Are You Sleeping?

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.

  1. 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 for more information.

  1. 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.

  1. 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.

  1. 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.

  1. 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.


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 and ChatGPT

Note: This blog post was written with assistance from ChatGPT

In recent years, telemedicine has emerged as a transformative force in healthcare, allowing patients to receive medical care remotely, breaking down geographical barriers, and providing access to expert advice. Amidst this digital revolution, one powerful tool has played a significant role in enhancing telemedicine services: ChatGPT. Powered by artificial intelligence (AI), ChatGPT has revolutionized the way healthcare providers and patients interact, making remote healthcare even more accessible and efficient.

Improved Patient-Provider Communication:

One of the key benefits of ChatGPT in telemedicine is its ability to facilitate seamless communication between patients and healthcare providers. Through natural language processing, ChatGPT can understand and respond to patients’ queries, alleviating concerns, and providing instant information. Patients can describe their symptoms, ask questions, and receive accurate medical advice from the comfort of their own homes, eliminating the need for in-person visits for minor issues.

Enhanced Triage and Diagnosis:

ChatGPT’s advanced AI capabilities have significantly improved triage and diagnosis in telemedicine. By analyzing patient-reported symptoms and medical history, ChatGPT can offer preliminary assessments, identify potential conditions, and suggest appropriate next steps. This assists healthcare professionals in making informed decisions, prioritizing urgent cases, and streamlining the diagnostic process.

I noticed this early on with the initial deployment of Artificial Intelligent systems in radiology. My favorite use cases were prioritizing worklists for radiologists and the ability to greatly enhance the QA process.

Accessible Healthcare Anytime, Anywhere:

One of the major hurdles in healthcare is accessibility, especially for individuals residing in remote areas or with limited mobility. ChatGPT has transformed telemedicine into a round-the-clock service, allowing patients to seek medical advice whenever they need it. This accessibility ensures that people can receive timely care, reducing the risk of delayed treatment and improving health outcomes.

Overcoming Language Barriers:

Language barriers have often been a challenge in healthcare, impeding effective communication and diagnosis. However, ChatGPT’s multilingual capabilities have bridged this gap in telemedicine. It can communicate fluently in multiple languages, breaking down language barriers and enabling healthcare providers to reach a broader patient base, ultimately improving the quality and equity of healthcare services.

While ChatGPT has shown great promise in improving telemedicine, there are still several hurdles that need to be addressed for its optimal implementation and effectiveness. Some of these challenges include:

Ensuring Patient Privacy and Data Security:

Telemedicine relies on the exchange of sensitive medical information. It is crucial to have robust security measures in place to protect patient privacy and prevent unauthorized access to personal health data. Safeguarding patient information should be a top priority to maintain trust and compliance with privacy regulations.

Handling Complex Medical Cases:

While ChatGPT is adept at handling routine queries and providing general medical advice, it may struggle with complex medical cases that require nuanced understanding and specialized knowledge. Training AI models to handle a wider range of medical conditions and treatment options is essential to ensure accurate diagnosis and appropriate recommendations.

Mitigating Bias and Ensuring Ethical Use:

Bias in AI systems is a significant concern that extends to telemedicine. It is crucial to continually monitor and address any biases that may be present in ChatGPT’s responses, especially related to race, gender, or socioeconomic factors. Additionally, ethical considerations such as informed consent, data ownership, and the responsible use of AI should be carefully addressed.

Building Trust and User Acceptance: Implementing ChatGPT in telemedicine requires gaining the trust and acceptance of both healthcare providers and patients. Some individuals may be skeptical of relying on AI for medical advice and prefer face-to-face consultations. Clear communication about the benefits, limitations, and safety measures of ChatGPT is crucial to build trust and encourage adoption.

Integration with Existing Healthcare Systems: Seamless integration of ChatGPT with existing electronic health record (EHR) systems and telemedicine platforms is necessary for efficient workflow management and data sharing. Collaboration between AI developers and healthcare providers is vital to ensure interoperability and avoid disruption to existing telemedicine infrastructure.

Addressing these hurdles through ongoing research, development, and collaboration will be essential in harnessing the full potential of ChatGPT to improve telemedicine and enhance the delivery of healthcare services.


ChatGPT has made a significant impact on telemedicine, revolutionizing patient-provider communication, enhancing triage and diagnosis, ensuring accessibility, and overcoming language barriers. As this powerful AI technology continues to advance, it holds the potential to further transform the landscape of telemedicine, improving healthcare delivery and expanding access to quality medical services for all.

I believe a friend and colleague, Joe McMenamin, partner at partner at Christian & Barton, LLP shared an astute observation when he wrote,” we need to acknowledge that, for all its risks, there may come a time when the standard of care will not merely permit, but will actually require, use of AI in patient care.”

Ethics and Telemedicine

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?

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?


Telemedicine Holiday Wish List

I was recently asked what the “Reis Telemed Program” would look like, especially regarding Senior Care.

Given the season, I present my Telemedicine Holiday Wish List.

The package arrives in the mail just before your 65th birthday.  The package consists of a tablet (with a handle) and a peripheral device along the lines of an MedWand or a Tytocare .  You plug the tablet in, and it works right out of the box with a welcome screen.  It can be voice activated with a touch screen option.  Security features include biometrics like an eye scan or a fingerprint with two factor authentication.

The main screen resembles something like the following (I need a real designer to make this, but you get the idea.)

The main screen is customizable by the patient, with on-line customer service available 24/7 to help.

Vital Signs includes a dashboard of all applicable medical information, all collected through Remote Patient Monitoring.  Any major changes are highlighted (with alerts sent to an appropriate healthcare provider.  This section also includes access to all medical records from all providers without the need to log into multiple systems.  Test results are also available here.

Friends and Family addresses one of the major concerns of the elderly, loneliness.  Easy links are provided for identified family members and can be accomplished by phone, video, text, or email.  Interest groups are also available for group chats or advice.

Current News is customizable based on items of interest to the individual patient.  News can be delivered by video, text, or alerts.

Healthcare Information contains searchable articles about diseases and conditions with the ability to receive the information at various levels of complexity.  There is a strong emphasis on “wellness” and suggestions for how to best avoid getting sick.  Gamification is included with incentives for healthy behavior.


The handle permits the patient to transmit EKG information.  Perhaps two handles are necessary.

Also included:

  • Automated scheduling of appointments and appointment reminders
  • Billing and tracking of bills and co-payments
  • Information about clinical trial availability
  • Easy to use directory about healthcare providers and their specialties
  • Notification if anyone has attempted to access personal information


Here’s a pet peeve:  By taking this tablet to any healthcare provider or appointment, information can be transmitted so that the patient never needs to fill out a clipboard again.

The system is free to the patient.  Funding for the system is provided by non-Medicare patients who want to participate, limited targeted advertising and actual product sales.  A non-advertising version is available for an additional fee.  Assuming the patient opts-in, data is available to third parties.

Clearly defined metrics is a key to success.  My hypothesis is that patients who monitor their care will be healthier and therefore incur lower medical bills.  Studies will need to prove this.  In 2021, the average Medicare cost per beneficiary in the US was $15,671, an increase of 9% or $1,323 from 2020.  How much will this system bring down these costs?  It remains to be seen.

In their recent book, Dr. Jay Sanders and Michael Gorton write about the Digital Medical Home (DMH), a living platform that can be fed the right data continuously to enable a care team to provide the next generation of healthcare.  As that data is fed into the DMH, Artificial Intelligence (AI) can monitor and watch for unusual blips, suggest interventions, coordinate care outreach, and support clinical decision making.  I believe this will be an important component of a successful system

All these components are available today.  The key is tying them all together into an easy-to-use system.

I welcome suggestions for additional feature functionality as well as identifying existing systems which meet most of this functionality.  Anyone want to help build this?


Telemedicine and Controversy

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.

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.

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.


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.

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.


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.,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.

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


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.

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.

License, Locums and Telehealth

One of the biggest challenges faced by healthcare providers in the post pandemic environment is in hiring and maintaining qualified staff. More than 30 percent of hospitals are reporting that they can’t locate enough candidates to fill open positions, and all are feeling the effects of staffing shortages.1

Staffing and Locum Companies have stepped up to help providers deal with the shortage. Telehealth has helped providers extend their reach geographically. This paper deals with some of the issues involved.

Licensing and Credentialing of Telehealth Programs

Licensing and credentialing telehealth providers can pose challenges to expanding telehealth programs. Licensing refers to the process of securing the authority to practice medicine within a state. Credentialing refers to the process of verifying the provider’s license, education, insurance, and other information to ensure they meet the standards of practice required by the hospital or healthcare facility. Virtually all states require physicians providing telehealth services to be licensed in the state of the patient receiving care. Further, every site delivering telehealth services must fully credential the physician.

State licensing policies

Almost every state has modified licensure requirements/renewal policies for health care providers in response to COVID-19, including out-of-state requirements for telehealth.

For emerging updates and the latest requirements for each state, see:

The Interstate Medical Licensure Compact is an agreement among participating U.S. states to work together to significantly streamline the licensing process for physicians who want to practice in multiple states. It offers a voluntary, expedited pathway to licensure for physicians who qualify.

The Compact currently includes 34 states, the District of Columbia and the Territory of Guam. In these jurisdictions, physicians are licensed by 46 different medical and osteopathic boards. Other states are currently in the process of introducing legislation to adopt the Compact.

Physicians, even those who practice telehealth, must obtain medical licenses for the states  where they wish to practice. Each state has different licensing requirements, timeframes, and fees. Some states have a reputation for making the process simple and affordable, while for others, it can take anywhere between three and nine months and more extensive costs.

With ongoing demand for telehealth services and a need for flexible staffing models, locum tenens can be a strategic and cost-effective way to enhance your telehealth program.

A case study sponsored by found that by reducing unnecessary delays in practitioner onboarding, health systems can capture services revenue that would otherwise be lost.  An in-depth analysis of one large health system indicated it will save $74,000 per physician by integrating real-time digital credentials into its processes.


According to the Federation of State Medical Boards, 56 state medical boards require fingerprints as a condition of initial licensure


And now, tele-fingerprinting, 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 provides 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

To discuss how tele-fingerprinting can benefit your organization, contact



Something Old, Something New – TeleFingerprinting

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 and

Stay at Home!

A new solution has emerged, TeleFingerprinting!

International Fingerprint, Inc (IFP), dba, 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

Telemedicine and the Ukraine

Pregnant patient and Ukrainian refugee Sarah Misk using Sheba Beyond’s telehealth technology in Kishinev, Moldova, March 2, 2022. (Sheba Medical Center)

How Can I help?

Almost two months into the crisis in the Ukraine with no end in sight, its somewhat comforting to see the telemedicine/telehealth community rallying to try and do what they can to provide remote medical support to those still in the Ukraine, and refugees crossing the borders.  Now, telehealth companies are offering free digital health services to fill some of the healthcare voids created by the war.

This article discusses various ways U.S. clinicians can participate and how any reader can contribute to the clause.

VSee is a video telehealth platform with a 14-year history supporting health efforts in North America, the Middle East, Africa, conflict zones, the International Space Station, and refugee camps.  VSee developed Aimee, a telehealth app that “brings together more than 2,000 U.S.-based physicians to provide free on-demand doctor visits covering all medical specialties, including Emergency Room and trauma.” VSee is a video telehealth platform with a 14-year history supporting health efforts in North America, the Middle East, Africa, conflict zones, the International Space Station, and refugee camps.

VSee is the telehealth platform used by Thank you, Milton Chen, for all you do.  Read about it here:

CTeL is a nationally recognized 501(c)(3) non-profit research organization focused on telemedicine and virtual care and has organized the Telehealth4Ukraine Coalition which is working to bring together telehealth providers to support virtual humanitarian healthcare efforts in Ukraine and the surrounding region. The goal of the Coalition is to produce a dynamic database of healthcare providers that humanitarian organizations can utilize for virtual care support.

Dr. Irving Loh writes about his efforts working with CTel and a as co-founder and chief medical officer of an international healthcare artificial intelligence company based in Poland and the U.S

More International Efforts

Viveo Health, an e-health platform based in Estonia, recently announced it is focusing its Telehealth without borders initiative on Ukraine through its ViveoCares Foundation.

Using computerized systems built in Israel, physicians examine refugees on the Ukraine-Moldova border, check lungs, blood stats and even conduct prenatal ultrasounds.  The medical professionals are located at Sheba Medical Center, Israel’s largest hospital.

Dr. Richard Simpson informed me about his efforts in working in conjunction Ina Burgstaller and her team at Bionabu ( in the UK. Bionabu has created an international Virtual Clinic for Ukrainian Refugees “Ukraine Refugee Virtual Clinic” (Likarnya Online) that provides direct doctor to patient mHealth triage and consultation services in Ukrainian and Russian through smart devices. U.S. physicians can sign up to participate on the website. Physicians and dentists globally can find more information and register to on-board and receive training at


Some of the age-old challenges to telemedicine still exist.  There needs to be sufficient bandwidth, although anyone with a working smartphone can use these services.  Patients and providers need to be aware that services like these exist.  Fortunately, reimbursement is not a barrier as physicians are generously providing their services for free, but there is a great need for funds to support infrastructure and support staff.  There is a need for Russian and Ukrainian speaking physicians.  The use of translation services is possible but provides yet another barrier toward the delivery of care.

Joe McMenamin, a telehealth attorney who has been involved in several of these efforts writes, “For one thing, there’s a war on, and responding to American volunteers is not the (Ukrainian) MOH’s #1 priority. It is doubtless short-staffed from deaths and injuries inflicted by the enemy. For another, the providers we are able to reach over there say that what they need more than expertise from foreigners is pharmaceuticals and medical supplies”

On a personal basis

So, you think this is all brand new?

On December 7, 1988, an earthquake destroyed a significant portion of the Spitak Region of Soviet Armenia. The destruction resulted in significant death toll, building and infrastructure destroyed, and the displacement of hundreds of thousands of people. The entire local medical infrastructure was significantly damaged. Before the disaster, the space medical leadership of the United States and the Union of Soviet Socialist Republics were collaborating on joint activities in medicine and biology which resulted in the “Spacebridge to Armenia”.

The leaders of this collaborative effort devised an approach to support a disaster recovery utilizing telecommunications assets. I had the privilege of representing NYNEX Corp in discussion which resulted in participation from several major telecommunications companies as well as NASA.

More than medical help is needed.  I want to applaud the work of Dan Abrams, a son of close family friends who is on the ground in Poland leading the effort for World Central Kitchen who is delivering over 100,000 meals a day to refugees.

How Can You help?

Through several of these links, clinicians can sign up to deliver their expertise. Many of these efforts are charitable organizations and financial contributions are most welcome.  Let others know about the good work being done by the telemedicine/telehealth community.  Contact me directly at with questions, or if you know of other efforts I can share with this community.

Next Big Things

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

  1. 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

  1. 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

  1. 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.

  1. 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).
  1. 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.
  1. 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.
  1. 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.

Some Dark Clouds for Telehealth


Warning Signs:

As a 30+ year veteran of telemedicine (mostly teleradiology and teledentistry) I have always been one of its biggest fans.  I remain enthusiastic, but there are several warning signs that should be considered.

Telehealth usage peaked in the early days of the Covid-19 pandemic and has since stabilized.  The industry is guessing where usage goes from here as pundits debate the pros and cons of utilization going forward.  While claims compared to pre-covid levels have risen significantly, a plateau seems to have been reached.

This summer, Telehealth giant Amwell reported that they expect fewer telehealth visits through the fall and winter.


Investing in Telehealth

An investor would have been well advised to avoid the two largest telehealth companies, Amwell and Teledoc since the beginning of 2021.  Amwell shares are down 65% and Teladoc are down 30% through mid-October. One smaller company looking to take advantage of the SPAC phenomenon, Up Health Inc., has seen a decline of 85 % YTD.  Investors continue to pour money into the sector with digital health funding reaching $15B by the end of the second quarter.

An investor would have been better advised to invest in one of the companies acquired by Amwell (Silver Cloud, Conversa) or Teladoc (Livongo, In Touch in 2000).

Industry News

Also of note, Google shut down its telehealth efforts (for the second time).

Haven, the Amazon-Berkshire-JPMorgan venture to disrupt health care, is disbanding after 3 years

Closer to home, at the end of June, now ex-Gov. Andrew Cuomo allowed New York’s executive orders regarding telehealth practice across state lines to expire.

The potential for fraud continues to be a threat to telehealth growth:

And the biggest threat may be challenges with cyber-security.


Primary care doctors are also concerned about the sustainability of virtual care. If regulations and payment restrictions on digitally delivered care relaxed temporarily during COVID-19 are restored, 41% of clinicians say their practice may not be able to continue offering telehealth. Meanwhile, roughly a fifth of clinicians have already had to pull back their use of telemedicine since payments were reduced.

Telehealth/ telemedicine is here to stay and may succumb to the predictions of just being part of health or medicine while the industry looks for the “Next Big Thing”.  Any Ideas?  I’d love to hear from you.


Howard Reis





How Do You Do Teledentistry? (Revisited)

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

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

David and Goliath and Telehealth

Having worked with several successful telemedicine/telehealth startups, I have long been captivated with the question of, “How does an ambitious new entrant company successfully do business with a much larger, well entrenched company?” This question applies to all start-ups, but my experience in telehealth/telemedicine provides some insights which can be appreciated by all companies.

Quick background.  I have held senior business development positions with two startup teleradiology companies and recently served as CEO of The TeleDentists, a startup teledentistry company.  Both teleradiology companies achieved the status of Inc. 5000 fastest growing private companies (three times each) and were acquired as part of successful rollups.  The TeleDentists may have a similar successful fate.

The TeleDentists is the only telehealth company with licensed dentists in all 50 states.  Since the start of the Covid-19 pandemic they have successfully delivered over 10,00 consultations for patients with toothaches, broken teeth, and bleeding gums.  Early pandemic collaborations with Cigna and Anthem were true telehealth David & Goliath success stories.  On August 1, The TeleDentists began delivering service to a major hospital system in Michigan where their service is available in three hospital emergency rooms and three ambulatory care facilities.  This is a significant milestone for several reasons.  While the American Hospital Association reported that 76% of hospitals used telehealth1, this will be the first major deployment of teledentistry in a hospital.  They are still waiting for permission to announce the alliance.

It only took close to four years from initial conversation to implementation.  What took so long?

The good news is that The TeleDentists found on the hospital side a champion, an emergency room physician with a true vision of the potential for the program.  So often when working with a large organization, the champion leaves or gets re-assigned, and that was not the case here.  Even a visionary at the hospital cannot make the decision and commitment alone.  Administration, Legal, and IT were just a few of the departments which needed to be involved.  Contract negotiation, Security Audits, and Hospital Credentialing all needed to be included.  The Covid-19 crisis proved to be another hurdle as the hospital rightfully had other priorities during the crisis.

So, what are the crucial lessons learned? These are the first ones that come to mind.

  1. Need a champion with a vision, a good internal network, and a track record of prior success.
  2. Persistence and a belief that all hurdles can be overcome.
  3. Don’t put all your eggs in one basket. Look for other projects and opportunities with smaller customers that can keep you afloat while you are waiting for “the big one”.

What took so long?

  1. Contracting
    1. Lawyers – Every lawyer will have their say about a contract. One suggestion is to ask to use an agreement that the larger facility is already comfortable with.
    2. Insurance – It is understandable that the large entity wants to protect themselves, but they may require that the small entity carries types and levels of insurance that are difficult to financially justify.
  2. IT
    1. Security Audits – The larger entity will want to conduct a Security Audit. Wouldn’t it be nice if there was a way to do this once, and have an organization certify that all requirements are met?
    2. Integration – Each large hospital organization has their own EMR. Once you have performed an integration with EPIC, you have performed one integration with EPIC.  It may not be easier the second time.  Every EMR has their own unique requirements and if a hospital has undergone mergers, it may be necessary to integrate with multiple EMRs.
  3. Changes
    1. Over the course of a long negotiation, change in technology is likely. This may require re-doing steps that have already been completed.
  4. Covid-19
    1. It could not be anticipated that Covid-19 would play into the equation. Covid-19 hit Michigan especially hard.  It is still unknown how Covid will impact relationships between providers and vendors.
    2. A crisis is not necessarily a bad thing for a nimble startup company. My favorite quote during the pandemic was when our Cigna partner said, “we just got done in 6 days what usually takes us six months.”  Having the infrastructure in place to be able to respond certainly helped.

Going Forward

The challenges don’t stop with a successful initial implementation.  Training is essential and can be a challenge if done remotely.  It is essential to have a communications plan in place.  I have also seen where constant staff changes were a primary unexpected challenge in a nursing home telehealth implementation.  The hospital system has additional facilities and expansion is likely if the program is a success.

Other David and Goliath challenges.

In 220 Becker’s reported that there were 260+ telehealth companies3 and I suspect that the pandemic has launched many new ones.  It is the goal of many of these new entrants (Davids?) to be acquired by the larger ones (Goliaths?)   It certainly didn’t escape attention when Teladoc acquired Livongo for $18.5 billion just a year ago.4 If Teladoc is looking for billion-dollar deals, the startup telehealth companies have a long way to go to catch their attention.

Even partnerships can be a challenge.  If a company with $1Million in annual revenue looks to partner with a major medical distributor with $10Billion in annual revenue, the priorities may not be compatible.  A $250,000 revenue opportunity increases annual revenue by 25% for the smaller company, but only .0025% for the larger firm.  Certainly, the larger firm has other priorities to capture their attention and resources. (Please contact me a to hear the details.)

The next time you hear about a David versus Goliath story, don’t think of an underdog. Think of a confident competitor who is more than happy to be underestimated.

I am also thrilled to write about the new David in my life as my grandson David turned one year old last month.  I look forward to being in his corner as he takes on the various Goliaths in his life.



3 Wishes for Telehealth

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.




TeleDentistry – After the Masks Come Off

I’m feeling pretty good. It’s two weeks past my second Covid-19 vaccine. It’s gotten me thinking. When will I no longer need to wear my mask in a crowd? And what will this mean for teledentistry?

For the Patient

According to Becker’s Hospital Review1 in March 2020, 19.5 percent of Americans had a telehealth appointment, whereas 61.05 percent had in March 2021. This is also true for teledentistry where most patients have now had a previous telehealth experience, and almost always a positive one. In March 2020, 65.6 percent of Americans doubted the care quality provided in telehealth appointments, but in March 2021, 87.82 percent wanted to continue using telehealth services after the pandemic subsides. Patients do not want to always travel for their medical appointments, and they do not want to wait in a (crowded?) waiting room.

Benefits are also significant for the patient population, or specific classes of patients. The great benefit of telehealth has always been improved access. This is especially true in rural areas where a visit to the dentist may mean a trip of many hours.   The elderly, and patients with disabilities or special needs are most likely to benefit the most from a remote visit.   There are cost reductions for patients, especially those without insurance. Insurance companies benefit by keeping patients out of the emergency room. Oral hygiene can be improved reducing more serious diseases which are likely to occur if oral health issues are ignored. A visit with a teledentist is much less intimidating for a patient who has always been afraid of what may happen in the dentists’ office.

For the Dentist

While the greatest impact of Covid-19 on dental practices has been a drop in revenue, At least one study has reported that the drop was less than had been anticipated.2 In any case, teledentistry can help to make up the difference.

Teledentistry provides great benefits for individual dentists.

  1. Use teledentistry to screen patients and maximize chair time with those patients that need a procedure.
  2. Attract and meet new patients using teledentistry and meet them face-to-face and not behind PPE.
  3. Integrate teledentistry into your practice management system and provide patient education and scheduling reminders.
  4. Create the ability to consult with a specialist in real time, and with the patient included.

One expression that many dentists hear now is ‘mask mouth.’ The phrase refers to a range of symptoms associated with wearing a face mask around your mouth for long periods. It’s not an official diagnosis, but it’s become a common phrase used to describe the rise in dental problems that have resulted from increased mask-wearing. There may also be specific procedure (like teeth whitening) that become even more popular as patients no longer “put off” procedure and plan to return to their regular routines.

There are also benefits for specific groups of dentists, namely those recently retired or dentists who have become disabled. What a great way to continue to use the skills developed over a lifetime of practice without the burden of managing an office.

For the Future

Teledentistry is one of a variety of technologies that have been identified (by MedCity News) as having the most likely ability to shape the future of dentistry over the next ten years. The list also included 3D Printing, Artificial Intelligence, Digital Dentistry, Tooth Remineralization and Augmented Reality. You can read the whole article here:


More immediately, 2021 will see expansion of teledentistry in areas are medical-dental integration, e-commerce (via the expanded selling of dental products to patients and dentists), electronic claims processing and further integration with electronic health records. The TeleDentists will be leading the way.




Tele-Dentistry – The State of The Union

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.




Stress and Teledentistry

We live in unprecedented stressful times. There is a global pandemic with no announced cure. Unemployment in the U.S. is at historic levels. Working parents need to supervise remote learners while trying to do their own jobs remotely. Racial tensions have gripped the country. Adult children with parents in nursing homes may not be able to visit. A national election is days away with a tremendous amount of anxiety on all sides. The list goes on.

High levels of stress have been linked to a number of severe conditions, including high blood pressure, anxiety, depression, stroke, irritable bowel syndrome and a weakened immune system. Stress can also be a major factor for dental health causing conditions like bruxism (teeth grinding) dry mouth, gum disease and TMJ/TMD.

Dentists are not immune. Studies reported in dental literature confirm that dentists are subject to a variety of stress-related physical and emotional problems. These problems included an alarmingly high incidence of cardiovascular disease, ulcers, colitis, hypertension, lower back pain, eye strain, marital disharmony, alcoholism, drug addiction, mental depression and suicide.

The Covid-19 pandemic has led to a new stressful event for both patients and dentists. Going to a dental office. Appointments are more difficult to schedule. Patients are afraid that they will be subject to infection. Dentists are afraid that not enough patients will visit, and their practices have suffered.

The TeleDentists Can Help!

There are several ways The TeleDentists can help relieve these stressful situations.

  1. Video Consults. Patients can see a licensed dentist from the comfort of their own home within 10 minutes of clicking on a link with their computer or phone ( If needed, medication can be prescribed and sent to a local pharmacy.
  2. Sponsored Products. The TeleDentists are promoting several products which can directly help a patient with specific conditions. (   Speed2Treat provides treatment for head, neck and jaw pain. SaliPen is a leading-edge medical device which treats dry mouth naturally.
  3. MY TeleDentist gives any practice the ability to add teledentistry to their own practice offering.
  4. If you don’t have a dentist, we can help you find one.

We do not pretend to have solutions to all the problems which are causing stress today. However, if those problems are leading to dental issues, we are here to help.

A New Dimension for Telehealth > E-Commerce

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:

Several companies offer online birth control:

Other offer solutions for Erectile dysfunction and hair loss:


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


The TeleDentists ( 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 ( to provide the SaliPen, a leading edge medical device that treats dry mouth. Another partner is providing Speed2Treat (, 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 ( 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.



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

How Teledentistry Has Changed – In the Past 30 Days

What has changed for teledentistry since the onset of Covid 19? In a word, everything.

For Patients

Patients can no longer visit their dentists as most offices have closed or are only seeing emergency patients. Patients can no longer go the Emergency Room for dental pain as they are standing on long lines or getting turns away. Patients are still getting toothaches. Many are finding The TeleDentists at where they can see a dentist, usually within 10 minutes, who can remediate the problem, get a prescription sent to a local pharmacy, and get information about local dentists whose offices are open for emergencies.

For Dentists

Many have closed their offices in compliance with the American Dental Association recommendation that dentists nationwide postpone elective procedures in response to the spread of the coronavirus disease.


Dozens of dentists have found The TeleDentists to be able to remotely provide service to their own patients, or patients of The TeleDentists.

For The Telehealth Industry

Established telehealth/ telemedicine providers have seen a substantial increase in patient volume especially as President Trump and Vice President Pence have extolled the benefits of telemedicine in their daily briefings and announced relaxed regulation and expanded Medicare benefits.

Among the new policies, the CMS Fact Sheet listed these key takeaways:

  • For the duration of the emergency, Medicare will pay for telehealth services furnished to beneficiaries “in all areas of the country in all settings” at the same rate of as regular, in-person visits.
  • HHS will not conduct audits to track whether there was a prior patient-physician relationship for claims submitted during the public health emergency.
  • Patients must initiate services, but physicians may inform their patients on the availability of telehealth services.

In addition,

  • States are allowing license flexibility

The general policy regarding medical licensure and telehealth is that the physician must be licensed in the state where the patient is located at the time of treatment. The AMA telehealth guide notes that CMS has waived this requirement for Medicare patients and that states may request a waiver for Medicaid patients.

  • “Discretion” on HIPAA rules

The OCR, the HIPAA-enforcement arm of the HHS, announced that it will exercise “enforcement discretion” and would not impose penalties for noncompliance with regulatory requirements during the “good faith provision of telehealth” services during the COVID-19 national public health emergency.

·         Prescribing of Controlled Substances

The Drug Enforcement Agency (DEA) published a COVID-19 Information Page on the Diversion Control Division website, providing guidance relating to the COVID-19 public health emergency, including the ability to prescribe controlled substances via telemedicine without a prior in-person exam.

Some Telehealth companies have been forced to let patients know to expect delays. This notice was found on the web site of a major provider:

We are experiencing longer than normal wait times due to the COVID-19 pandemic.

For The TeleDentists

Significantly increased patient volumes, hundreds of interested dentists, new business opportunities, very little sleep.

We have signed agreements with two multi-state DSOs (dental service organizations) and will be implementing service for their dentists and patients this week. We are also in discussion with several major insurance companies who want to provide relief for their patients during the crisis. Our dentists have stepped up significantly. Our partners have been understanding. Our technology vendor has been able to handle the increase in volume.

Is this the turning point we hoped for which will put teledentistry on the map?

Possibly mention what is happening in Maine and Texas, and our response?


We at The TeleDentists are amazed and humbled by the response from healthcare workers and support staff around the country and are hoping to do our part. We pray that readers of this blog and their families are healthy and safe. We’re all in this together.

Howard Reis, CEO, The TeleDentists


Would You Recommend the TeleDentists to a Friend or Family Member?

The TeleDentists stepped up during the Coronavirus pandemic providing an important service during a time of critical patient need. Dental offices closed, but patients continued to get toothaches. Patients found relief by looking for solutions on the Internet or were guided to our site by two major insurance companies, Cigna and Anthem.

For most patients, this was their first experience with teledentistry, in fact it was their first experience with telehealth of any kind. We had promised our partners that we would be able to see patients in 10 minutes or less and we met that metric 99% of the time. But we also wanted to make sure our patients were satisfied with the experience. So, we asked them.

Net Promoter Score (NPS) is a management tool that can be used to gauge the loyalty of a firm’s customer relationships by asking a single question. According to the June/July 2020 issue of Fortune Magazine, it is a tool which is used by 2/3 of the Fortune 1000 companies.

But it can be easily used by small companies such as ours. The question we asked,

“Would you refer a friend or family member to The TeleDentist service?”

Patients were asked to rate us from 0 (not very likely) to 10 (very likely). Results can range from -100 to +100. Our results were “off the charts” positive as we scored an 82.

Companies are usually compared to others in their field, and below is a chart of average NPS by industry with a range of 27 to 71.

This article from 2017 says that the average NPS for dental providers is “1”.

This article says that Teledoc has an average NPS of “9” and that we even beat the very highest ranked companies, Costco and Starbucks.


Many companies, when reviewing the results of their first NPS survey are in a position off asking themselves, “How can we do better?”. We, the TeleDentists are in the fortunate position of asking, “How do we keep doing what we’re doing?”. We are very conscious of the fact that the results are largely a factor of the ability of a qualified dentist to provide expert relief at the time of patient need. Delivering a service which is valued by its customers is one way that a small company becomes a larger one.


Telemedicine for Millennials

The Millennial generation is the biggest in US history—even bigger than the Baby Boomers.  They value (among other things) Innovation, Convenience and Experiences. Has telemedicine found the demographic group which will make this delivery system a ubiquitous component of medicine?    Several new service offerings suggest that perhaps it has.

Slingshot – – Is a marketplace which allows you to book an appointment online with a doctor near your location at a price you are willing to pay.

Uberdoc – – Gets you a guaranteed appointment with the best specialist for you, without being put on hold, needing a referral or waiting many weeks

XpertCare – – Is a network of Pediatric Subspecialists who provide e-Consults to pediatric primary providers and is about to launch its direct-to-the consumer service.

Millennials (anyone) can currently purchase:

A recent count showed over 220 active telemedicine/telehealth providers happy to provide online assistance to parents looking for immediate attention to their children’s medical needs.  For example, a child is teething in the middle of the night? The parent can See The Teledentists at

91% of employers are expected to offer telemedicine by 2020, according to a First Stop Health survey of midsize to large employers.

Earlier this year, Healthcare IT News reported on a new study that showed millennials rate telehealth as “extremely or very important” to their choice of medical provider.

Media Logic suggests that some of the most salient statistics on millennials and their comfort level with telehealth include:

  • 74% prefer a telemedicine visit to an in-person appointment.
  • 26% would switch current doctors over one that offers telehealth.
  • 71% want to be able to book their appointment through a mobile app.
  • 75% that have used telehealth rated it as superior to a traditional on-site office visit.

This study says millennials are the age group most likely to use telehealth, especially for mental health:

That’s not to say that there won’t be hurdles.

While the vast majority of midsize to large employers offer a telemedicine benefit, less than 2% have used the service, according to Willis Towers Watson’s 2018 Annual Changes Ahead Survey.

Visibly (formerly Opternative) was forced to recall its online vision test

The California Dental Association was instrumental in passing a law that offers protections for patients using teledentistry (for tele-orthodontia).

So, with additional popularity comes controversy.  If the services are cost effective, easy to use, and available on a mobile phone, it looks like they are here to stay.