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Seeing the Doc

As the barriers to video communications fall, it will break out of the conference room with new use cases, thereby pushing the boundaries of acceptable use. The appropriate use of video can be confusing, as illustrated in the 2009 film Up In the Air, with its depictions of employees being laid off via video conference.

In general, though, video communications are effective because a significant portion of how we communicate involves visual information. But another compelling benefit is realized before and after the conversation--efficiency. Calendar invites typically come in increments of 30 minutes and rarely accommodate for necessary transit time. Transit overhead as a percentage increases when meetings are distant (air travel) or short (when it may take longer to get to the meeting than the meeting itself actually lasts).

This overhead burden applies to all participants, but not equally. Doctors often maximize their productivity by pushing the inefficiencies to the patients. The house-call is long gone, replaced with appointments in closely clustered examination rooms. A 15-minute exam can easily consume two hours of the patient's time with commuting and wait times.

Obviously, the productivity burden on patients is a bit one-sided. The inefficient system also incentivizes medical professionals to work in population centers. Since billing rates are primarily set by insurance companies, productivity is the prime lever for doctors to impact their income. Outside major population centers, medical care is becoming hard to find--particularly specialists. Inconvenience aside, not all patients are able to travel, resulting in major gaps in provider coverage.

Actually, the supply of medical professionals in the cities is also a concern. Numerous sources predict physician shortages worldwide including U.S. cities. Doctors are expected to retire faster than medical schools can replenish them. Plus, the demand for services is increasing because the Affordable Care Act provides coverage to more people (at a time when the population is aging).

Something has to give, and it seems likely it will be the attachment to in-person doctor visits. Telehealth offers efficiency gains for doctors and patients through the use of video communications. As with corporate conferences, video reduces the impact (benefit and punishment) associated with location. Patients can reclaim their lost productivity, and doctors can "see" patients across wider geographies.

There are multiple video use cases within Telehealth. The term "eVisits" describes doctor-patient interaction via the Internet or network communications. The WSJ reported that, "Deloitte predicts there will be 100 million eVisits globally in 2014, representing a 400% increase from 2012 levels. eVisits have some obvious limitations, but offer some incredible efficiencies where suitable.

eVisits are appropriate for nonemergency conditions such as colds, flu, stomach pains, allergies, and rashes. They are not appropriate for life-threatening situations or annual checkups.

However, eVisits are often in conflict with medical structures that were designed around in-office consultations. For example, state-level licensing requirements restrict the geography of potential care providers. Also, some states require in-person consultation as a precursor to prescriptions.

Despite these restrictions, video usage within health care is increasing. Earlier this month, HealthSpot raised an additional $8 million ($23 million in total) toward its medical kiosks designed for supermarkets, pharmacies, and other retail locations. The kiosks provide a private enclosed examination room for patients to virtually meet with doctors over high-definition video, and include various medical devices that can measure vital signs and other diagnostics. The kiosks connect patients to doctors over Sprint's 4G network.

Teladoc is skipping the kiosks and directly connects patients to medical professionals over phones and Internet connections (housecalls are back!). Teladoc taps into a supply of semi-retired doctors who are willing to see patients from their homes. The firm's services are typically provided through employers as a benefit and available in 49 states. (Services are not available in Idaho due to a "difference in interpretation between Teladoc and the Idaho Board of Medicine regarding state regulations.")

Telehealth technologies also interconnect healthcare professionals to each other. It is increasingly common for medical professionals to consult over video. St. Louis-based Mercy health system uses a centralized TeleICU to monitor patients across 15 hospitals in five states. It built a centralized monitoring operation that can see patients and the equipment in the rooms, so staff can interact with patients and visitors directly.

This approach splits the staff into (remote) monitoring specialists, and (on-site) providers that perform treatments and other physical activities. Mercy hospitals use eCare Manager by Philips, integrated with VidyoWorks for video communications. In addition to improved patient care, Mercy increased its revenue by expanding its monitoring services to additional, third-party hospitals. Mercy also reports increased utilization of its specialists.

Telehealth makes a lot of sense for patient care for the same reasons it does in the enterprise: The use of video communications has a positive multiplier effect on reach and a negative multiplier on cost.

Attitudes and regulations need to adapt. Last month, the Federation of State Medical Boards (FSMB) approved guidelines that encourage individual states to recognize video-based eVisits as equivalent to in-person visits. If states adopt these guidelines, it would eliminate bias against video--at least for prescriptions, reimbursements, and other legal matters.

There's still emotional hurdles to overcome. Video seems awkward to some, yet visual communications are inherently more natural than audio-only or textual communications (getting a doctor on the phone is rare, but not awkward). Prior generations adapted to phones; the transition to video technology is occurring now.

Dave Michels is a Contributing Editor and Analyst at TalkingPointz

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