Mobilizing online care to deliver population health

mTelehealth + primary care = population health

By W.C. Thornbury, MD

Health care’s necessity for cost-control and consumer demand for access will inexorably drive a portion of health care delivery online. Recent advances in mobile technology have enabled telehealth to become efficient—and, for the first time, practical for family physicians to implement.1

Online health care delivery is undergoing rapid change. In the past, care has been directed by technology into two divergent paths: Store-and-forward (e-visits) or live telemedicine (secure video). Store-and-forward is convenient and efficient for the physician to use; secure video provides an emotional comfort and the visual nuance face-to-face interaction affords.

There is an emerging generation of technology, mTelehealth, which leverages the capabilities of the mobile platform, like smartphones and tablets, and marries them to e-visits and video. mTelehealth distributes mobility and the system’s computational power to both patient and provider. This close combination yields synergistic advantages that allow the physician to direct the virtual care encounter rather than the technology dictating the direction of the physician. Health professionals may now address online care in the same manner as they do in-office care, determining how much and what type of information and communication are most appropriate for an encounter.

Efficiency is premium. A family physician with a well-established relationship with his or her patient understands how much information will contribute to an efficient online care encounter. The clinic, be it in-office or virtual, presents a variety of clinical complexities.  Physicians invest differing amounts of intellectual capital in the gentle care and disposition of each case. It is illogical and inefficient to restrict clinicians in their approach to care, though past technology has conspired to do so. What is clinically important to the physician is that the appropriate amount of information be collected and documented to safely and efficiently provide care. The practicalities of practice management demand it.

mTelehealth links primary care to the virtual clinic. mTelehealth’s mobility allows care requests to follow the provider. Further, its store-and-forward capability affords the clinician flexibility in his or her response. The technology can render care up to 300 percent more efficiently than older generations of telemedicine—in as little as four minutes for a fully documented encounter.2 Thus, this new generation of telehealth yields an ability to incorporate virtual medicine seamlessly during a hectic office or after hours. This efficiency is the catalyst that overcomes important previous impediments of first-generation technology, finally making it practical for the family physician and the medical home.

mTelehealth links the virtual clinic to chronic disease. Family physicians are in a unique position to leverage their patient relationships with the cost-savings of the virtual platform. Their capability to render continuity of care via mTelehealth offers the mechanism to expand the palate from the treatment of minor acute care to the management of chronic disease care, which accounts for 75 percent of the health dollar.3 Over time, upwards of 40 percent of office-based encounters may well be amendable to the virtual clinic. Thus, family medicine can influence and substantively change the nation’s delivery of outpatient care.

mTelehealth links chronic disease to population health. More consequential is mTelehealth’s ability to drive population health. Hospitals presently retain the majority of health providers and will leverage their capacity to work efficiently with patients, families, caregivers, and colleagues inexpensively online to provide an extended suite of services. Primary care enables virtual follow-up during transitional care, thus reduced readmissions. Increased access allows for chronic diseases to be addressed before unnecessary time, travel, or higher level care is required. Assisted-living, skilled, and long-term care facility adaptation may reduce transportation costs and ED misuse. It provides a vehicle to implement CMS’s chronic care management initiative addressing needs online before a costly intervention. Most importantly, it opens access to brick-and-mortar facilities that don’t have a provider for patients requiring face-to-face care.

mTelehealth is evolving as a new generation of delivery technology offering clinicians the ability to provide online care practically. Its breadth of influence will place family physicians in the position to support the patient-centered medical home, impact population health, and bend the cost curve of the nation’s escalating health care system. It has the means to help end medical homelessness.

Time and talent will be required to embed this new delivery model between patients and their providers. However, such investment will open the door to increased provider productivity, lower per-capita cost of care, and an improved consumer experience—the tenets of the triple aim. Family physicians and their leadership should respect the developing megatrend that mTelehealth will bring to the profession and implement a global mHealth strategy moving forward.

Dr. Thornbury is a family physician in private practice and medical director of Medical Associates of Southern Kentucky in Glasgow, Kentucky. He is the founder of a mHealth technology company, meVisit Technologies.

1. Kaibara P. Should You Treat Patients Virtually? Fam Pract Manag. 2015 Jul-Aug;22(4):16-20.

2. Thornbury W. How Mobility Within the Medical Home Can Positively Disrupt Healthcare. Journal KAFP. 2013 Summer; 79;20-23.

3. Thornbury W, Thornbury S. mHealth in Chronic Disease Management: Case Study of a Mobile-to-Mobile Delivery Model. Global Telemedicine and eHealth Updates-Knowledge Resources. 2014 Apr(7):649-653.