth technology. And with more and more providers doing this, now we can.

At this point you might be thinking, Wow, this could save all of us a lot of time and money and also make those quick cold flus go away much faster. Why isn’t this widely used already?

“Are there laws to regulate telehealth?”

The general premise of laws is that they’re there to protect us as a society and uphold certain values. But in some cases, such as telehealth, the law can’t keep up with the industry’s changes and ultimately hinder growth and innovation.

The freedom to post anything on the internet and reach anyone instantaneously is great. Medicine, however, is something special and, let’s be honest, requires guardrails. When it comes to taking care of you, it’s important that the doctors who are giving you an opinion are board-certified. After all, you don’t want just any random person trying to give you advice about a condition you might have — or end up using Mr. Google, which sometimes ( often) leads to information with a disclaimer that says a condition can result in X, Y, Z “… or death.” Not very comforting.

Not All Laws Are Created Equal

In the U.S., when it comes to healthcare, each state has its own medical board and laws that define things such as:

  • Proxy (the ability to see someone else’s record, for example, your child’s)
  • Lab releases (what kind of labs you get and when)
  • Abortion (perhaps the most controversial of all)

Each state has its own laws for telehealth too. This means a doctor can’t practice across state lines unless he or she is licensed in that state. You can see how this can get tricky where telehealth is concerned.

What This Means for You

There are a couple areas where this hinders the adoption and rate at which this technology can grow. This could mean a few things for you:

  • Not every doctor will do this
  • You can’t always get a doctor right away
  • Slow growth of adoption due to certifications and legal drawbacks

Over time we’ll see this change and there is a lot of movement already on this from a law perspective to allow transportability between state lines. While this will take time, it will gradually get better and better. A great thing about technology companies is that they can adapt quickly, so they should be able to adapt swiftly along with any law changes

I’ll fill you in on the answer. It’s time to explore the other side of telehealth, the one where telehealth meets the law.

“I’m sold, how much does this cost?”

Of course, patients usually like the sound of telehealth but wonder whether it will cost them more or less than what they’re already paying for healthcare. The reality is, it actually costs less than what most people would think, especially when you consider costs associated with your time, gasoline, and the wear and tear on your car.

With telehealth, there are currently two models for payment:

  • User Pays: You cover the cost of the visit.
  • Insurance Pays: Your insurance covers the cost of the visit.
  • Sponsor Pays: Your employer or other entity sponsors/pays the coverage fee.

User Pays

Among the leading telehealth providers, the price for visits ranges between $49 and $99. All things considered, that’s a fairly economical price range so long as you aren’t calling the doctor every day. Or what if it were the middle of the night and your child were crying and you had no idea what was going on? That price would most certainly be worth the immediate answers and peace of mind.

Most of these companies have online signup or even mobile apps — just register and you’re ready to go. Some companies have a subscription model which requires you to pay a yearly fee in exchange for a lower price per visit or several free visits over a certain period of time.

Insurance Pays

A lot of insurance companies are still catching up to this, however, great strides have been made. If you use your insurance, the cost will vary depending on your plan type and your co-pay.

In order for a telehealth company to take insurance, it has to make a contract with each insurance plan provider, which can take some time to get in place. That’s one reason why a company may not presently take insurance or insurance by a specific plan provider.

Most likely you’ll see that by the end of 2017 all insurance plans will have some form of coverage for telehealth. It’s in their best interest, after all, as it lowers their own overall costs when insured customers make use of telehealth.

Sponsor Pays

Additionally, an employer or another sponsor can choose to pay for the entire cost or subsidize the cost of a visit.

Sometimes You Need a Doctor Right Now

There are other companies that allow you to call a doctor to make a house call on demand. While that’s not telehealth, it’s still using digital technology to summon a doctor to your doorstep — kind of like back when your parents were children and the doctor used to visit their homes. The prices for these vary and there are also options for both payment models.

“Why doesn’t my doctor do this?”

By now you’re probably excited about this type of technology. And if you’re like me, you’re probably wondering why your own doctor might not do this yet. Remember the state laws and insurance complications I mentioned? While some aspects of telehealth have evolved rather quickly in response to consumer demands, the area of contracts with doctors is still a work in progress.

Simply put, not all doctors can get paid for this type of service … yet. This is changing more and more as insurance companies are seeing the benefit. Today doctors still requires you to come in so they can bill the insurance company , that’s how they make money. Unfortunately, they can’t yet bill for telehealth visits in all areas or all states.

New Laws

It’s not just telehealth that’s evolving — the healthcare industry as a whole is undergoing many changes. That includes changes in how we pay for value, and there are new laws being put in place to focus more on the value than the fees. Hence, it’s becoming more prevalent to see your health system and/or doctor offering telehealth services.

Operations

There are also other complications to consider, such as balancing the doctor’s schedule — after all, some people still need to go see the doctor in person, as not everything can be addressed via video.

These changes in workflows and operations will take some time to work through, however, I see the industry making great strides and I’m very excited for the next few years in care.`

“What if I still have questions?”

We never talk about anything in healthcare without these questions coming up:

  • Is it safe?
  • Is it secure?
  • How do I trust the service?

The short answer is: Yes, it is safe; yes, it is secure. However, all that said, you should do your research and go with a reputable company.

You’re Not Being Recorded

By law, the encounter you have with the doctor is only between you and the doctor — same as when you visit with your doctor in person. Once the video connection is made, that video connection is secure, private and never preserved as part of your medical record. Regardless, do your homework. Check the privacy terms just as you would for any service you use. And keep in mind that laws can change, so review those terms often.

This Isn’t the End of Going to the Doctor

This is a great question and the answer is no. There are still many cases in which you will need to visit a doctor due to either laws or just the nature of practicing medicine. These include but are not limited to:

  • Getting certain prescriptions or renewals
  • Physicals
  • Critical care
  • Surgery

Maybe in time all of these and others will be possible over tele-means, without the patient ever leaving home. I would argue, however, that there will always be a reason to see the doctor in person. My biggest reason for it?

Simply put, we like the interaction of being with others — we are, after all, social beings.

“What lies ahead?”

You’ll see telehealth practices evolve over time and you may be hearing the term “population health” more and more as healthcare focuses on While this has many different meanings, I have my own predictions about where we will see health go.

Health Coaching: I believe you’ll be assigned some sort of a health coach or care navigator — someone who’ll be your guide on your health journey. Imagine them seeing your step tracking, working with you on your diet and becoming your personal health cheerleader.

Precision Medicine: With DNA sequencing becoming cheaper every day, the thought of precision medicine becomes more and more appealing. This will be the practice of medicine that is tailored to one person and only one person: you. Imagine knowing exactly what you need to do to keep your body in its top shape.