John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician.

As reimbursement evolves from fee for service to alternative payment models, incentives will shift from treating sickness to keeping the population healthy. New investments will be made in technologies that reach into the home and enhance care team communication. 2016 saw an acceleration of telemedicine/telehealth. 2017 will see exponential growth.

Telemedicine is hard to define. It could be real time video teleconferencing between clinicians (a consult), between a patient and clincian (a visit), or group to group (tumor board discussion). It could be the transmission of a static photograph, such as the poisonous mushroom/plant teleconsultation I do 900 times per year. It could be secure texting to coordinate patient care.

Patients might provide care teams with objective data from devices in their homes. Patients might answer surveys about their mood, activity, or pain.

All of these are telemedicine.

Many companies will offer cloud-based tools and technologies to support these new workflows. Some organizations will use bridging technology to link together every kind of endpoint (Skype, Facetime, commerical telemedicine apps) with every kind of endpoint.

There are so many use cases and so many possibilities that one approach will not serve all needs, so most organizations will have a multi-faceted strategy.

There are some unanswered questions.

1. How do you bill for telemedicine? There is a new CPT code, but it’s not clear how it should be used.

2. How do you address multiple conflicting state laws when consulting across borders?

3. How is the record of a virtual encounter stored and who is the steward of the record?

For my personal telemedicine practice, toxicology consultation, I use an iPhone and email to review cases and images. No protected healthcare information is exchanged.

I am credentialed by BIDMC for telemedicine practice

I am malpractice insured for telemedicine practice.

When consulting across state lines, I provide advice to licensed physicians in that state and never interact with patients directly (or prescribe).

I do not bill for these services, they are a public good.

Medical records are kept by the physician consulting me and that physician is the steward of the record.

As hospitals expand to serve patients at the national and international level, as payment models require more home care/wellness care, and as consumers demand the same kind of convenience from healthcare that they get from other industries, telemedicine will expand and mature.

Telemedicine at BIDMC (part of Media Services) reports to me and I’ve requested additional staffing and investment for 2017. Technology, business needs, and customer demand are aligning to make telemedicine an increasingly important service offering for clinicians and hospitals.

Please connect with Dr. Halamka LinkedIn, Twitter or subscribe to his Blog.

Originally posted on July 27, 2016

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Our 6th post in the doxy.me "Voice of Telemedicine" blog series brings you insights from North Pine Counseling Center owner, Ken Scroggs.

This is an opportunity for telemedicine professionals to share their experience with telemedicine.
About the author, In 1987, Ken founded the North Pines Counseling Center.
Ken received a BA from LaGrange College with a double major in Psychology and Social Work. He received his Masters in Social Work from the University of Georgia. He’s earned three licenses to practice in Georgia: Clinical Social Work, Professional Counseling and Marriage and Family Therapy. He’s also a Certified Employee Assistance Professional.

If you enjoy his post please connect with him on
Linkedin
, Twitter or Facebook

Tell our readers about yourself and why you decided to get involved in the telemedicine space.
Utilizing technology to make mental health services available to more people was a natural progression for me and my colleagues. Over the years my Employee Assistance Programs have made the transition from only providing face to face counseling services to telephone counseling (especially via our Crisis Hotline), and then to video conferencing.
We’re not attempting to replace face to face counseling, but to augment it with support in between sessions. The need for mental health services is greater than ever and corporations are seeing how this can impact their bottom line.

What’s your background and specialty? How long have you been in telemedicine? Where is your primary focus?
My background goes back to the early days of civil rights when I was a juvenile probation officer working out of the Office of Economic Opportunity in a small town in Georgia. After completing an undergraduate degree with a double major in Psychology and Social Work, I attended the University of Georgia obtaining a Masters in Social Work. During the Vietnam War I was a Social Work Officer providing services in a variety of capacities including an Army Hospital, Mental Hygiene Clinic, Army Community Services and eventually working under General Robert Shoemaker, FORSCOM Commander at Ft. Hood Tx. He assigned me to launch the Leadership Development Program and to be the General Secretary to the Human Services Counsel coordinating all human services on post. After leaving the military 30 years ago I have been the CEO of a private psychotherapy practice, North Pines Center, Inc. as well as the CEO of EAP Works. My involvement in TeleMental Health became more significant about 8 years as the technology became more advanced with a focus on providing emergency mental health services.

What motivated you to start get into telemedicine?
My goal has always been to help as many people as possible by providing mental health services. Over the years I’ve met many healthcare professionals and this is one thing we all have in common, helping others. Technology greatly expands our ability to reach so many people many of which would be without the care they need.

How has telemedicine changed in the last year?
One significant change in the use of technology occurred last year when the State of Georgia Composite Board, which governs three professional groups, Social Workers, Professional Counselors and Marriage and Family Therapist passed a regulation (Ga. Reg. 135.11.01) requiring all these licensed professionals to complete six hours of training in TeleMental Health. This makes TeleMental Health (TMH) mainstream within the mental health profession. I was involved in the design of the requirements within the course content. A significant portion of the course focuses on how to protect PHI, and it addresses the fact that most health care professionals use cell phones (which we refer to as Handheld Computers requiring HIPAA protection) and emails. The course also includes best practices in the use of synchronous and asynchronous delivery methods.

Where do you see the telemedicine market 1 year from now?
Mental health services are a perfect fit for using technology. I believe the use of technology within mental health will grow at an enormous rate. Additionally, the greatest change we’ll see over the next year and years to come is the need for making services convenient. This reduces time lost away from work and school for millions of adults and children.

From your POV, how do patients like meeting with doctors by telemedicine?
For those people where TeleMental Health is a good fit for their therapy, they love it! Also, people greatly appreciate being connected to their therapist, especially in times of crisis. When there is an accident, overdose or relapse, death of a loved one, divorce or your teenager runs away from home the client wants help and they need it immediately. Some of these issues need to be directed to a medical facility, but most do not. Even when they need medical attention, support via the use of technology can be vital.

What do doctors find most valuable about telemedicine?
Perhaps the most valuable service therapists enjoy is the expansion of their service area. We often think of the fact that there is a tremendous need for healthcare in rural areas, and we all know that it’s true across the country. For example, the Georgia Partnership for TeleHealth has been connecting doctors and nurses with patients in rural areas for about seven years and have helped thousands at hospitals, clinics and in schools. At there recent annual conference, I couldn’t help but appreciate several speaker’s mention of the need for more behavioral health services to augment their existing healthcare delivery system. Additionally, what we’re realizing with our traffic problems in Atlanta, is there are times your therapist is only 20 miles away, but the time it takes to get through traffic might be well over an hour.

Do you have any insightful, interesting, funny, or notable experiences from your tenure in the telemedicine space?
Perhaps one of the most interesting and helpful uses of telemedicine is with couples in marriage counseling who are separated by their jobs being in different parts of the country. The separation of a couple can create issues or complicate existing problems. Having the husband, wife and therapist meet weekly via telemedicine can greatly help support and even save marriages. Often there are humorous exchanges within these distance counseling sessions to uplift what can be some “heavy” situations. Once I had a husband show up in a clown suit on a video counseling session. His wife was greatly impressed by his efforts and we all got a big laugh! Of course, he would never have dressed up like a clown to come to a face to face session. It worked to get our session off on a good start that day and his wife frequently made mention of it after that. Underlying the humor is the fact that it showed how much thought and energy he was putting into the marriage as well as that one funny gesture.

What challenges have you seen doctor’s experience with telemedicine? How did they overcome them? I believe the main challenge is our technology infrastructure with bandwidth as well as the frustration with upgrades that are required from time to time. Of course, it’s frustrating for everyone when there’s a technology glitch, but technology issues that create problems of connectivity and disruption can have exacerbating effects on a person experiencing anxiety, major depression and so forth. For some clients, such technology issues make the use of video conferencing unacceptable. For clients that have the technical skills and equipment as well as the temperament, I recommend that the first counseling session be face to face in the therapists office, if at all possible. The client can bring their laptop and during an extended session the therapist can conduct an assessment of the prospective client’s emotional concerns as well as connect over doxy.me or the platform most comfortable for the client. Of course, it must be HIPAA compliant and the therapist should have a BAA in place with the provider platform.

What advice would you give to other healthcare providers interested in starting telemedicine?
I strongly encourage my mental health colleagues and participants in my TeleMental Health courses to experience a “mock session” with a colleague to see the ease and effectiveness that TMH offers. In my advanced courses we offer “hands on” training to help therapists set up their equipment, learn best practices and answer all their questions. We also examine the importance of client selection so they are comfortable working with clients where successes have the greatest potential. My main advice is to simply try it because I think most therapists will like it.

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This is the third post in our "Great Telemedicine Content" series.

Doxy.me telemedicine has great partners and friends that write insightful content. Today we bring you a post by Nick Hernandez.

About the author, Nick Hernandez, MBA, FACHE, is the CEO and founder of ABISA, a consultancy specializing in solo and small group practice management. Nick is a graduate of the United States Naval Academy and a former Captain in the U.S. Marine Corps. His company’s client list includes physician groups, hospital systems, healthcare IT organizations, venture capitalists, private equity investment groups, and strategy consulting companies.

If you enjoy his content please connect with him on
Linkedin

Originally posted on Nov, 2015

Although organizations in the United States are still trying to optimize the use of current telehealth solutions, telehealth is undoubtedly poised for continued growth in the U.S. (and many other countries as well). Telemedicine is gaining momentum as it has proven to increase access to care and reduce costs via teleconsultations and remote patient monitoring. U.S. consumers are beginning to use wearable devices to track and collect their personal health data. Over time, we will see more of a willingness to share that data with healthcare providers and intermediaries.

The Healthcare Information and Management Systems Society (“HIMSS”) conducted a survey on telemedicine adoption in the United States. The survey polled 276 healthcare decision makers and physician executives. Brendan FitzGerald, research director at HIMSS Analytics, discussed the results with some of us last week. Here are some highlights of the survey’s findings, of those engaged in telemedicine:

70% utilize a two-way videoconferencing system.

57% use a hub and spoke model (audio/visual only between originating sites)

49.7% are using a patient portal or application-focused patient engagement (services delivered via portal with mobile or desktop access)

20% utilize concierge services (i.e. eVisits and online consults)

The number of respondents engaged in remote patient monitoring in the home decreased from 38% in 2014 to 30% in 2015.

52% are still uncertain about future investment in telemedicine; 28% polled are not increasing their current investment; 20% are planning on future investment on top of their current program.

26% are planning to expand their telemedicine programs to add other specialties in the near future.

34% are engaged in telemedicine primarily to develop a service that increases access and integrates care across rural areas; 22% are focused on developing a service that reduces overall costs for their organization; 18% are seeking to develop specialty services not otherwise available in the region.

The HIMSS Analytics survey can be found here.

You can contact ABISA, a consultancy specializing in solo and small group practice management by visiting them at ABISALLC.com.

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For the 5th post in the doxy.me "Voice of Telemedicine" blog series we’re joined by Dr. Joe Krainin.

This is an opportunity for telemedicine professionals to share their experience with telemedicine.

About Dr. Krainin My name is Dr. Joe Krainin and I’m the founder of Singular Sleep, the first (and so far only) sleep telemedicine practice. We launched just 3 months ago. Contrary to what many people think, this does not involve me watching people sleep at night! We diagnose and treat a wide array of medical disorders that make it difficult for people to either sleep at night, stay awake during the day, or both

What’s your background? Specialty? How long have you been practicing? Where is your primary location?
I’m a sleep medicine physician with a background in neurology with board certification in both of these specialties. I graduated from Tufts University Medical School in 2004 and have been practicing sleep medicine since 2008. Our offices are based in Mount Pleasant, SC. I’ve had a diverse career thus far, including serving as the medical director of both a large sleep lab and a professional sports team. Sleep is my passion and I have an entrepreneurial streak that I probably inherited from my father, John, who founded several successful businesses. Singular Sleep allows me to practice sleep telemedicine in 17 states, and we are rapidly expanding throughout the country. We’re excited about entering the New York and Illinois markets soon. Our plan is to be nationwide by the end of this year.

How long have you been practicing telemedicine?
During my tenure at Medical University of South Carolina (MUSC), I was part of the team that launched the tele-neurology program in 2014. The value of telemedicine and its disruptiveness, in a good way, to what I call the "hospital-insurance complex" were immediately apparent to me.

What motivated you to start practicing telemedicine?
I’m convinced that today’s medical landscape will be almost unrecognizable in 20 years. Telemedicine will be a huge part of that change. I see tremendous opportunity to use telemedicine to increase access to healthcare and reduce its costs. Sleep medicine is vastly underserved throughout the country and we are trying to change that.

How has telemedicine changed your practice?
In a word: freedom. Freedom from the tyranny of being told how to practice medicine by hospital administrators and insurance companies alike. I did not go to medical school to be told what medication to prescribe my patient by a healthcare administrator with a clipboard.

How do your patients like meeting with you by telemedicine?
So far they have been very responsive. We do deal with a select group of people who are comfortable using the Internet to solve problems, including medical ones. I don’t think that direct-to-consumer telemedicine is for everyone.

Do you have any insightful, interesting, funny, or notable experiences using telemedicine?
Yesterday I received a letter from United States Congressman Mark Sanford! I thought it was going to be junk mail and was shocked to see that he had written me a very kind, supportive note. To me, this is further evidence that the promise of telemedicine is captivating the minds of our best and brightest.

Regarding clinical telemedicine, there is one case that stands out. A middle-aged woman, we’ll call her Linda, scheduled a consultation with me because she wanted to talk about alternatives to CPAP, which is the traditional, first-line treatment for obstructive sleep apnea. She gave up on talking to her regular doctor about the problem because he didn’t have any other solutions for her besides sleeping pills, which just made her feel worse. It’s very common that patients are not compliant with CPAP for a host of reasons. Linda had really been suffering for years; she was unable to sleep well at night and felt like crud during the day. A review of her previous records indicated that she had severe sleep apnea that was worse in REM sleep. When we started the conversation, she had less than zero interest in ever trying CPAP again, but I was able to quickly detect what the problem was by picking up on a few key details of her history. It was just a matter of the machine’s settings. I explained to her what I thought was going on and she agreed to try CPAP again. We tweaked her machine and now Linda tells me that she feels 20 years younger! She sleeps peacefully at night and told me that she has "1,000%" more energy during the day.

What challenges have you experienced practicing telemedicine? How did you overcome them?
The biggest challenge is getting patients to log into their consultation on-time! But seriously, there is an attitude in America that, when you have a medical problem, you go to the doctor and the doctor tells you what to do. This is a barrier for people in adopting telehealth solutions but I see that the wind of change is upon us. Patients are fed up with paying too much money and waiting too long for unsatisfactory results, and they are increasingly open to new, innovative solutions.

What advice would you give to other healthcare providers interested in starting telemedicine?

There are many ways to incorporate telemedicine into your practice. Start now! To all the providers out there who might be reading this, think of it like electronic medical records. Everyone hemmed and hawed and resisted EMRs but now they are ubiquitous, and you know what? They have actually, for the most part, made our lives easier and improved our medical practices.

You can visit with Dr. Krainin on his website , connect via linkedin
or follow him on twitter

Brought to you by the team at doxy.me

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This is the 4th post in our "Voice of Telemedicine" blog series.

An opportunity for telemedicine professionals to share their experiences in telemedicine.

Today’s guest blogger is Dr. Medhavi Jogi, a Houston based Endocrinologist.

About Dr.Jogi, I co-founded the endocrinology practice Houston Thyroid and Endocrine Specialists
in 2009. We now have a 4-doctor endocrinology-only group with two locations in the metro area. We’re located in Katy,Texas and the Houston Medical Center. We’ve been early adopters of technology as we’ve strived to be a paperless practice.
I’m a native Texan, as I was born in Austin and attended the University of Texas Austin for my undergraduate education in biochemistry. I then attended medical school, residency in internal medicine, and endocrinology fellowship at Baylor College of Medicine in Houston. I have interests in thyroid disease and technology solutions for patients with diabetes mellitus. The practice sees all general endocrinology patients.

What is your background? Specialty? How long have you been practicing? Where’s your primary location?
I’m an adult endocrinologist, which is a subspecialty of internal medicine dealing mostly with hormone disorders including diabetes, pituitary, thyroid, and adrenal issues. More information about the training required of an endocrinologist can be found here http://www.houstonendocrine.com/the-doctors/What-is-an-endocrinologist
My primary location is our Houston medical center location office. I started to see patients as a double board certified endocrinologist since I graduated endocrine fellowship in 2009. I’m also a volunteer endocrinology clinical assistant professor teaching endocrinolgy fellows at the Baylor College of Medicine in Houston. I do enjoying teaching in general.

How long have you been practicing telemedicine?
I started using aspects of telemedicine since January, 2015. Originally it was only for diabetes education but now we are using it for multiple other patient services.

What motivated you to start practicing telemedicine?
I have an excellent diabetes educator who moved to Dallas in 2015. I wanted to retain her as an employee so I realized technology was the answer. I was able to keep her as part of our practice with telemedicine. Our patients also love the concept of a telemedicine solution and have been requesting this type of service for quite some time

How has telemedicine changed your practice?
I feel it’s made our practice accessible to more patients. It’s reduced the in-office burdens and slow downs. Patient satisfaction seems to be very high with this technology since a virtual waiting room allows for the patient to save time.

How do your patients like meeting with you by telemedicine?
Most of my patients would prefer televisits in general. They almost all seem to embrace it fully.

Do you have any insightful or notable experiences using a telemedicine solution? Patient portal usage has been pushed by the government but is an unfunded mandate. I spend many unreimbursed hours per week responding directly to portal messages from patients. This leads to back and forth disjointed messaging. Granted, it’s better than phone-tag, but portal messaging is far from perfect. Secure telemedicine automatically improves patient care since it’s convenient for both doctors and patients, allows for a more robust discussion of the medical issues, and is theoretically reimbursable by insurances.

What challenges have experienced practicing telemedicine? How did you overcome them?
The biggest challenges are navigating the medical board laws and regulations to make sure we are following all proper procedures. This is a work in progress. Over time I hope that the medical societies and telemedicine societies make the law and regulations less cumbersome and more clear to follow.

What advice would you give to other healthcare providers interested in starting telemedicine? “Just do it”. Telemedicine is not going away, and I think it will be how patients will expect medical care delivery to occur very soon. Start working on your workflows now.

You can connect with Dr. Jogi @
Twitter
or Linkedin

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This is the 3rd post in our "Voice of Telemedicine" blog series.

An opportunity for telemedicine professionals to share their experiences with telemedicine.

Today’s guest blogger is Bryan Arkwright, Senior Consultant at Schumacher Clinical Partners

About Bryan. I’m a passionate telemedicine advocate and consultant with Schumacher Clinical Partners focusing on telehealth / telemedicine strategy and operations. I am also an avid speaker on telehealth/mHealth and future healthcare and active on Twitter.

I decided to get involved with telemedicine early in my career because I was fascinated with technology and designing new and innovative processes to deliver care. It was not long before I actively chose to dedicate my career to telemedicine as an Administrator at a large Academic Medical Center and later as a Director of Telehealth at a large integrated health system. Each opportunity and consulting since then allowed me to lead, oversee, and advise others on the expansion and growth of telehealth clinical programs for hospitals and health organizations of all sizes.

What is your background?
How long have you been in telemedicine? Where is your primary focus?
I have a bachelor’s degree from Ohio University, a M.H.A. from Medical College of Virginia / VCU, and a Six Sigma Black Belt from the American Society for Quality. My healthcare experiences to date include four not-for-profit Health Systems, two Academic Medical Centers, and Consulting. I have been working with telemedicine since 2006 and my primary focus is on assessing, designing, and implementing telemedicine programs.

What motivated you to start getting into telemedicine?
A problem arose at a health system I was working at and we researched potential solutions, the one we decided on was telemedicine oriented. I had fun with the project and it wasn’t long before I had the opportunity to work with another telemedicine related project.

How has telemedicine changed in the last year?
The biggest change I see is two-fold, there’s more of it in new markets due to the fast paced growth. And second, there’s a growing awareness of what telemedicine is and how and where to access it.

Where do you see the telemedicine market 1 year from now?
One year from now I’m hopeful the empirical foundation of telemedicine value will have expanded further and the healthcare industry will take more action towards new and proven designs/implementations.

From your POV, how do patients like meeting with doctors by telemedicine?
The programs I’ve been involved with include a patient survey component and time and time again we see overwhelming satisfaction. We’ve seen statements around the experience being “better than in person”, “doctor paid more attention to me”, “eye contact was fantastic”, “I felt like I was in the future”, and more.

What do doctors find most valuable about telemedicine?
This can vary doctor to doctor, but the value I hear most from doctors is related to giving more convenience and choice to their patients, improving their patient’s care experience, serving underserved areas, and helping to bring innovation and new efficiencies to their status quo operations.

Do you have any insightful, interesting, funny, or notable experiences from your tenure in the telemedicine space?
My notable experience is serving as a telemedicine patient myself. I came down with a bad cold, but being new to the area it was hard to get into a doctor unless I was willing to wait 1-2 weeks or more. I chose a regional provider who I knew had recently launched a telemedicine program and within minutes I was in a consult; shortly after that my newly prescribed antibiotic was waiting for me at a local pharmacy. The total time from my decision to have a telemedicine consult to when I was back in my house and on the couch having taken the first dosage was 45 minutes. Compare this to every experience I’ve ever had with visiting the doctor and it was much, much better. I was always a telemedicine advocate but this moment made it that much more real. My family and I have had telemedicine visits since then for different things, and each time we were pleased with our experience.

What challenges have you seen doctor’s experience with telemedicine? How did they overcome them?
The obstacle and challenge I see the most is related to process. Either a poor process has been designed and implemented for the telemedicine initiative or process was left completely out of the due diligence and planning. Training and education is also critical to implementing a well-designed telemedicine process. Doctors overcome the process, training, and education pitfalls by understanding the current processes and status quo operations and then taking a team approach with key staff/stakeholders to design and implement the process for using telemedicine.

What advice would you give to other healthcare providers interested in starting telemedicine?
Do it! Seriously though, find a partner you can trust who has experience designing and implementing successful telemedicine programs. Next, have an open conversation about your organization’s current operations and any problems/issues that impact your patients and fellow providers. Lastly, seek to understand how a telemedicine initiative would work, step by step, and how it would impact your patients and fellow providers in a positive and manageable way.

You can connect with Bryan on
Linkedin

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This is the second post in our "Great Telemedicine Content" series. Nate Lacktman is a Health Care Partner at Foley & Lardner LLP.

He’s the smartest and most creative attorney we know in telemedicine.

His post had a great response last week so we’re sharing a new one.

If you enjoy his content please connect with him on
Twitter

Linkedin

Originally posted on Dec 1, 2015
International markets – particularly developing countries with a need for the depth of expertise offered by U.S. health care providers – will play a significant role in driving telemedicine growth and continued health care transformation in 2016.

Arrangements between U.S. health care providers and overseas medical institutions are becoming an increasingly important pathway to new patient populations, revenue growth, and stronger global brands. The advantages fueling telemedicine’s stateside growth – lower costs, greater convenience, and fewer unnecessary emergency room visits – are equally compelling abroad. An international telemedicine model offers great benefits to rural and developing regions, where access to medical facilities is limited. The largest driver to date, however, has been a desire to tap into the deep specialty expertise of marquee U.S. health care providers.

In 2016, we expect telemedicine’s international expansion to come primarily from provider collaboration, the expansion of clinical trials overseas, and the desire to reach new patient populations. Here’s a look at each of those three drivers:

1. International Collaboration
Health system executives are realizing international partnerships can extend their brands around the world. For example, UCLA Health recently partnered with the city of Zhengzhou, China to establish the Zhengzhou International Telemedicine Center ZITC
The partnership will not only allow UCLA Health to provide services in diagnosis, treatment, and rehabilitation, but to also exchange education, research, and training with ZITC.

2. Global Clinical Research
Telemedicine offers medical researchers with expanded access to large patient participant populations around the world, which can result in faster and more powerful clinical trials. The technology enables research studies to go directly to patients, decentralizing the process and giving researchers increased access to patients with rare diseases. And, whereas traditional clinical trials often experience long delays, transportation constraints, and high dropout rates, telemedicine can mitigate these problems using tools such as remote collection of biometric data, video consultations, and remote medication monitoring. The potential for growth has led Verizon to invest in network services for telemedicine clinical trials.

3. New Patient Populations
Expansion into remote rural areas abroad will fuel telemedicine’s growth in 2016. This will be particularly evident in countries with emerging economies and a need for access to health care services, including China, India, and South America. Western Europe will continue growth as well, particularly mHealth and wearables, but the rate will not be as significant as these other regions.

Global expansion will inevitably spawn more innovative business models that, in turn, will propel further growth in telemedicine in the coming year. International growth is among five telemedicine trends driving health care transformation in 2016 and beyond. Next, I will cover U.S. state lawmakers driving telemedicine expansion.

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This is the first post in our "Great Telemedicine Content" series.

Doxy.me has awesome partners. One of them is Nate Lacktman @ https://www.foley.com/nathaniel-m-lacktman/

He’s the smartest and most creative attorney we know in telemedicine.

If you enjoy his post you can read more @ https://www.linkedin.com/in/natelacktman or follow him on Twitter @Lacktman

Five Telemedicine Trends Transforming Health Care in 2016

Originally published Nov 16, 2015

Telemedicine is a key component in the health care industry shift to value-based care as a way to generate additional revenue, cut costs and enhance patient satisfaction. One of the biggest changes to health care in the last decade, telemedicine is experiencing rapid growth and deployment across a variety of applications.

The quick market adoption of telemedicine is fueled by powerful economic, social, and political forces — most notably, the growing consumer demand for more affordable and accessible care. These forces are pushing health care providers to grow and adapt their business models to the new health care marketplace.

Simultaneously changing is the misconception that telemedicine creates a financial strain or relies on grant funding. Smart health system leadership are creating sustainable telemedicine arrangements that generate revenue, not just cost savings, while improving patient care and satisfaction. Research conducted by the American Telemedicine Association reveals that telemedicine saves money for patients, providers, and payers compared to traditional health care practices, particularly by helping reduce the frequency and duration of hospital visits.

It is expected that the global telemedicine market will expand at a compound annual growth rate of 14.3 percent through 2020, eventually reaching $36.2 billion, as compared to $14.3 billion in 2014. And while the growing demand for convenience, innovation, and a personalized health care experience may be the greatest factor, other forces are at work as well.

These five trends will drive telemedicine’s continued growth and transformation of health care delivery in 2016:

1. Expanding Reimbursement and Payment Opportunities

Both private and government payers will continue to expand telemedicine coverage as consumers gain experience with the technology and increasingly demand access to telemedicine-based services. Some health plans have already begun bolstering their coverage of telemedicine, which they view as a form of value-based care that can improve the patient experience and offer substantial cost savings. On the government side, 2016 will particularly see more coverage among Medicaid managed care organizations and Medicare Advantage plans.

While Foley’s 2014 telemedicine survey revealed that reimbursement was the primary obstacle to telemedicine implementation, new laws requiring coverage of telemedicine-based services have been implemented at the state level, and 2016 will be the year these laws drive implementation in those states. Similarly, providers are becoming increasingly receptive to exploring payment models beyond fee-for-service reimbursement, and 2016 will continue the growth of these arrangements. Examples include institution-to-institution contracts and greater willingness by patients to pay out-of-pocket for these convenient, valuable services.

2. Uptick in International Arrangements

In 2016, more U.S. hospitals and health care providers will forge ties with overseas medical institutions, spreading U.S. health care expertise abroad. These cross-border partnerships will provide access to more patients, create additional revenue and help bolster international brands.According to the American Telemedicine Association, more than 200 academic medical centers in the U.S. already offer video-based consulting in other parts of the world. While many of these are pilot programs, 2016 will see a maturation and commercialization of much of these international arrangements, as they are a win-win for participants in both countries.

The growing purchasing power of middle-class populations in countries like China is giving more patients the means and opportunity to pursue treatment from Western medical centers. We have seen both for-profit and non-profit models for international telemedicine — hospitals partnering with organizations in the developing world to expand health care availability or offering commercial care to customers in nations with areas of concentrated wealth but lacking the capabilities and access of Western health care.

3. Continued Momentum at the State Level

State governments across the U.S. are leading the way in telemedicine expansion. According to astudy by the Center for Connected Health Policy, during the 2015 legislative session, more than 200 pieces of telemedicine-related legislation were introduced in 42 states. Currently, 29 states and the District of Columbia have enacted laws requiring that health plans cover telemedicine services. In 2016, we will see more bills supporting health insurance coverage for telemedicine-based services introduced in various state legislatures.

While state lawmakers are leading the way in incorporating telemedicine into the health care system, two recent developments point to a burgeoning interest at the federal level. The Centers for Medicare and Medicaid Services (CMS) is considering expansion of Medicare coverage for telemedicine, and a bill working its way through the U.S. House of Representatives would pay physicians for delivering telemedicine services to Medicare beneficiaries in any location.

4. Retail Clinics and Employer Onsite Health Centers on the Rise

A recent Towers Watson study found that more than 35 percent of employers with onsite health facilities offer telemedicine services, and another 12 percent plan to add these services in the next two years. Other studies suggest that nearly 70 percent of employers will offer telemedicine services as an employee benefit by 2017. The growth of nation-spanning telemedicine companies such asMDLIVE and the now publicly-traded Teladoc, which offer health services tailored to the specific needs of employers and other groups, is a reflection of the demand for these services.

Additionally, consumers are increasingly willing to visit retail medical clinics and pay out-of-pocket for the convenience and multiple benefits of telemedicine services when telemedicine is not covered by their insurance plans. Both CVS Health and Walgreens have publicly announced plans to incorporate telemedicine-based service components in their brick and mortar locations.

5. More ACOs Using Technology to Improve Care and Cut Costs

2016 will be the year of telemedicine and ACOs. Since the advent of Medicare Accountable Care Organizations (ACOs), the number of Medicare beneficiaries served has consistently grown from year to year, and early indications suggest the number of beneficiaries served by ACOs is likely to continue to increase in 2016. These organizations present an ideal avenue for the growth of telemedicine.

While CMS offers heavy cost-reduction incentives in the form of shared-saving payments, only 27 percent of ACOs achieved enough savings to qualify for those incentives last year. Meanwhile, only 20 percent of ACOs use telemedicine services, according to a recent study. We believe the widespread need to hit the incentive payment metrics, coupled with the low adoption rate will lead to significantly greater telemedicine use among ACOs in 2016.

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This is the second post of our "voice of telemedicine" blog series. An opportunity for telemedicine practitioners to share their experiences with telemedicine. Today’s guest blogger is Dr. John Silver:

A Retrospective of my 20 Year Voyage through Cyberspace

FREE SEX THERAPY! That was how my psychotherapy practice was listed on AOL if you were on the Information Superhighway in 1995 searching for “Therapy in Los Angeles.” Thus began my trip through Cyberspace 20 years ago. I had just sold The Counseling Center of West Los Angeles, which we created in 1979, and was casting about for a new source of patient referrals. My practice was now called Counseling Until Midnight, since I keep nocturnal hours. I turned to the Internet to augment client referrals, driving up the onramp at snail-like speeds with a personal computer, Windows 3.1 and a dial-up modem.

This little old computer brought back memories of 20 years before while working at the RAND Corporation where we did some of the early work in the integration of computers and psychology, in those days computers took up entire walls and the Internet was called the Arpanet and was used to link the government and universities together (in case of nuclear attack). In 1991 the Arpanet became the World Wide Web (or the Wild Wild Web as it was called) and was accessible by anyone with a personal computer and a telephone line. Webcams were not in use yet and Internet pages took sometimes 2 minutes to load. Communication was by email and chat (Instant Messages they were called). There would be no Skype until 2003. I decided to try the World Wide Web as a vehicle to advertise my services. I learned about the new Internet and taught myself how to build and code websites for maximum exposure (now called search engine optimization ). In designing my website, I thought free email advice was a good way to get my name out there. One of my certifications was as a Sex Therapist. AOL (the main ISP and search engine at the time) serendipitously combined Free Email Advice with Sex Therapist on my Website, resulting in the listing FREE SEX THERAPY. That shot me to the top of most searches having to do with Therapy in Los Angeles. I played upon this fortuitous event and got myself listed on every mental health directory or listing service possible. For almost 10 years the little one-page website I had created kept my practice filled.

Online Therapy And Counseling Until Midnight

During my private practice years with Counseling Until Midnight, I had learned all I could about Telemedicine. I had obtained Certification in Online Therapy in 2001. I studied what minimal information was available regarding the integration of law and ethics at it applied to online therapy. I developed my own telemedicine informed consent forms, contracts and other documents in order to protect the client and myself. Cable Internet and Skype had evolved so that Webconferencing was available, though the audio and video were primitive at best. There were no clear cut guidelines on the practice of online therapy. Laws were vague or non-existent. Psychological associations were maintaining their distance and would not take a position on the ethics involved. Was Online Therapy even under the purview of my California MFCC license? Since the Internet is accessible world wide, what about counseling across state and national boundaries? What about malpractice? How does one even practice online therapy? How is it similar or different than other modalities?

John Silver, Voyage

Through a consistent and diligent approach of researching best practices in this new world of technology, I spent the next 5 years taking every online course offered, reading all the latest articles on telemedicine and refining my online therapy practice to ensure it met all clinical, ethical and legal standards. At the same time, I became certified in psychoanalysis and cognitive behavioral therapy (CBT). My combination of clinical skills, coupled with my experience in online therapy, moved my practice forward, and I was able to expand it further by answering hundreds of email questions from around the world. I felt I was qualified to make clinical decisions as to what type of patient and what type of therapy would work for online therapy.

About 5 years ago I noticed that my placement in searches was falling further and further behind. It was time to evolve. I learned the new SEO as it related to Google’s ranking of websites and rebuilt my website. At the same time I was thinking of (semi) retirement. It occurred to me that having an online therapy practice would allow me to practice virtually world wide from wherever I settled. Of course the caveat was to invest the time, energy and resources required to become licensed, certified and compliant with the evolving Laws and Ethics in telebehavioral health.

Since “Counseling Until Midnight” was still coming up in search results, I attached Online Therapy to the name and became ‘”Online Therapy and Counseling Until Midnight”. It took about 2 years of intensive work doing SEO and website composition. As a result of my efforts to monitor my traffic and fine tune my outreach tactics, my company has migrated back to the top in most searches for Online Therapy (in Los Angeles and elsewhere). I had begun during the Wild West of Online Therapy, evolved with the times and now am practicing the art and science of Telemedicine.

John Silver can be reached at Email@DrJohnSilver.Com.

Online Therapy and Counseling Until Midnight
http://www.DrJohnSilver.Com ~ (310) 268-8282 ~ FAX (978) 268-8286 ~ Email@DrJohnSilver.Com
2100 Sawtelle Boulevard Suite #204 ~ Los Angeles, CA 90025
Marriage, Family and Child Counselor, M14943
Certified Modern Psychoanalyst, P90366
Certified Online Therapist, #00663

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