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Patients clamor for virtual visits, email communication; providers texting (at least to one another)

Monday, July 14, 2014

If it seems like the health care industry is ready for a seismic, technology-driven shift, some recent survey results suggest that’s because patients and providers alike are turning to new technology, or at the very least ready to turn to new technology.

It’s been widely reported that investment dollars from venture capitalists and others are flowing into health care technology, looking for the next big solution to the mandates for efficiency and value-driven care coming from the Affordable Care Act, Medicare and private payers alike. 

Patients and providers, already used to doing business online and using new avenues of communication such as texting, seem to be a ready market.

Turning back to the survey results, let’s start with the patients. recent study from telemedicine firm MDLIVE suggests that 82 percent of patients between 18 and 34 believe that being able to consult with a physician using a mobile device is the preferred way to go. 

Taking it a step further, 42 percent of those patients would be willing to sacrifice something for regular mobile device access to a physician, with the options including giving up shopping for a month, a vacation, showers for a week or a pay raise, according to Beckers’s Hospital CIO. Comparatively, only 19 percent of patients aged 55 to 64 would make a similar sacrifice. 

But almost everyone wants email. A different survey from Catalyst Healthcare Research found that 93 percent of patients wanted to have e-mail communications with their provider, with 25 percent of respondents sticking to that answer even if it came at a cost of $25 per episode. 

Such communications would include test results and discussions of care recommendations.

It’s not as though the providers themselves aren’t more technically proficient. Telemedicine and e-Health reports that 60 percent of physicians send and receive work related texts, with the top senders and receivers being other providers or facilities. More than half are having these communications even while off duty, and nearly half admit to privacy concerns about these exchanges. 

What’s the hold up?

The privacy concerns admitted to by the providers are not without merit. In fact, more than 10 percent reported seeing patient protected health information (PHI) in text messages. Given the already significant concerns of the prospect of patient health identity theft, it’s clear that any move toward texting health information with patients or any type of virtual visits can be done only with measures in place to protect patient security.

After all, the same patients who clamor for better physician access through email, texting and mobile visits will also expect that their information will be protected in the transaction and place the burden for doing so on the service provider. 

A second hold-up, at least when it comes to mobile visits and telemedicine, has to do with state laws regulating licensure. As we blogged about earlier in the week, telemedicine groups are pushing for more standard regulatory structures for physician licensure and scope of care to accommodate an explosion in growth in telemedicine and mobile services.

On the other hand, the AMA is pushing for tight rules that require providers who furnish services to have license to do so in the place where the patient is located. The beauty of telemedicine, of course, is that the provider can be located virtually anywhere to deliver the service. The regulatory infrastructure is not nearly as elegant. 


The last major barrier is payment. The common lament of providers is that there aren’t currently enough mechanisms in place to ensure proper and fair payment for technology driven services that don’t involve fee-for-service care delivered face to face by the physician. 

As a result, movement toward virtual visits, telemedicine and email and text communications are seen as ways to drive up cost and place significant additional burdens on the provider’s time without delivering revenue to the organization.

Many large health systems are moving toward more digital communication anyway, believing the benefits to the patient are worth the impact on the bottom line. This includes everything from online scheduling and payment, access to test results and even the ability to have health questions answered. 

It’s a business move they can afford to make. Not everyone is so fortunate.

How to break the logjam

Changes are already happening. Accountable Care Organizations (ACOs) and shared savings programs pushed by Medicare and private payers are rewarding efficient care and allowing for the possibility of putting revenue behind non face-to-face work that is keeping the patient healthier.

Costly penalties for re-admissions are resulting in hospitals becoming more engaged in keeping patients out of the hospital – including buying other provider types. 

The next, most obvious step toward virtual visits is some standardization of the licensure process or some mechanism to make it easier for providers to see patients across state lines. At the very least, even intrastate telemedicine and virtual visits will make it easier to deliver care to rural areas even without these changes.

Most rural areas, however, lack the population density to make true investment and reward in telemedicine a reality. 

Expect the avalanche of money pouring into investments in these new technologies to also help tell the story of the merits of telemedicine and become a push for regulatory change. 

The robustness of the investment in these technologies would hopefully also be accompanied by investment in the ability to secure communications with patients – if not by text, then at the very least by secure email.

The last frontier being addressed is how to harness the reams of data being added to the health care universe in a way that allows for care to be delivered in a smarter, more organized fashion. 

Population health management tools are starting to give health systems and providers much better insight into the current overall health and behavioral trends of their own patient population. It’s that data, properly used and applied, that will facilitate much better management of an entire patient population using a care delivery team.

The ability to determine how best to reach the patients who need to be reached with more limited resources will ultimately make it easier for even small and mid-sized groups to build better virtual relationships with patients around health management, including reminders for lab tests and screening services. 

Payers, who would also benefit from the efficiencies gained through better data management applied to patient care intended to keep the patient out of the costly hospital setting – and, in some cases, even the relatively more costly physician office setting – will be better positioned to quantify their own payment decisions around non face-to-face visits. 

It won’t happen overnight, but the change is already starting.

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