Insiders: Health care's 'Uber moment' isn't here yet

While telemedicine is touted as the future of healthcare in the US with its ability to remotely manage patients and provide on-demand care, it still has much more to give, according to healthcare IT movers and shakers who attended the Politico health IT advisory forum last week. For some, the ultimate goal is for all users to feel comfortable with the technology, such as apps, to obtain health advice and care, while others stressed that there will always be medical conditions that require face-to-face consultations and a balance between the two needs to be struck.

But they all agreed that health care’s “Uber moment” — where the vast majority of consumers feel comfortable using apps to get on-demand consults and care — isn’t here yet.

“Telemedicine is absolutely more real than hype,” said one CEO. "[But] this is just the beginning.”

“The tipping point will occur when the public believes that they get equal quality care via telemedicine as they do in person,” said an investor.

“The most common reasons for physician office visits can’t be done online yet,” added another investor, pointing to conditions like a sore throat or an earache. “We are overestimating the impact of technology today and probably underestimating its long-term impact in the virtual visit.”

Still, the case studies of success are mounting, participants said, especially by hospitals that are using the new technologies strategically.

One CEO cited the example of Banner Health, a health system that reduced hospitalizations and long-term care stays in its highest-cost chronic care patients by 27 percent after giving them health apps and remote monitoring tools — such as blood pressure cuffs and weight scales — to record daily vitals.

Other forum members said telemedicine is successfully extending health systems’ footprints. “The most action seems to be in hospital systems bringing in vendors to add health system-branded telemed capacity,” one investor argued. That way, “they can retain the patient and not lose them to MinuteClinic and others.”

In some ways, the new technologies are closing gaps that span distance and dollars. “We’re already seeing tele-services that can move world-class care out of academic medical centers and deliver it to populations in underserved markets,” said a health care executive. “Today, a South Dakota rancher with an arrhythmia can gain access to the same doctors that an executive in Boston might have.”

“For a rural or otherwise isolated location with limited clinical expertise it saves lives and dollars daily,” added one physician. “Last-mile limitations” — the telecommunications challenge — “are still more significant in many rural areas than most folks think.”

But different experts see different trends, depending on where they sit. Several consultants and investors said these new technologies are potentially exacerbating gaps, with well-heeled patients especially likely to benefit from them. “Where telemedicine has shown some traction is in the type of concierge medicine embellishment,” said an executive. “But is that really where health care should be focused?”

Several participants said some new models of care could detract from continuity and quality. For example, retail clinics often don’t share information with primary care doctors. Recent studies have also raised concerns about the clinical quality and medical ethics of some direct-to-consumer telemedicine providers, a physician said.

The common perception of telemedicine as simply a real-time video consult tends to ignore some of the truly exciting possibilities of new technologies, several participants said, pointing to tools like remote monitoring, devices that help patients manage their conditions, and online patient support groups.

“I’m not sure what the ‘promise’ [of telemedicine] was,” said one executive, “but I’m not sure it ever accounted for the potential for advanced data science applied to the much richer datasets that can be collected through truly holistic remote care.”

“Maybe telemedicine will be a true innovative force when we integrate real-time monitoring and other [Internet of Things] access points into the standard offerings so that telemedicine is not just a rehash of today’s medicine but a reinvention that makes face-to-face care delivery obsolete in many circumstances,” said another executive. “Just like paper ordering is now in all U.S. hospitals.”

One CEO who’s bullish on telemedicine said that health care’s new new thing can take lessons from the centuries-old practice of medicine.

“At the end of the day, people need relationships — it’s a part of human nature,” the CEO said. “Those telemedicine technologies that survive will be the ones that foster a deeper, more intimate relationship between patient and provider.”