Back in 2008 when American Well was founded, there was some skepticism as to the impact telemedicine – and the newly minted “telehealth” – could realistically have on the industry, and the benefits for health systems and their physicians and patients. Legitimate questions about technology, security and usability largely drove these concerns. But over the years, as comfort with technology (including the near-ubiquitous adoption of smartphones and tablets) and wireless broadband improved, the landscape for telehealth became more fertile. Coupled with payment reform and the evolution of next-generation telehealth technologies, these top-level concerns and barriers have largely been erased. However, we’re not naïve enough to think there are no more hesitations.
Early adopters of telehealth were health plans and employers that traditionally focused on online urgent care use cases. This simple, isolated transaction delivers value in the form of time and cost savings to patients by giving them immediate access to clinicians, but barely scratches the surface on the real impact that telehealth can have for health systems and the $3.8 trillion industry broadly. Just in the past couple of years – and specifically with the recent release of AW8 – these second tier concerns related to widespread integration are rapidly eroding, as described below.
Problem: Limited physician mobility
It was never realistic to have a “launch center” for telehealth, or even have it only accessible from a physician’s computer, like the old point-to-point hub-and-spoke telemedicine technologies of the past. The average doctor isn’t sitting at a desk; he or she is visiting with patients and navigating the hospital or office. Telehealth technology needs to be as mobile as doctors themselves.
Solution: With our new provider mobile app doctors can now carry their telehealth practice in their pocket, and see patients when they’re available from their smartphone or tablet. They have everything they need to practice telehealth in the palm of their hands, including being able to schedule appointments, review patient records, perform documentation, prescribe medication, send secure messages and have live, face-to-face video visits.
Problem: Limited physician availability
With traditional telehealth, it was necessary for a physician to block off time in order to see patients online, but reserving an hour or two each day to practice telehealth simply isn’t feasible when attending to patients in-person. Bridging the gap between brick-and-mortar medicine and telehealth is essential to efficiently utilize clinical resources.
Solution: With AW8’s AskMe status, doctors can make themselves available to receive telehealth requests from patients, but then simply accept or decline them based on their current availability. If the doctor has ten free minutes—the average time of an online appointment—he or she can accept the visit. If the physician is busy, American Well’s patented brokerage system simply pings another available doctor within that specific physician network straight away. This type of availability management allows health systems to project their clinical resources in a much more efficient manner, without requiring physicians to sign up for pre-determined times to staff the telehealth service. This functionality also makes it much more feasible to connect clinical resources with each other for virtual curbside consults via American Well’s Telemed Tablet.
Problem: Limited usability with existing patients
Doctors have established relationships with their own patients. The real value of telehealth is allowing doctors to care for those patients remotely, but this has been difficult to support in the past. Because of this disconnect, telehealth had been relegated to only urgent care transactions and not lived up to its full potential.
Solution: American Well allows doctors to utilize telehealth to care for their own patients, and control their online practices right from a simple, easy-to-use mobile app or website. These can be immediate or scheduled visits, and email invitations guide patients directly into the visit with their doctor. Scheduling with practice management systems and EMRs can also be integrated into the telehealth platform for a more robust experience for both patients and doctors.
Problem: Telehealth is primarily for urgent care
Urgent care and telehealth have traditionally been synonymous with one another. Strep throat, fevers, headaches, urinary tract infections—these are all easily and effectively diagnosed via telehealth, which is great, but has limited telehealth’s usability for health systems and physicians.
Solution: Integrations with biometric devices—in combination with being able to see their own patients—allows physicians to really expand the scope in which they use telehealth. Doctors can review data collected from a patient’s home biometric reader and actually monitor progress or changes over time. This type of capability is dramatically shifting telehealth from a tool largely reserved for urgent care, to one of population health and chronic care management. AW8 is integrated with Apple Health to allow this type of remote monitoring. Our provider mobile app makes it possible for physicians to view these integrated biometric readings wherever they are, making remote monitoring easy and convenient.
Problem: Telehealth doesn’t include physician-to-physician consults
In many health systems, there isn’t a specialist available 24 hours a day, seven days a week at every facility, which makes immediate consultations difficult. But old school telemedicine technologies were clumsy and required hands-on scheduling and dedicated and very expensive hardware.
Solution: American Well’s Telemed Tablet transforms the concept of traditional telemedicine consults by connecting physicians all over the country in just two clicks. Using a touchscreen interface, physicians can request and immediately connect for live video visits with clinicians and remote providers in specific specialties for consultations.
Problem: Consumer interest, adoption and engagement
Consumers gravitate toward what they are familiar with, which has been in-person doctor appointments. Because of this, consumers have been hesitant to adopt or engagement with telehealth. Yet, traditional healthcare options come with huge gaps in care, namely accessibility, availability, and convenience.
Solution: American Well partnered with Harris Poll to run a nationally projectable online survey to find out how consumers feel about telehealth. An impressive 64% of consumers said they were willing to have a video visit with a doctor, stating convenience and time saved as two big factors. Telehealth allows patients to receive the right care at the right time; compared to traditional options that limit the time and place you are able to access a doctor. Generally, we are also seeing a huge adoption of smartphones in the U.S that is leading to a more app-based culture. As of April 2015, 64% of Americans used a smartphone compared to just 35% in 2011. This tells us people are more willing to use your smartphone to see a doctor than ever before.
Problem: Regulatory acceptance
Since its existence, telehealth has been viewed as the wild, wild west of healthcare—and for good reason. There were no rules or regulations as to how the industry should operate, and no distinguishing factors between good telehealth and bad telehealth. Many telehealth companies operated – and still do – on the periphery, skirting medical board regulations. It didn’t help that many medical boards lacked formal definition of safe and efficacious telehealth.
Solution: In April 2014, the Federation of State Medical Board (FSMB) set forth guidelines for the safe practice of telehealth. Overall, they stipulated over a dozen operating principles. These guidelines give states a complete roadmap for ensuring that patients are protected in this ever-changing healthcare delivery environment. It also gave states clear definitions and principles to guide policies governing the use of telehealth. American Well is FSMB compliant, meeting all principles for the acceptable practicing of telehealth.
So, what’s next for telehealth?
Many of the issues relating to telehealth have been resolved. Reimbursement appears to be the final hurdle, but with half of all states having legislated private payer reimbursement for telehealth, the deck stacked against telehealth will shrink even more. It’s only a matter of time before telehealth is broadly adopted and just a more convenient, cost effective way for doctors to care for patients. Don’t be caught on the sidelines as telehealth becomes a dominant way to practice good medicine.