Telehealth, the use of digital information and communication technologies to access healthcare services remotely, has become increasingly important for managing and treating patients in pain. Pain is considered to be chronic if it lasts or comes and goes (recurs) for more than three months. Here are five ways telehealth can be utilized to help these patients:

1. Remote Consultations with Specialists: Patients suffering from chronic pain or specific pain conditions can use telehealth to consult with specialists who may not be available in their immediate geographic area. This is particularly beneficial for those living in rural or underserved regions, where access to pain management clinics or specialists is limited. Through video conferencing, patients can receive diagnoses, discuss treatment options, and have follow-up appointments without the need for travel, reducing physical discomfort and stress.
2. Virtual Physical Therapy and Rehabilitation: Telehealth platforms enable physical therapists to guide patients through exercises and rehabilitation programs remotely. This is crucial for patients who are in pain and may find it difficult to leave their homes for physical therapy sessions. Therapists can demonstrate techniques, monitor patients’ progress in real-time, and adjust exercises or routines as needed, all through video calls. This approach ensures that patients receive consistent and personalized care, which can be pivotal in their recovery process.
3. Access to Psychological Support: Chronic pain is not just a physical condition; it has significant psychological effects, including anxiety, depression, and stress, which can exacerbate pain. Telehealth provides a conduit for patients to access psychological support and therapies, such as cognitive-behavioral therapy (CBT), from the comfort of their homes. This ease of access can encourage more patients to seek the help they need, improving both their mental health and their ability to manage pain.
4. Medication Management and Prescription Renewals: Managing medications is a critical component of pain management for many patients. Through telehealth, healthcare providers can review a patient’s medication regimen, adjust dosages, and renew prescriptions as necessary. This remote monitoring and management can help prevent medication overuse, address side effects promptly, and ensure that patients have access to their necessary pain relief medications without requiring in-person visits.
5. Education and Self-Management Resources: Telehealth platforms offer a wealth of resources for patient education, teaching individuals about their conditions, pain management strategies, and lifestyle modifications that can mitigate pain. These resources can be personalized to the patient’s condition and needs, and they empower patients to take an active role in managing their pain. Interactive tools, webinars, and educational materials can help patients understand their pain, learn new coping strategies, and adhere to their treatment plans more effectively.

In summary, telehealth can significantly improve the quality of life for patients with chronic pain by offering personalized, accessible, and comprehensive care options. By addressing the physical, psychological, and educational needs of patients remotely, telehealth can play a crucial role in the holistic management of this complex condition.

Sleep is an essential component of a healthy lifestyle, but for many, it remains an elusive and often challenging aspect of daily life. Sleep disorders affect a significant portion of the population, leading to both short-term and long-term health consequences. Fortunately, innovative solutions are emerging to address these disorders, offering hope to those who struggle with sleep-related issues. In this blog post, we will explore the most common sleep disorders and the innovative ways to address them.

Common Sleep Disorders

1. Insomnia: Insomnia is the most prevalent sleep disorder, affecting millions of people worldwide. It involves difficulty falling asleep or staying asleep, leading to impaired daytime functioning and overall quality of life. Stress, anxiety, and poor sleep hygiene are often underlying causes of insomnia.
2. Sleep Apnea: Sleep apnea is a condition characterized by interruptions in breathing during sleep. It can be obstructive (due to a blocked airway) or central (caused by a failure of the brain to signal the muscles to breathe). Sleep apnea can lead to serious health problems, such as heart disease and stroke.
3. Restless Leg Syndrome (RLS): RLS is a neurological disorder that causes an irresistible urge to move the legs, especially during periods of inactivity or at night. The sensation often makes it difficult to fall asleep or stay asleep.
4. Narcolepsy: Narcolepsy is a rare disorder that results in sudden, uncontrollable sleep attacks during the day. Individuals with narcolepsy often experience excessive daytime sleepiness, cataplexy (sudden loss of muscle tone), and disrupted nighttime sleep.

Innovative Solutions for Sleep Disorders

1. Continuous Positive Airway Pressure (CPAP) Devices: CPAP machines are commonly used to treat sleep apnea. Recent innovations have made these devices more comfortable and user-friendly. Some newer models include features like heated tubing, adaptive pressure settings, and data tracking for improved adherence and effectiveness.

Almost 8 million people in the U.S. use a CPAP machine. (Forbes); Unfortunately, 34% of those prescribed the ‘medical gold standard’, CPAP, discontinue effective treatment within a year due to discomfort. And not one of these current care options treats central apnea.

As a result, Harvard Medical School and McKinsey & Company estimate that untreated sleep apnea costs $165B each year in the U. S. alone because of automobile crashes, lost work-place productivity and the chronic diseases that have been linked to this condition.

2. A CPAP Alternative – WhisperSom™ Corporation is bringing a patented, non-invasive medical device through the FDA approval process. One that helps individuals breathe better while they sleep by delivering personalized neuromodulation to reduce snoring and help maintain regular breathing.  WhisperSom™ is the first to patent, develop, and test a combination diagnostic, treatment, and nightly monitoring device for sleep apnea—requiring nothing on the face, in the mouth or nose, no surgical implants, and no electric shocks.  WhisperSom is looking for investors and Beta Users.  Contact me at hreis@healthepractices.com for more information.

3. Telemedicine and Remote Monitoring: Telehealth has revolutionized the way sleep disorders are diagnosed and treated by offering convenient and effective solutions to patients. Through telehealth, individuals can access sleep specialists and healthcare providers from the comfort of their own homes, eliminating the need for in-person visits. This technology enables patients to discuss their symptoms, medical history, and concerns with sleep experts through video calls or online chats, facilitating a comprehensive evaluation of their condition. Additionally, telehealth can also provide remote monitoring tools, such as wearable devices, that allow for the continuous tracking of sleep patterns and vital signs, contributing to more accurate diagnoses and personalized treatment plans. With the flexibility and accessibility of telehealth, individuals can receive timely care, advice, and guidance, ultimately improving their sleep quality and overall well-being.

4. Wearable Sleep Trackers: Wearable devices like smartwatches and fitness trackers now offer advanced sleep tracking features. These devices monitor sleep duration, sleep stages, and even sleep disturbances. With this data, users can identify patterns and make lifestyle changes to improve their sleep.

5. Medications and Supplements: While traditional medications have been used to address sleep disorders, more natural supplements and innovative sleep aids have gained popularity. Melatonin supplements, herbal teas, and relaxation apps can help regulate sleep patterns and promote relaxation.

6. Sleep Hygiene Apps: Mobile applications offer innovative ways to improve sleep hygiene by providing sleep tips, relaxation exercises, and even white noise or ASMR content to help users fall asleep faster.

Sleep and Oral Health

The relationship between sleep disorders and oral health is intricate and bidirectional. Conditions like sleep apnea, which involves intermittent breathing interruptions during sleep, can have a significant impact on oral health. Prolonged and untreated sleep apnea can lead to issues such as dry mouth, which increases the risk of dental decay and gum disease. Additionally, the excessive force exerted on teeth during grinding or clenching, common in sleep disorders like bruxism, can result in tooth wear and damage. Conversely, poor oral health, especially conditions like gum disease, can contribute to sleep disturbances, as the pain and discomfort may interfere with a restful night’s sleep. Recognizing and addressing the interplay between sleep disorders and oral health is essential for a comprehensive approach to overall well-being.

Conclusion

Sleep disorders can significantly impact one’s quality of life and overall health. Fortunately, the advancement of technology and innovative approaches to treatment have provided new avenues for addressing these disorders. Whether it’s through telemedicine, wearable devices, or therapy apps, individuals now have more options than ever to improve their sleep quality and ultimately enjoy the many benefits of a good night’s rest. If you or someone you know is struggling with a sleep disorder, it’s essential to explore these innovative solutions and seek professional guidance to find the most suitable treatment approach. A good night’s sleep is not only a luxury but a necessity for a healthy and productive life.

Telemedicine has revolutionized healthcare in recent years, and with it has come a variety of ethical considerations.  These ethical concerns can range from patient privacy and data security to physician-patient relationships and medical decision-making.   Just last week the F.T.C. accused GoodRx of leaking health data to Google and Facebook.  An ethical lapse?

https://www.nytimes.com/2023/02/01/business/goodrx-user-data-facebook-google.html

Patient privacy and data security are of paramount importance in telemedicine. Due to the nature of the technology, patient data must be encrypted and transmitted securely. Furthermore, any healthcare provider must have the proper authorization to access and view a patient’s data.

The physician-patient relationship is also of great importance in telemedicine. Telemedicine can provide patients with timely access to medical advice and care, but it also raises concerns about the quality of the doctor-patient relationship. It is important that physicians can develop rapport with their patients and build trusting relationships.

Medical decision-making is a key ethical concern in telemedicine. Because telemedicine is often conducted remotely, physicians must ensure that they are making the best decisions possible for their patients. This includes considering all relevant medical information, considering the patient’s individual situation, and discussing any decisions with the patient before making a final determination.

I asked some renowned experts in the field to help with this question.

Jay H. Sanders, M.D., and CEO, The Global Telemedicine Group shared:

“while telemedicine assures access to care, it does not necessarily improve the quality of care if the physician is not up-to-date, or if the time allotted for the information exchange is inadequate and/or in the absence of having all the critical information, offers a misguided diagnostic and/or therapeutic opinion. I should point out, however, that in the absence of EHR inoperability today, lack of availability of all the important information leads to the same mistakes as well as if the patient is standing in front of the physician”.

Joseph P. McMenamin, attorney with Christian and Barton wrote:

“To me, one of the most important ethical questions is the one I would recommend a provider ask himself at the beginning of the visit, or at least soon after he understands the chief complaint: is the nature of this patient’s problems such that virtual care will probably be beneficial, or is it too likely that proper evaluation will require techniques or procedures that can be carried out only in person?”

Christian Milaster, telemedicine veteran and CEO of Ingenium Digital Health Advisors wrote about three aspects of privacy in a virtual care environment:

1. Seeing the patient’s environment: does seeing some paraphernalia behind them, or seeing someone else in the background change the level of care?
2. Not knowing who else is in the room with the patient: who could overhear the conversation, or could just through their presence influence what the patient is willing to share?
3. And on the other side — How private is the clinician’s environment? Who can overhear? What if at home – can the conversation be overheard by their teenage kid outside the office door?

And when would it be unethical NOT to offer telehealth? According to Christian:

“From my perspective, it would be unethical not to offer care via telehealth when it is clinically appropriate, but the provider does not want to do it and as a result the patient does not receive care. Some patients may have limited access to transportation or do not want to leave the house and telehealth may be most conducive option for them to receive care.”

 

Maria Kunstadter, founder and CEO of The TeleDentist shared:

“The AMA Journal of Ethics in January 2022 addressed the ethical responsibility of physicians and dentists to patients. These apply to patients served with hands-on care or virtually.

The AMA code has two directives a physician must follow. 1. To care for the patient in the moment. 2. To provide appropriate follow-up referral or care.

The ADA Code of therapeutic alliance, and virtue ethics states a dentist has a duty to advocate on a patient’s behalf and to encourage him to seek and pursue treatment for his health care generally.

Both organizations emphasize the need for Dental/Medical Integration. Providing the right specialist for the right condition at the right time is now available through virtual care platforms that have physicians and dentists on their site or refer to a telemedicine and/or teledental site to provide the continuum of care with a referral which is required. Ethical duty made simple, thanks to virtual care access.”

Some other ethical issues come to mind:

• In an emergency, might a telemedicine service provider deploy an un-licensed (in that state) provider to deliver care?
• Might a telemedicine doctor choose which patient to see (first?) based on age, race, gender, medical condition, or ability to pay?

Telemedicine will likely increasingly use artificial intelligence going forward.  The issue of ethics in Artificial Intelligence (AI) with regards to healthcare is a complex and important one. AI has the potential to make healthcare more efficient, accurate, and cost-effective, however, ethical considerations must be considered to ensure that its use does not lead to unintended negative consequences. The potential for AI to collect, store, and use sensitive personal data can lead to ethical considerations.  This data could be used to inform decisions about treatments or to identify new treatments, but it must be done in accordance with laws and regulations that protect patient privacy. Additionally, AI algorithms must be designed and implemented in a way that respects patient autonomy; AI should not be used to override a patient’s wishes or to make decisions without their knowledge or consent. Another important ethical issue in AI for healthcare is fairness. AI algorithms can have built-in biases that lead to biased outcomes, such as incorrect diagnoses or treatments that are not appropriate for certain patient populations. It is essential that AI algorithms are designed and tested to ensure that they are free from bias and are fair to all patients, regardless of their race, gender, or other characteristics.

One would hope that all physicians are ethical, but this is not always the case.  It is the responsibility of all involved (physicians, service providers, and patients alike) to call out unethical practices and ensure that the benefits of new technologies continue to flourish.

This blog post was reviewed using an A.I. Bot (Wordtune).  Ethical?

 

I have had the privilege to be involved in telemedicine for forty years.    Then, and now I view this as mostly a very good thing.  The doctor with expertise does not have to be in the same geographic location to help a patient.  While Telemedicine has evolved in so many positive directions, it has been fascinating to observe how telemedicine has become embroiled into some of the most controversial issues of our days, and has managed to create some major issues of its own.

Telemedicine and Abortion

Medication abortion now makes up the majority of abortions in the United States, according to data released by the Guttmacher Institute, a reproductive rights organization.

https://abcnews.go.com/GMA/Wellness/majority-abortions-us-now-pills-data-shows/story?id=83075210

According to the New York Times, women in states with abortion bans are turning to Telemedicine.  The misoprostol pill is used to terminate early pregnancies.

https://www.nytimes.com/2022/11/02/briefing/abortion-pills.html?searchResultPosition=1

Telemedicine abortions just got more complicated for health providers. In the U.S., more than a dozen states severely restrict access to abortion, and almost as many have such laws in the works. Across the country, since Roe v. Wade was overturned, clinics that do provide abortions have seen an increase in demand. Many clinics rely on help from physicians out of state, who can alleviate some of the pressure and keep wait times down by providing services via telemedicine.

https://www.npr.org/sections/health-shots/2022/09/26/1124360971/telemedicine-abortion-medication-ban

 

Telemedicine and Gun Control

Telemedicine became part of the dialog regarding Gun Control this past June when U.S. Senators reached a bipartisan compromise on gun violence and school safety that includes new federal investments for mental health services and telehealth.

https://www.fiercehealthcare.com/providers/bipartisan-gun-violence-deal-supports-major-investments-behavioral-health-telehealth

While the agreement does not include the outright bans on semiautomatic assault rifle purchases or age restrictions backed by most Democrats, it does introduce new scrutiny for buyers under 21 years of age, stiffer penalties for illegal straw purchases of firearms and grants for states to implement red flag laws.

Also core to the proposed deal are “major investments” in mental health and supportive services delivered through community behavioral health centers and schools.  Further supporting these investments would be additional funds aimed at increasing mental and behavioral telehealth accessibility “for youth and families in crisis,” the senators said.

Telemedicine and Opioid Abuse

There has been increased use of Telehealth for OUD Services During COVID-19 pandemic associated with a reduced risk of overdose.

https://nida.nih.gov/news-events/news-releases/2022/08/increased-use-of-telehealth-for-opioid-use-disorder-services-during-covid-19-pandemic-associated-with-reduced-risk-of-overdose

 

But prescribing controlled medications online is controversial. There’s a concern that fewer safeguards will lead to more abuse. Should it be OK to prescribe controlled substances via telemedicine? Limits on virtual addiction treatment may soon return, making care harder to access.

https://www.npr.org/sections/health-shots/2021/12/30/1064818982/telehealth-addiction-treatment-prescribing#:~:text=This%20is%20why%20virtual%20prescribing%20of%20controlled%20medications,the%20R%20Street%20Institute%2C%20a%20free-market%20think%20tank.

 

How Are Telehealth Laws Intersecting with Laws Addressing the Opioid Overdose Epidemic?

Opioid-involved drug overdose deaths have been a growing concern in the US for several decades. The Centers for Disease Control and Prevention identified several strategies to address the opioid overdose epidemic, including increased availability of and access to medication-assisted treatment and guidance on safer opioid prescribing practices. Telehealth offers the potential for increasing access and availability to these strategies, and laws governing telehealth have implications for their utilization.

https://www.cdc.gov/phlp/publications/topic/telehealth.html

Telehealth fraud

Recent federal crackdowns on Medicare fraud linked to telehealth have raised concerns in Washington that virtual care introduces new opportunities for criminals to defraud vulnerable patients. But lobbyists and researchers say risks aren’t necessarily greater than in-person, and warn that fear could drive lawmakers to make virtual care harder to access

 

https://www.statnews.com/2022/08/08/telehealth-fraud-doj-risk-hhs/

 

Telehealth’s Limits: Battle Over State Lines and Licensing Threatens Patients’ Options

If you live in one state, does it matter that the doctor treating you online is in another? Surprisingly, the answer is yes, and the ability to conduct certain virtual appointments may be nearing an end.

Telehealth visits for medical care took off during the worst days of the pandemic, quickly becoming commonplace. Most states and the Centers for Medicare & Medicaid Services temporarily waived rules requiring licensed clinicians to hold a valid license in the state where their patient is located. Those restrictions don’t keep patients from visiting doctors’ offices in other states, but problems could arise if those same patients used telemedicine.

Now states are rolling back many of those pandemic workarounds.

https://khn.org/news/article/state-medical-licensing-rules-threatens-telehealth-patient-options/

I have hope that the benefits of telemedicine will prevail and that unscrupulous operators do not take advantage of the telemedicine’s capabilities for their own well being.  HHS reported that there were 52.7 million Medicare telehealth visits during the pandemic.  Patient satisfaction was extremely high.   Delivering better patient care shouldn’t n be controversial.

I welcome your thoughts and comments.

In ancient Babylonia and China, thumbprints and fingerprints were used on clay tablets and seals as signatures. The idea that fingerprints might be unique to individuals dates from the fourteenth century. Fingerprints weren’t used as a method for identifying criminals until the 19th century. In 1858, an Englishman named Sir William Herschel was working as the Chief Magistrate of the Hooghly district in Jungipoor, India. In order to reduce fraud, he had the residents record their fingerprints when signing business documents. Sir Edward Henry, commissioner of the Metropolitan Police of London, became interested in using fingerprints to nab criminals. In 1896, he created his own classification system based on the direction, flow, pattern, and other characteristics of the friction ridges in fingerprints. In 1901, Scotland Yard established its first Fingerprint Bureau. The following year, fingerprints were presented as evidence for the first time in English courts. In 1903, the New York state prisons adopted the use of fingerprints, followed later by the FBI.

But how has fingerprinting changed since the 19th century?

The Henry system finally enabled law enforcement officials to classify and identify individual fing­erprints. Unfortunately, the system was very cumbersome. When fingerprints came in, detectives would have to compare them manually with the fingerprints on file for a specific criminal (that’s if the person even had a record). The process would take hours or even days and didn’t always produce a match. By the 1970s, computers were in existence, and the FBI knew it had to automate the process of classifying, searching for and matching fingerprints. The Japanese National Police Agency paved the way for this automation, establishing the first electronic fingerprint matching system in the 1980s. Their Automated Fingerprint Identification Systems (AFIS) eventually enabled law enforcement officials around the world to cross-check a print with millions of fingerprint records almost instantaneously.

That changed in 1999, with the introduction of Integrated AFIS (IAFIS). This system is maintained by the FBI’s Criminal Justice Information Services Division. It can categorize, search, and retrieve fingerprints from virtually anywhere in the country in as little as 30 minutes. It also includes mug shots and criminal histories on some 47 million people. IAFIS allows local, state, and federal law enforcement agencies to have access to the same huge database of information. The IAFIS system operates 24 hours a day, 365 days a year.

But IAFIS isn’t just used for criminal checks. It also collects fingerprints for employment, licenses, and social services programs. When all these uses are taken together, about one out of every six people in this country has a fingerprint record on IAFIS.

Covid-19, Fingerprinting and Telemedicine

A long-standing tenet of telemedicine requires physicians to be licensed in the state where the patient presents. Radiology, which was the first medical specialty where telemedicine was widely used, often saw physicians in need of multi-state licenses. In was not unusual for a radiologist to carry 25-30 (even 50) individual state licenses. All states require fingerprints as part of the licensing process. A radiologist would go to the police station, sheriff’s office, or the office of a commercial fingerprint service. Documents often got lost in the process.

Then came Covid-19. Telemedicine blossoms with more than 300 commercial telemedicine or telehealth providers, all with growing staffs of physician needing to expand their staffs and their licenses. And many of those places where physicians could previously get their fingerprints scanned were closed due to the close contact required with examiners. Locum Tenems Companies thrived, many of which proving physicians to facilities experiencing staffing shortages. This too required an efficient solution. A new breed of company emerged with private equity backing emerged which enables facilities to outsource much of the credentialling process. See www.axuall.com and www.medallion.co.

Stay at Home!

A new solution has emerged, TeleFingerprinting!

International Fingerprint, Inc (IFP), dba TeleFingerprinting.com, is an innovative U.S.-based biometrics company formed as a spinoff corporation from National Fingerprint, Inc. (NFp) an industry leader in expediting FBI criminal history checks required by licensing laws and privacy regulations. TeleFingerprinting™ provided the only secure, patented, and scalable remote fingerprinting solution for batch submission to licensure authorities from anywhere in the world. TeleFingerprinting™ is a one-time, virtually witnessed, end-to-end encrypted HD video collecting of fingerprints, ID credentials, attestations, and biometrics comparison standards for Privacy compliance. Certified Enrollment Agents ensure accurate fingerprint self-captures that comply with Chain of Custody and all other regulatory requirements from your isolated location.

Beyond healthcare, clients include multiple components of the financial services industry, law firms, on-line gaming, international outsourcing and multiple additional vertical markets. Anywhere that multi-state licensing is essential, and time is a critical factor.

To find out how TeleFingerprinting can benefit your organization, contact hreis@healthepractices.com

I have been blessed to have a career at the leading (bleeding?) edge of several exciting technologies.  From the early days of electronic banking and the early experiments in telemedicine, I have seen several innovations become mainstream.  What’s Next?  My focus for the past 30+ years has been largely healthcare.  I asked some industry leaders, and I am happy to share their answers.

First, what are the biggest problems to solve? Here’s a top 5.

High Cost of Prescription Drugs

• Prescription drug prices in the United States are significantly higher than in other nations, with prices in the United States averaging 2.56 times those seen in 32 other nations, according to a new RAND Corporation report.

Unintentional Medical Errors

• Frequently cited studies have placed the number of deaths as high as 250,000 deaths per year, which would make medical error the third leading cause of death, behind cancer and cardiovascular disease

Keeping up to date with current medical literature

• Clinicians and researchers must keep abreast of new publications in their field. This represents a major challenge due to the exponential growth in the number of publications and the ever-growing availability of the internet favoring the emergence of online-only publications

Health Inequity

• Health inequity refers to avoidable differences in health between different groups of people. These widespread differences are the result of unfair systems that negatively affect people’s living conditions, access to healthcare, and overall health status

Un-Integrated Electronic Medical Records

• 40 years ago, I could access my bank account from almost any bank ATM, yet today two different hospital systems often can’t share my medical records, even in the case of an emergency.

So what technologies are being deployed to address these challenges?    One answer comes back, loud, and clear.  Artificial Intelligence (AI)!  Use cases abound.  Just a sampling includes:

1. AI supports medical imaging analysis

– Image dependent specialties are the first to benefit including radiology, pathology, and dermatology

2. AI can decrease the cost to develop medicines and can support drug discovery.

– Supercomputers have been used to predict from databases of molecular structures which potential medicines would and would not be effective for various diseases.  AI algorithms can identify new drug applications, tracing their toxic potential as well as their mechanisms of action

3. AI can forecast disease

– In 2019, the Department of Veterans Affairs (VA) and DeepMind Health created a Machine Learning (ML) tool that can predict Acute Kidney Injury (AKI) up to 48 hours in advance

4. AI contributes to cancer research and treatment, especially in radiation therapy

– Automatic generation of clinical notes integrated with EHRs leads to a reduction of time spent by clinicians in managing patient treatment plans.

5. AI supports health equity

– The AI and ML industry has the responsibility to design healthcare systems and tools that ensure fairness and equality are met, both in data science and in clinical studies, to deliver the best possible health outcomes.

What are the other Next Big Things?

1. Asynchronous Remote Patient Monitoring

• Asynchronous technology is one of four modalities in telehealth. Importantly, it can standalone for effective care delivery for hundreds of low acuity conditions, or can be paired with another modality of virtual telemedicine to streamline care, including synchronous telehealth, mobile health, or remote patient monitoring (RPM).

2. Cancer Care Innovations

• Technologies and innovations like CRISPR, artificial intelligence, telehealth, the Infinium Assay, cryo-electron microscopy, and robotic surgery are helping accelerate progress against cancer.

3. Medication at Home

• The COVID-19 pandemic turned lives upside down, and the social distancing guidelines in place have exacerbated the difficulty of the task of medication management for many.

4. Population Health Management – Big Data

• An effective population health program will automatically identify patient care gaps, using a combination of claims data and clinical data from multiple sources. It will also use automated messaging via phone, email, or text to alert patients with care gaps that they need to make appointments to see their providers.

What else?  How about hand-held (low cost) ultrasound?  Virtual Reality for rehabilitation? Stem cell cures for diabetes?  Immunotherapies? The possibilities are endless.  Also keeping an eye on the industry.  I suspect that we are in for more consolidation as there are over 250 telehealth companies and not room for all to be successful.  Keep a close watch on Amazon, Apple, Facebook, Google, and Microsoft.  Delivering healthcare to their own employees will lead to new strategies (and acquisitions).

And Beyond telemedicine and telehealth.  I have begun looking at new technologies for answering the climate change crisis, specially a app which will help large and small providers reduce carbon emission.  I hope to have more to report as we move into the new year.

Howard Reis, President, HEALTHePRACTICES

When I first started working as the CEO of The TeleDentists up until today when I continue working with them as an advisor and Board member, I continue to get asked one common question.  “How do you do teledentistry?”  The question is a natural one as most of us think of a visit to the dentist to include a cleaning, an X-Ray and (hopefully not) a cavity repair.  I can answer the question a bit better today having the benefit of being able to review close to 10,000 teledental visits.

The reasons patients contacted The TeleDentists remained quite consistent from the first time we measured the results.  They had toothaches, bleeding gums or broken teeth.  Parents had teething children.  Seniors had problem with their dentures.

The disposition of cases also stayed quite consistent.  We were able to prescribe (non-narcotic) medications and could also get the patient an appointment to see a local dentist if that was deemed necessary.

There has been some shift in the type of questions asked as the pandemic progressed.  Patients want to know if it is safe to return to the dentist’s office.  They also want help in finding a dentist as it has become more difficult to schedule an appointment due to closed offices and some limited hours.

I’ve also been asked, “What are things that can be treated with teledentistry” (and without entering the patient’s mouth).  Here’s just a partial list of what has been experienced:

• Do I need ortho?
• Whitening questions—what to use, how safe?
• Cold Sores/herpetic infection
• Canker Sores/Aphthous Lesions
• Sensitive teeth
• Dry Mouth—symptoms/solutions
• “I have an appointment Monday, but swelling started and I can’t get ahold of my dentist” palliative care/intermediate help when someone has a dentist
• Preventive Services that can be done by NP or Med Tech:
• Fluoride Varnish application— “immunize against decay”
• I need a dentist referral. Don’t know any.
• Consultation with Diabetics about improving oral health/reducing A1Cs

And there’s more.

The TeleDentists recently connected with an Accountable Care Organization in Michigan to provide connectivity to three hospital emergency rooms (and soon three urgent care centers).  Also launched is The Virtual Tooth Fairy which connects a child to a hygienist for reassurance and instructions about taking care of their teeth.

TeleDentistry also combines the E-Commerce.  At The Marketplace on The TeleDentists web site you can find solution for Dry Mouth, TMJ, missing teeth, teeth aligners among other.  See https://www.theteledentists.com/marketplace.

Looking forward we expect to see Remote Patient Monitoring, and the incorporation of Artificial Intelligence to assist in the practice of teledentistry.  I do not believe teledentistry replaces dentists.  It helps them take better care of patients, especially patients who continue to find an office visit to be difficult.  And when an office visit is necessary, both the patient and dentist can be better prepared.

Contact:  Howard Reis hreis@healthepractices.com

Thanks Seema Verma, then the CMS administrator, who in April 2020 declared, “the genie out of the bottle on this one”. ¹

As a 30-year telemedicine veteran, now that the genie is out of the bottle, do I get my three wishes? Here’s what I would wish for.

1. Interoperability – 40 years ago, I helped initiate home banking for both Citibank and Chemical Bank. This was on the heals of the installation of ATM machines around the country, and around the world. Soon thereafter your ATM card could access your bank account worldwide. Why is it today, 40 years later, two healthcare institutions across the street from each other still can’t share medical records? For telemedicine to be truly ubiquitous, institutions will need to share records much more easily than they do today.
2. Collaboration – If integration is largely a Systems issue, Collaboration is mostly a personal one. Q1 2021 closed with $6.7B in US digital health funding, the most-funded quarter to date. ²  As investors pour money into all these startup companies, it is clear to me that no one company has all the answers. Collaboration will be a key to success. Here’s one example. The COVID-19 Telehealth Program provides$200 million in funding, appropriated by Congress as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, to help health care providers provide connected care services to patients at their homes or mobile locations in response to the COVID-19 pandemic. ³ Thanks to the federal government and the funding that they are providing. Long Term Care has always been an attractive model for telehealth. Cost justification can often be achieved just by reducing the cost of transporting seniors to appointments which can readily be administered by telehealth. What’s missing is collaboration. Individual companies can provide services such as telepsychiatry, tele-ophthalmology, tele-dermatology and even teledentistry. What’s needed is one stop shopping. A single source that can be deployed which makes available a menu of services depending on demand. The most needed tele-service in nursing homes is mental health support. A next valuable service is the ability to remotely provide wound care.
3. Integration – Do you want to provide a telemedicine solution to a hospital? It better integrate with the hospital’s EPIC system, or whatever EHR system that the hospital is using. And as the saying goes, once you’ve done one EPIC integration, you’ve done one EPIC integration. I’m all for standards and insuring the (data) quality of all connected systems, but this can also be an impediment to successful deployments.

Or can I use my last wish to wish for more wishes? 10 more wishes?

1. Retire the term telemedicine – As Dr. Jay Sanders, known as the father of telemedicine, said, “We’re going to get rid of the term ‘telemedicine,’” Instead, remote care is going to become routine, which makes sense because the home is a better place for examining patients because clinics are sterile environments,” ⁴
2. Reimbursement is still a challenge. While temporary relief has been available during the pandemic, widespread adoption is dependent on finally recognizing that telemedicine needs to be reimbursed on par with a regular doctor’s visit. And while we are at it, lets get rid of individual state licensing requirements which inhibit telemedicine’s growth.
3. Celebrate our successes – Telemedicine can be lifesaving. Here’s just one recent example from Pacific Medical Centers. ⁵   More stories like this will convince our payors and legislators about the need for telemedicine.
4. Vaporize the fraudsters – Two nurse practitioners who worked with Medicare patients in Montana admitted that they conspired to cheat Medicare of millions of dollars through exploiting Medicare’s telemedicine provisions. ⁶ As Telemedicine becomes ubiquitous, more stories like this are bound to emerge. They are headline-grabbing and can deter all the many benefits that can be provided.
5. Consolidation of players – Becker’s Hospital Review identified 260+ telehealth companies in 2020 ⁷ There are probably twice as many a year later as the pandemic saw dozens of start-ups. They can’t all survive, and consolidation will become the industry norm.
6. Build the data – Cost savings! With a all these new telemedicine programs, outcomes become even more important. Let’s have a discussion about how to measure success of these programs, find the programs that are having successes, and figure out how to replicate.
7. Telemedicine for All – There is a tremendous amount of good which can be provided to underserved communities. This is as true in rural America as it is in underdeveloped countries. While profitability still is elusive for even the largest of telemedicine companies, there needs to be a mechanism to provide telemedicine support in areas of need where the business case is still uncertain.
8. Bandwidth – When I began my personal telemedicine journey (with Nynex Corp.) thirty years ago, sufficient bandwidth was an issue. Its still an issue today. Throughout pockets in the U.S. as well as around the world, telemedicine will never reach its full potential without the pipes and wires (and wireless) to ride on. Infrastructure? You bet!
9. Encourage Innovation – Make funding available for startups with innovative ideas. Make is easier to work with large healthcare institutions that need this technology, but do not have the easy ability to work with small companies. Areas of great potential include the use of Artificial Intelligence, expanded availability of Remote Patient monitoring, and innovative ideas which are popping up all over and need to be explored.
10. The Next Big Thing – I know its out there and I look forward to continuing to be in a position to see it when it comes.

 

Notes:

1. https://www.beckershospitalreview.com/telehealth/the-genie-s-out-of-the-bottle-on-this-one-seema-verma-hints-at-the-future-of-telehealth-for-cms-beneficiaries.html
2. https://rockhealth.com/reports/q1-2021-funding-report-digital-health-is-all-grown-up/
3. https://www.fcc.gov/covid-19-telehealth-program-invoices-reimbursements
4. https://medcitynews.com/2016/03/father-of-telemedicine/
5. https://www.pacificmedicalcenters.org/news/parents-use-telemedicine-to-get-daughter-life-saving-care/
6. https://www.natlawreview.com/article/united-states-department-justice-scores-another-victory-exposing-telemedicine-fraud
7. https://www.beckershospitalreview.com/lists/260-telehealth-companies-to-know-2020.html

Teledentistry is the union of dentistry and telehealth (or telemedicine). The State of the union is very strong.

The Telehealth industry is booming. The Covid-19 virus changed everything. Research by McKinsey & Company reveals that while only 11 percent of consumers used telehealth in 2019, 46 percent were using these remote services by May of 2020 to replace canceled office visits. ^[1] McKinsey went further to predict that the telehealth industry could grow to a quarter of a trillion dollars. ⁽²⁾ Telehealth investment, according to the Mercom Capital group venture finding in digital health in 2020 came to $14.8 billion. ³ Telemedicine was the top funded category and led VC funding activity with $4.3 billion, a 139% YoY increase compared to $1.8 billion in 2019.

Last year presented unprecedented circumstances for the dental industry. From the threats of the global pandemic, to a complete shutdown, to a staggered reopening approach across the country, dental practices faced many challenges. Figuring out how to triage patients without the face-to-face option, bring in revenue, and maintain staffing levels are just a few of the issues that dentists experienced. Spending on dental care fell by up to 38% in 2020 the ADA projects. Of dentists surveyed by the trade group, more than 46% said their patient volume was down at least 15% from usual levels during the week of Oct. 5. ⁴ The market size of the Dentistry industry is $138.8bn in 2021. ⁵

Teledentistry is the use of information technology and telecommunications for dental care, consultation, education, and public awareness. One industry study said the global size of the teledentistry was expected to reach $2,214.5 Million by 2027 compared to $667 Million in 2019 ⁶. Becker’s Dental, a leading publication identified 13 market leaders in 2020. ⁷ Most of these provide software for dentists to provide teledentistry to their own patients. A very few have established a network of providers.

Services provided by teledentistry are remediation, e-prescribing, and scheduling on-site appointments if necessary (usually the next business day). Conditions which can be addressed include broken teeth, lost fillings, canker sores, clear aligner monitoring, bleeding gums, parents with teething children and senior with problem dentures.

Covid-19 significantly accelerated the growth of teledentistry. Reimbursement codes for teledentistry consults were approved for the first time. As much of the population experienced their first telehealth experience, the idea of receiving telehealth support for a dental problem was no longer a foreign concept.

There are several key indicators which represent growth opportunities for teledentistry including:

• In 2018, 39% of the US population did not see a dentist. For most people, it takes an average of 3 years for them to go into a dental appointment. That’s about 125 million people today who need dental help.
• ​8 million work and school hours were lost due to a need for dental care in the US.
• There are more than 2 million visits every year to hospital emergency rooms for dental pain. Most emergency rooms (ER) do not have dentists on staff to provide dental treatment so patients are typically prescribed painkillers or antibiotics ,⁸ Visits to the ER for dental pain are costly and can range from $400 to $1,500 compared to a much less expensive visit to a teledentist.
• 1 in 3 parents feel the pandemic has made it harder to get preventive dental care for their child; families with Medicaid may face greater barriers. ⁹

Several key new initiatives will accelerate teledentistry in 2021 including increased consumer awareness, integration with electronic medical records, automated claims processing, medical-dental integration, expanded e-commerce with the ability to promote dental products (both prescription and non-prescription based) and the first steps into remote patient monitoring via the availability of an innovative intra oral camera. Future innovation will incorporate the use of Artificial Intelligence (AI) and international expansion.

Notes:

• https://www.nethealth.com/surveys-show-telehealth-booming-in-popularity/
• https://www.mckinsey.com/~/media/McKinsey/Industries/Healthcare%20Systems%20and%20Services/Our%20Insights/Telehealth%20A%20quarter%20trillion%20dollar%20post%20COVID%2019%20reality/Telehealth-A-quarter-trilliondollar-post-COVID-19-reality.pdf
• https://mercomcapital.com/product/q4-and-annual-2020-digital-health-healthcare-it-funding-and-ma-report/
• https://www.usatoday.com/story/money/2020/10/19/dentists-coronavirus-pandemic-ada-cdc/3653734001/
• https://www.ibisworld.com/industry-statistics/market-size/dentists-united-states/
• http://www.digitaljournal.com/pr/4955004
• https://www.beckersdental.com/teledentristry/36105-10-teledentistry-companies-to-know.html
• https://www.ada.org/~/media/ADA/Public%20Programs/Files/ER_Utilization_Issues_Flyer.ashx
• https://healthblog.uofmhealth.org/childrens-health/how-covid-19-has-disrupted-childrens-dental-care

 

 

Telemedicine has been with us for sixty years.¹ The Covid-19 pandemic of 2020 has brought this capability to the forefront as it is now an accepted component for the delivery of healthcare expertise.

Where do we go from here?

So many new opportunities. With Teladoc’s recent purchase of Livongo there will be more incorporation of remote patient monitoring. The largest telemedicine companies are actively raising money and more acquisitions are to be expected. I expect to see more collaboration with companies developing Artificial Intelligence tools and with academic medical centers focused on population health.

There’s been another aspect of telemedicine/telehealth which has been partially under the radar. You can use the technology to sell things, especially things which require a prescription.

Simple Contacts allows you to order contact lenses online: https://www.simplecontacts.com/

Several companies offer online birth control:

https://www.nurx.com/

https://www.simplehealth.com/

Other offer solutions for Erectile dysfunction and hair loss:

https://www.getroman.com/

 

So, what about dental products? Certainly, companies are offering teeth aligners:

https://smiledirectclub.com/

https://www.invisalign.com/

 

The TeleDentists (www.theteledentists.com) has a network of 300 dentists providing virtual consults for patients 24/7/365. These dentists can all write prescriptions. We are about to start working with Saliwell (https://saliwell.com/) to provide the SaliPen, a leading edge medical device that treats dry mouth. Another partner is providing Speed2Treat (https://www.speed2treat.com, a home healing kit for patients with head, neck and jaw pain. We are also starting a pilot program with Proctor & Gamble for their SmileAdvisor program (https://smileadvisor.com/) which is looking to match millennials with dental professionals and also promote P&G products. We have also spoken with a company which is using 3D printing for denture replacement.

 

Where does the industry go from here? Medical products and devices targeted to specific diseases or age groups.   Online wellness and education either for sale or bundled into offerings from insurance companies and medical groups. New opportunities emerge regularly, and it will be exciting to be part of future offerings.

 

Contact

Howard Reis, CEO, The TeleDentists

1. In 1959, the University of Nebraska used interactive telemedicine to transmit neurological examinations, which is widely considered the first case of a real-time video telemedicine