Marketing Health Optimizing sales & marketing yield

I think the adoption will happen over time, like any new technology, it takes time to break down the barriers of entry. Fear, price, privacy, regulation, and legal are all significant barriers. These barriers can be over come but at a steep cost of time and money (often time is the most expensive). 

US Healthcare is in a sad state because we are so afraid to try anything new that is technology related because of assumed risks. No one wants to be the "first" (plenty of people want to be the first to develop but not many want the liability) 

I developed a pilot project back in 1998 that would allow a single doctor to interact with nurse practitioners and patients in nursing homes. Rather than having to shuttle these elderly patients all over town to have their medical visits, 80% of the diagnosis and checkups could be conducted in a special designed room that would allow telemetry of patient biometrics and two way video conferencing with a HD video wand that could be used to give the doctor a detailed look at lesions and other visually diagnosed conditions. 

A NP or nurse would in effect be the doctors hands and help facilitate the session. This would have helped to reduce injures sustained while in transit to the medical facilities which we found was alarmingly high. 

The ideas was to early for its time and we had difficulty getting traction even though the idea was widely loved due to the factors listed above. 

I have since developed walk-in medical clinics that have been deployed in shopping centers and drugstores, another area that no one said would ever happen and has shown great success. 

In the end, time is really the solution no matter how frustrating the wait can be. Keep pushing and innovating and you can lead the industry. 

We have since developed simulations that allow doctors to experience what a patient is feeling when they have a disease such as heart failure or MS. These multi-sensory and immersive simulations use the biometric technology I developed to sense the doctors anxiety, respiratory and heart rate as well as muscle stimulation to deliver a realistic and clinically accurate disease state simulation. These simulations help HCPs communicate more empathetically as well as have a contextual understanding that can differ from the clinical diagnosis. 

You can see our work here:

Human Condition

www.hcxlabs.com

Hi Peter,

Very interesting work. I think there are possibilities of me looking at some solutions from you.

Walk in clinics is good idea.In India, it has been into practise for quite sometime.

I have been thinking of neighborhood telemedicine. This is by setting up weekly visiting vans in targeted geographies. These vans will have telemedicine equipments and nurses deployed. Patients who have time shortage, or patients Who are immobile would benefit the most. They will be able to get consultation from their doctors  right in their neighborhood.

I would like to know if there is a technology that allows device in van can connect to multiple bases? This means that the vans can connect to multiple hospitals offering telemedicine consultation. BY this I would free up my model from any obligation to any hjospityal. The patients would be able to choose their doctors from any hospital that registers to offer its services in my model.

Ashish,

That sounds like an interesting model, what are the systems currently in place at hospitals now? What is your local cellular network's technology?

I am not familiar with Indian medical regulations so I don't know the nuances or barriers yet.

Regards,

I have this telemedicine quipment from local manufacturer. We use dedicated broadband for data transffer.

Its point to point.

In the model that I am talking of, I have option of using 3G network of cell phone operators, or wimax hotspots (this will not work as its binds freedom of location.)

I think, I am left with 3G option to use net. Additionally, I would like to explore, if my service center in van can connect to multiple hospitals for teleconsulting. Of course, I can use it if its one hospital to connect to. 

Good to see comprehensive email. Surely the reach and utilization in telemedicine is slow. This also applies (not only telemedicine) to other healthcare applications like HIS, HMS etc. The IT systems are used more for accounting and administrator task, in general. Telemedicine being networking product it makes utilization more challenging.

Top 3 factors for lesser utilization of IT healthcare are

1. User resistance

2. Incomplete system and

3. Cost

For better utilization of IT system, it must deliver better patient care or it must save time. Otherwise it is hard to inspire user to use it. To overcome partial use we need to implement standards and integrate all healthcare domains.

Specific to telemedicine; the telemedicine 1.0 can be defined as clinical (Doctor to doctor) telemedicine. Where main users are doctors from remote clinic & expert doctors are from speciality hospitals. And telemedicine 2.0 can be defined as home healthcare. There is requirement and scope for both the system.

Telemedicine 1.0 is more used for

• Second opinion; first opinion, education & CME
  

Whereas telemedicine 2.0 is more used for

• Patient monitoring and follow up.
  

In case of tm1.0; viability of business will be attractive once one is out from shadow of existing system or we must remove the hurdle or complexity related with tm1.0. The biggest hurdle is inconvenience to doctor. How one can assume busy physician to walk 100-500 mt to telemedicine center and wait for video conf call? Unless close tie-up between remote physician and expert doctor you can't make telemedicine success. We need to provide tm1.0 @ doctor's laptop or PC. So that he can access it at his convenience time slot; mid night or early morning. The software must be easy to use hence doctor can use it even w/o training. Your system must be built with many uses case; application for hospitals; for remote physician; for patient etc. Thus one can utilize the system for wide audience.

The ROI or direct return will not be very attractive in telemedicine. Though it has many indirect advantages; like better patient satisfaction. e.g. for international patient (or patient come from distance) give access of telemedicine to patient once his surgery is over. The patient can use the system to communicate with you for follow up. It saves patient time and provides assurance of your availability even after surgery. If so the low ROI can be very well acceptable with medicos. Arguably, what is the ROI of MRI machine?

Cost is the big concern for such tm1.0 setup. The biggest cost component is video conferencing system and atypical communication media like VSAT. This can be easily eliminated.

Coming to telemedicine 2.0; also called home healthcare. As indicated it is mostly for patient monitoring (also called remote patient monitoring (RPM)). There are lot of such equipments like tele-weight, tele-bp, tele-ecg, tele-temp, tele-diabetic etc. are available.

How important remote monitoring is? How it add value next to existing process? Group member especially physician better opine it, will be excellent. The existing equipments are very costly; naturally the cost (added to subscription) will be borne by patient. How the business or cost equation works after you add doctor's monitoring charges? I see the case and business opportunity for tele-ecg. Will add more detail on response.

Thanks.

Devendra Patel

A medical care service that replaces the standard doctor's check-up for a virtual, webcam-based one - while still working within the traditional U.S. healthcare system.

Interesting artile about that in the New York Times:

Patients who are members of the health plan pay a co-pay, just like at the doctor's office. Doctors hold 10-minute appointments, which can be extended for an optional fee, and can file prescriptions through the system. Uninsured patients can also use it, for a fee that the health plans choose but which will be less than $50, much less than a visit to the emergency room, which is where the uninsured often end up. Health plans pay American Well a license fee per member to use the software, as well as a transaction fee of about $2 a patient each time a patient sees a doctor.

Doctors, meanwhile, pick up a few extra dollars on the side. They get paid less than an office visit but more than a phone consult and do not have to worry about scheduling, overhead and paperwork. They just log on and wait for patients to come to them. American Well files all the claims, and the money is deposited into the doctor's bank account.

Diabetes is a looming public health crisis, commanding the attention of providers, policy-makers, payers and, of course, patients themselves. Today, with close to 24 million people in the United States diagnosed with diabetes and another 57 million people with pre-diabetes, 27 percent of the population has or is at signifi cant risk of developing the disease.

The total annual economic cost is estimated at $174 billion and rising quickly.

Like other chronic conditions linked to obesity, nutrition and exercise, diabetes presents a substantial opportunity to leverage connected health applications. DiabetesConnect, a program developed by the Center for Connected Health, focuses on controlling diabetes through collaborative management, using patient self-care, remote monitoring and real-time provider interventions to drive better clinical outcomes. The program encourages patient and provider engagement and empowers patients to become more active managers of their condition.

DiabetesConnect patients monitor and upload their glucometer data on a regular basis and enter observations and medication changes in an online journal. Patients and providers share access to blood sugar levels, graphs, and journal content.

Providers can see up-to-date patient information, send secure messages and change treatment plans without waiting for a scheduled appointment. Providers participating in the program give it high marks for improving the effi ciency with which they provide care to patients.

"Ideally, I would recommend every diabetes patient be enrolled in the connected health program, and certainly every patient on insulin," said Marcy Bergeron, RN, MS, ANP, Bulfi nch Medical Group, Massachusetts General Hospital. "More efficient patient monitoring also may lower barriers and reduce the inertia that prevent clinicians from starting patients on insulin." Shila Hill (left), Diabetes Nurse Educator at Brigham and Women's at Newton Corner, said, "This program improves communication between the patient and the provider. I think all type 2 diabetes patients would benefi t. The program is also easy for the provider to use, we get real-time data and can view the information in different ways."

Jeanne Wood, a patient of Shila Hill, noted, "About two years ago, my blood sugar elevated and oral medications were no longer helping to control my diabetes. And I started taking insulin. At that point, my readings were very high, and tracing became critical. As a result of my ability to easily track and report my blood sugar levels, I've had my medication changed about eight to ten times in the past few months. This program is very easy to use and very user friendly. The ability to make comments and the charts and graphs are very helpful. I could see myself using this program indefinitely."

After piloting DiabetesConnect in several primary care practices affi liated with Brigham and Women's and Massachusetts General Hospitals, the program is now expanding across the Partners HealthCare system. With added functionality and a customer service team in place, the program is also getting ready for use by physicians and group practices outside of the Partners network.

Telemedicine in India is in a development phase.

To begin with We have a telephonic exchange between a junior doctor and a senior/specialist doctor.

Now, say an ECG is there. The junior can read and tell the expert on phone and decide about the treatment.

If he is not able to interpret he faxes it and then talks about the treatment.

Now he has the option to send the ECG directly on  the  monitor through internet ( realtime or store and forward)

BP measurement by digital instruments is still a controversy

Transmission of heart and lung sounds is a problem.

Conferencing with other people/experts is not a great thing now.

So it is a big thing in rural India even at this level.

However a session with a non-medical person as a care provider is difficult and risky

Dr R P Pareek

Dr. Pareek,

Given the rural scenario in India and other emerging economies, any kind of connectivity (like the one you are talking of) is a great boon.

In India, the penetration of BSNL is fairly good in rural areas. BSNL has a good band width to enable rich data ( medical- visual and audio) transmission.

On telemedicine 2.0 front, I think we need to experiment with patient interaction on cell phones. A standard entry level phone has a high penetration in rural India. Most of the interaction may be sms driven, but that can be integrated to web for a doctor to monitor.

With recent audio messaging system launched by cell phone operators, I see much larger scope by enabling rural citizens to interact more effectively rather than texting!.

check this out on mobile telemedicine:

http://blog.alensa.com/blog/2009/01/23/3g-doctor-pioneering-mobile-telemedicine-in-the-uk/