Some Thoughts on Telemedicine – by Robert Nelson, MD

Labtop.stethoscope.iStock_000017019201MediumThird-party free practices such as DPC, cash-only and other non-insurance-based models are a natural fit for a variety of electronic media that can be used to communicate with patients. Patients love it. I call it simply lifestyle-friendly medicine. It syncs seamlessly with how people currently live their lives and communicate with friends, family and business colleagues.

So why not utilize these same tools to communicate with your doctor?

You’ve heard the saying, “all politics are local”.  Well, all good primary medical care eventually becomes personal and local. But things happen. Medical Boards set guidelines. Malpractice policies rear their ugly head. What if patient needs to be seen in person? They are a litany of what if’s that can get in the way of a good thing.

Point of emphasis: HIPAA/HITECH still applies even if a practice does not take or bill insurance! Email, text, and non-HIPAA compliant video platforms are not secure.

Telehealth companies are springing like weeds in July; they are everywhere. They claim to be “change agents”, “disruptors” and “innovators”and are going to change healthcare; promising doctors a significant boosts in income just by sitting in front of their computer at home.

News flash! People are not buying in anywhere close to the quantities predicted based on survey interest. The video screens are not lighting up! I know, I have been on the ground floor of two well designed Telehealth platforms and I made myself reasonably available. AND, in a 9 month period of experience between the two I DID NOT HAVE ONE VIDEO CONSULTATION FROM A PATIENT THAT WAS NOT ALREADY MY PRIVATE PATIENT. To be fair, the potential patient base was only the whole state of Georgia, though!

So what going on? Do patient-consumers not use electronic communications as much as we thought? No, they use them plenty.  The problem is, we are not using electronic platforms in the right way and when we do, we are not educating patients on the advantages and proper use.

There are some systemic roadblocks as well. Insurance-based practices rarely use e-platforms because they can’t get paid for it and don’t have time due to schedule being packed with co-pay patients. Some DPC and concierge practices still believe they can use any platform (Skype, non-secure texting, etc…) and don’t have to worry about HIPAA violations – Not so.

Also, we’ve anointed Telehealth as unwitting surrogate for personalized, convenient care. While it is convenient, and much like walking into a local urgent care or ER, it can be a potpourri of unpleasant surprises and disappointments.  Like Forrest Gump would say, “you never know what you’re gonna get.”

Patients are not unsophisticated and they tune their shopping radar to match the services they seek. In this case it is medical care – not widgets or apps or data plans.

Telehealth is not a YouTube video or the latest smartphone app. It is about leveraging convenient communication platforms with OUR patients so we are rarely ever out of touch. Patients will and do use Telehealth liberally when the person on the other end of the transmission is a doctor or provider they know, like and trust.

This is why it is critical that private practices, especially the small ones that can adapt quickly, start to use a variety of secure (think HIPAA) e-platforms and secure messaging services to stay in touch with patients.

Someone is eventually going to do this right. Shouldn’t it be the doctors who are already providing great in-person care for their patients?  Let’s just extend that beyond the office walls. As primary care doctors, we take pride in the fact that we can take care of most of our patient’s needs. Let’s start by being available for them in a lifestyle-friendly way. Our patients deserve that.