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Telemedicine
The Solution You Don’t Know You Need
Basic Information – Who Is This Guy?
• Elisha Yaghmai
– Internal Medicine/Pediatrics
– Still in active practice, ambulatory and inpatient
– Frequently sees patients via telemedicine
– Started a company because wisdom is what you get right after
you need it.
Basic Information – What’s the Company?
• Formerly Vigilias Telehealth
• Physician-owned
• Founded 2014 to help with doctor shortages
• Added tech wing initially out of necessity
• Grew to over 25 specialties and 30 sites,
Central Midwest
• Run a tech-enabled clinic
• Helped change telemedicine law in Kansas
Inefficient
Cost
Structure
Very
Inconvenient
Poor Data
Infrastructure
State of Affairs in Healthcare
Inconsistent
Quality
Expensive
Where Employers Lose on Healthcare• Sick days
• Time off for family illness
•Poor performance due to sickness
•Deferring preventive or maintenance care Major emergency
• Incorrect Care Triage Simple cold that goes to the ER
•Rising insurance premiums/Self-insured expenses
•Poor preventive care
Old Solutions
• Wellness Programs
• Encourage yearly physicals
• Nursing Lines
• Healthcare Navigators
• On-site clinics
A Solution That Sticks?
•Distribute doctor’s brains to hundreds of employees and sites
simultaneously
• Coordinate care remotely
• Create data collection and movement infrastructure to support this
• Pay the doctor differently?
• Sum all that up in one word: “Telemedicine”
Definition
The practice of medicine through the use of video-conferencing and remote examination technology.
Then a lot of other things not mentioned above.
History
1948: First radiologic images sent by telephone in Eastern Pennsylvania.
1950s: Canadian teleradiology system; University of Nebraska first to use two-way interactive TVs for medicine
1960s: ECG rhythms sent over voice radio channels from fire rescues; NASA weighs in
1970s: Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC). ECG/X-ray by microwave
1980s: Australian North-West Telemedicine project uses satellite; U.S. offers USSR use of telemedicine network
1990s: Canada, Germany, WWAMI states, others expand use of telemedicine; internet grows
2000s: Internet takes over, smart phones popularized
2010s: Processors catch up to software
Failure To Launch
Equipment Unreliable
Very Expensive
Nobody Paid For It
Legal/Regulatory Barriers
Advantages for Patient Care
Convenience
Safety
Quality
Opportunity to Recenter Care Around Patient Needs
Pitfalls
Hands Still Needed (for now)
Patient/Provider Acceptance
Old Habits
If we do not substantially reform the baseline healthcare system, telemedicine will never reach its potential.
Services
Common:
Telestroke
TeleICU
TelePsychiatry
Growing:
Telehospitalist
ED Backup
TeleRehab
“Direct-to-Consumer”
Needs to Grow:
Everything Else
Technology
Technology
Current:
Expensive
Bulky
Heavy
Short Battery Life
Low Video Quality
“Legacy” Software
Rebels!:
iPad with Software!
Cheap!
Limited functionality!
The Future (Is Now):
Hardware - Common Questions
Do I need to install hardline connections in 2018?
No.
I saw a $60,000 robot/$30,000 cart/$27,000 “mobile” suitcase/expensive screen with a $5000 camera on top that does 8X zoom! Do I need any of that to do great telemedicine?
No.
Does my iPhone equal or outperform all those other devices?
Yes!
What can I plug into an iPhone these days?
Stethoscope, Otoscope, 12-lead ECG, Spirometry, Ophthalmoscope, ultrasound, endoscope, microscope, etc.
Do I need a bunch of new equipment to offer on-site telemedicine to my employees?
No.
If I want to do this, where should I spend my IT hardware budget this year?
Upgrade the wireless network; buy some peripheral exam tools.
Software - Common Questions
Can’t I just use Skype?
No. Sort of.
Can’t I just use Facetime?
Yes and no. Mostly no.
Any reason not to just use the free telemedicine software I found?
Depends on desired functionality. Also if it’s free, you are the product.
Should modern telemedicine software require use of a proprietary hardware system to work?
No.
What does HIPAA-compliant mean?
Not much.
So what do I really need?
A Business Associate Agreement (BAA) with anyone STORING PHI offsite. If information is only transmitted, but never stored, a BAA is not required.
Services - Common Questions
What kind of services can I get through telemedicine these days?
Essentially anything not involving a procedure (changing)
Can doctors get paid to do this?
Yes-ish
Can local providers do telemedicine for local patients?
Yes!
I see lots of people online claiming to be longstanding, world-leading telemedicine experts. Given that modern telemedicine has only become feasible in the last 4-5 years, how is that possible?
It is not.
I can’t afford to offer health insurance. Can I still do this?
Absolutely
Services – Potential Applications
Virtual Onsite Clinic
Second Opinion
Immediate Triage/Treatment for Injuries/Acute Illness
After-Hours Care
Remote Attendance of Doctor Visits
Doctor in Every Pocket (and Every Home)
Uber of Healthcare? NOT SO FAST
Services – A Potent Combination
Local In-Person AND Telemedicine Care
• Better continuity
• Better coordination
• Better follow up
Current Non-Billing Obstacles
Shoddy Wireless networks
Equipment Still Expensive (changing)
Legal/Regulatory Barriers: Licensure, Credentialing, Stark Laws, etc., etc., etc. (NOT changing)
Data Infrastructure – Dumpster Fire
Urgent Needs
Direct data management/sharing – NOT just a HIE
EMRs that talk to each other
Better basic IT infrastructure
Improved mobile diagnostic/exam aids
Way to Assess Provider Quality
Billing and documentation standards MUST change
Future Trends
National Licensure?
Every home telemedicine-ready
All employees have telemedicine in their pockets
Care increasingly centered outside the hospital
Home hospital
Doctors can soon can reach any patient, any time, anywhere. The opposite is also true.
Additional Resources
Heartland Telehealth Resource Center
http://heartlandtrc.org/
American Telemedicine Association
http://www.americantelemed.org/
Center for Connected Health Policy
http://cchpca.org/
