TruClinc - A telemedicine platform that is gaining acceptance with providers.

Telemedicine is finally getting off of the ground with TruClinic.

Very different from the doc-in-a-box model of other telemedicine players, TruClinic is the first truly embedded technology that closely fits how providers already work.

TruClinic has been built into a full telemedicine platform with a knack for tackling hard integrations, bottom-up user growth, and jaw-dropping uses. TruClinic’s cloud-based portal gives providders and patients access to each other from anywhere. All they need is a computing device, Internet connection, and a webcam, smart phone or tablet. From remotely wiring every home on the Goshute Reservation to facilitating interactions between a mother and her newborn child in an ICU to hosting surgical followup appointments, the uses of an always on, instantly connected telemedicine platform are only starting to be realized.

TruClinic is already being used actively by both small individual physician clinics, and larger hospital and clinic chains like the University of Utah Health Care that serves 5 surroundings states in a referral area encompassing more than 10 percent of the continental US and where TruClinc helps the U to reach their clients better, particularly in fields that mostly require communication, like mental health or post-surgery follow-up.

The University of Utah Health Care System is a thought leader in telemedicine. Here's a video:

You can request a demo of TruClinic here.

One of the places that this is likely to be addopted first by individual physicians is around concierge or cosmetic medicine, where a very high-touch interaction at a distance can really have an effect on an ability to scale and interact with more patients in the same amount of time.

Theranos - It’s now worth more than $9 billion, and poised to change health care.

I see a lot of startups that look at some form of incremental increase. Theranos is looking to remake the diagnostic and blood testing industry entirely.

Theranos is a story worth learning about: Could there be one of the first real moves towards always-on diagnosis technology that really drives preventive medicine forward?

Holmes had then just spent the summer working in a lab at the Genome Institute in Singapore, a post she had been able to fill thanks to having learned Mandarin in her spare hours as a Houston teenager. Upon returning to Palo Alto, she showed Robertson a patent application she had just written. As a freshman, Holmes had taken Robertson’s seminar on advanced drug-delivery devices–things like patches, pills, and even a contact-lens-like film that secreted glaucoma medication–but now she had invented one the likes of which Robertson had never conceived. It was a wearable patch that, in addition to administering a drug, would monitor variables in the patient’s blood to see if the therapy was having the desired effect, and adjust the dosage accordingly.

“I remember her saying, ‘And we could put a cellphone chip on it, and it could telemeter out to the doctor or the patient what was going on,’ ” Robertson recounts. “And I kind of kicked myself. I’d consulted in this area for 30 years, but I’d never said, here we make all these gizmos that measure, and all these systems that deliver, but I never brought the two together.”

Is Telemedicine A Perfect Solution?

Telemedicine has been the subject of many recent discussions between me and this guest author, Murdoc Khaleghi, MD, MBA, FACEP, FAAEM.

Keeping up with the healthcare trends is essential, whether you are practicing clinically or in a non-clinical job because those trends determine tomorrow’s opportunities.  The Supreme Court decision regarding the Affordable Care Act set certain wheels in motion regarding future mandates and legislation.  However, we would argue that the US health system is in the midst of innovation and change regardless of the judicial system.   Some of the problem like rising costs, older, sicker people and consumerism are independent of any federal legislation.

Technology solutions aim to solve some of those problems and have been written about on this site.   Jeff Barson discussed how medical outsourcing is becoming standard practice for certain specialties (http://freelancemd.com/blog/2010/12/6/physician-outsourcing-technology-will-flatten-the-medical-wo.html).  Arlen Meyers wrote about different interface technologies that are intended for non-medical use but have potential medical or healthcare applications or value (http://freelancemd.com/blog/2010/12/12/working-on-the-edge.html)

Telemedicine or telehealth appears to be one of the fastest growing areas of health care.  Physicians like the flexibility of when and how much they work, without the tie to the office.   Not having to work in an office also reduces overhead significantly, while allowing physicians to work from anywhere.  It seems telemedicine may be another tool for the doctors who are looking for help improving and expanding their practices or exploring a non-traditional medical area.   One doctor had this to say,

“I can consult from the comfort of my deck, or easily schedule exercise and breaks into my day.  I am even planning a few consults per day at a vacation home.   There are no refills to sign for, no urgent care calls in the middle of the night.”

Obviously, telemedicine does not take care of all medical issues, such as those that require procedures or immediate interventions, but for preventative care and low-acuity complaints, telemedicine can be an effective form of healthcare delivery.  For example, telemedicine can take advantage of many internet-based features.  Health information, diagnostic tests, consultations, and recommendations can all be performed or shared with providers and patients via the cloud.  A recent article published online on June 22 in the British Medical Journal reported that for patients with long term conditions, telehealth can reduce 12-month mortality by nearly half.  Other benefits included reduced hospital stay and mean number of emergency admissions.

WellnessFX and ISelectMD are two telemedicine companies that seem to be doing something unique and innovative.  WellnessFX has a focus on preventive medicine but hires doctors of all specialties.  Companies like Teledoc, American Well and Ring-A-Doc also continue to bring new and useful products and services to market.  These companies all hire doctors as consultants to do work on a part time or piece meal basis.   Some doctors want to launch concierge medicine services and others want to bring in more clients and offer service outside of traditional working hours. 

As physicians, we are always interested in patient outcomes and patient satisfaction. Many patients like telehealth because it allows for more flexibility in scheduling appointments and they can avoid time in waiting rooms.  Going back to recent health reform trends, with more regulation and legislation, patient satisfaction scores are becoming more important as a reflection of overall quality of care.  Interestingly, telehealth seems to be meeting patients’ needs.  From these actual notes, it seems apparent to us that telehealth not only meets patient needs but also can contribute to coordination of care. 

"WellnessFX saved my life. Without it, I would have struggled through more specialists, different drug treatments, and continued fatigue and ill health. Now, I'm in control to optimize my health."

"I would like to take the time to thank ISelect MD for helping me over the weekend. I tried several times to reach my doctor over the weekend who did not return my call. I called ISelect MD and within 10 minutes I received a call from one of your doctors.

He asked me a variety of questions relating to my issue and knew all about the problem. He spent a great deal of time on the phone with me….and directed me to a specialist who I now have an appointment with.  I was surprised by the concern that the ISelect MD people have for me. Since the initial call, I have been contacted by the doctor and the staff at ISelect MD three times for follow up.  This has been the best experience I have ever had concerning my medical needs."

What do you think of telemedicine?  Is this a solution to some of the problems in healthcare?

10 Ideas To Spark Health Care Change

What does the future hold for other industries? We can use these ideas as a springboard in our medicine culture.

A recent article from the online and print magazine Inc. titled: "10 Cool New Tech Ideas to Help You Market Your Business" showcases many innovative approaches that businesses are utilizing to engage their customers. While I think that these ideas are worth viewing from the marketing perspective, I think there is also great value in changing the perspective to view these ideas in terms of medicine and health care.

Specifically, how can we embrace these visionary ideas to help transform medicine towards a brighter future? Let's dive right in:

1) Facial recognition: imagine pulling out your iPhone or Android and taking a facial recognition photo and sending it to your doctor via your EHR platform. The software could read your facial expressions, wrinkles, and blemishes and compare this to a facial photo from 6 weeks or 6 months ago. Do you have difficulty sleeping (dark circles under your eyes), are you more stressed than usual (deeper wrinkle set) or are you getting too much sun (deeper skin blemishes)? The potential here is enormous.

2) Hyper Targeting: imagine being able to make recommendations to patients based upon pre-determined factors such as age, fitness level, diagnosis, medicine, supplements, etc. The software for this type of process already exists--we would just need to tweak it to make it work for health issues. So, patient Jane who shares characteristics with patient Mary could receive updates providing ideas for cooking, exercises, book choices, etc. This would not only personalize Jane's experience but also have the potential to improve her outcome as a patient.

3) Eavsdropping Apps: maybe we should rephrase this one as Preference Apps: allow patients to tell us about their lifestyle choices by what they focus on. Again, we could use the EHR as a platform where the patient would allow access to her smartphone apps, book, food, exercise preferences and we could then gain better insight into how the patient lives and walks. We could then make better holistic recommendations to her regarding all aspects of her life. As we know, health is more about our choices than anything else.

4) Augmented Reality: I have written about this before...I truly think that medicine and health will embrace the gaming of our society and incorporate virtual health/ medicine in a gaming type of structure. Doctors and patients will be able to interact in a meaningful way via a Sims like game-style approach. I'm excited to see this come to fruition.

5) Mobile: Codes and Spot Targeting: At first glance this one does not seem to fit into a future of medicine model, but I think we can be creative and start incorporating these Quick Response (QR) codes onto prescription meds and health related products. Maybe a patient can scan the code to learn about the side effects of medicine or be taken to a link to a forum where people are using this same medicine? Not sure, but there are many possibilities with this technology.

6) Video: the other day my kids and I were waiting outside in the car while my wife mailed some packages--we sent each other video texts back and forth to amuse each other while we all waited. We can do the same with patients--sending them quick, relevant and timely text messages could mean the world to them.

7) Incentives and Virtual Currency: we are seeing a thrust of different games and Apps that allow users to "win" points to be used elsewhere. We can do the same in medicine. We already see how well the Wii fitness games have pushed us in the same direction. We can take this several steps further where patients who play these games get points towards supplement purchases, coupons off medicines or office visits, etc. 

8) Social analytics: We need this in medicine to help us get a sense of how well we are reaching out to our patients/ clients. The faster we adopt the approach that seeks to reward physicians based upon how well they communicate with patients, the better. We have the tools for this, but are lacking in the will right now.

9) Web: this one is fairly obvious....we all have websites, but how can we interact with our patients better and make the web experience more valuable to each of them? This will be a perpetual challenge for time to come.

10) Deals: our patients are consumers and the sooner we create a practice environment that embraces this notion, the better. Who isn't looking for a deal? In medicine we tend to shy away from this mentality as we don't want to be too salesy, but the more confidence we have in the product we are selling, the less we are actually selling. In health and medicine we have been focused to acutely on the medicines themselves as the prescriptions, but the better product is the connections with our patients. So why not create better deals to help you connect with your patients?

I am sure that you can take these ideas and run with them in more expansive ways than I have. Change often occurs faster when we take advantage of "outsider" ideas and perspectives. We are all here because we are seeking much more than the routine medicine has shown us. These ideas can serve as a spark to help get you going. 

What With All You ER Docs Starting Things?

Everywhere I look, there's another ER application.

When I'm at a cocktail party, one of the questions I get asked the most is , "What made you become an ENT doctor?" My thought is that medical students make their career decisions based on a lot of factors, but perhaps the one that stands out the most is the "personality" of the specialty they choose.  Take the following quiz by matching the word with the specialty:

A. Jock                                            A. Cardiothoracic surgeon

B. God                                            B. Psychiatrist

C. Looking for answers                  C. ENT doc

D. Geeky gadgeteer                       D. Orthopod

E. Life Styler                                   E. Emergency Medicine Specialist

One of the great things about working with SoPE (http://www.sopenet.org) is I get to hear about a lot of great innovative ideas. Lately, it seems, I've met more ER docs with great ideas than I can recall.

One , www.scribesstat.com, assigns pre-med scribes to ER docs to enter data into the EMR, thus making them more efficient.  Another, www.itriage.com, is a mobile health triage app that directs patients to the right place at the right time, and even gives you wait times in the ER or ambulatory facility you choose. Another ER doc wants to revisit an old infatuation with marine biology and commercialize products that come from the sea. As we all know by now, Bledsoe created this website and runs medical conferences looking for polar bears in Canada.

What's with these people? Can any of you out there help me understand this?

I think the rest of us can learn a lot from these life-stylers. Give yourself a present if you got that answer right.

Medical Cloud Computing Applications Can Generate Revenue & Cut Costs

Get Your Head in the Cloud. Cloud computing can accelerate your growth and save your bottom line.

Twenty five years ago, on my first day of business school, I was issued a 25 pound dumb terminal and a modem.  My fellow students and I used them to connect to a mainframe computer 36 miles away by way of telephone wires so we could do financial analysis and simulations. The most difficult part of the entire process was listening to our families complain about us tying up the telephone lines every night.

Today, I was sent an email solicitation for a cloud-based SaaS (software as a service) application that integrates voice-to-text dictation with a billing and collection software module. Indeed, things have changed.

The IT industry has migrated from direct attached storage (DAS) to nework attached storage (NAS) and storage area networks (SAN). Cloud computing is the next step in IT evolution.

Cloud computing has several key attributes:

• The ability to rapidly provide a service
• A consumption model were users pay for what they use
• The ability to scale up or scale down use without extensive pre-planning
• A secure, direct connection to the cloud without having to recode applications
• Multi-tenancy capabilities that segregate and protect the data

http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=cloud+storage+for+dummies

The promise of cloud architecture means you no longer have to have your own server, store your own data, worry about backup systems, update software or deal with down time. The Colorado Telehealth Network, e.g. (http://www.cotelehealth.com), offers over 50 cloud based software applications for medical practices including EMR's, scheduling, billing and collection, voice-to-text dictation, and payroll management. The ability to intregrate scheduling, with clinical systems and  with financial systems reduces the need for repetitive data entry, makes entering data easier, by dication or other interfaces, and gets the bills out quicker and more accurately.

Cloud computing is rapidly changing how doctors do business. What's more, it is another non-clinical career pathway. The best part, though, is my wife no longer complains about the busy signal.

What Can Mobile Health Learn From Mobile Commerce?

Mobile health is the next wave. We should learn from Ikea.

Consultants at Booze recently released a report on the growth of mobile commerce, m-commerce. http://www.strategy-business.com/article/00053?pg=3  Retailers are creating imaginative ways for shoppers to have a better shopping  experience and, in so doing, drive sales. IKEA. the furniture giant, allows customers to first create a virtual model of the room they are buying furniture for, by entering the dimensions, and then load 3-D models of items to see how well the pieces fit. Mobile health, mHealth, is following the same pathway and could learn a thing or two from m-commerce merchants.

The report mentions that m-commerce numbers will surely grow rapidly, if only because the penetration of smartphones (a category that includes the iPhone, Android, BlackBerry, and others) is expected to increase from 17 percent in the U.S. and 15 percent in the E.U. today to 74 percent and 43 percent, respectively, by 2014. By 2013, as many as half the consumers in a typical retail store will use their smartphones for shopping.

Likewise, more and more patients will use their phones to access and experience healthcare. Imagine your patient tweeting their friends in real time about what they've experienced in the PACU.

Or, sending cell phone images of reception areas, birthing suites and even their doctors. Booz found that  conversion rates (turning browsing into sales) increase by as much as 240 percent when consumers view ratings and reviews while shopping. The same will happen in healthcare.

The objective of m-health products and services are the same as they are for m-commerce: to improve the customer/patient experience, to provide information, to make it easier to access and use your products and to create loyalty.

In a short time, we've gone from Sears catalogues, a game changer in its time, to mcommerce. Mhealth will follow.