Telemedicine Revisited- Rethinking the Opportunity


I’ve spent more than 10 years working in telemedicine, watching the industry evolve from a largely grant-funded academic interest to a scalable model that could change the way we care for patients. However, in order to maximize the benefits of telemedicine, the folks with the purse strings—that is, healthcare administrators and payers—need a better framework.

The Problem

The aging population across the developed world threatens to overwhelm healthcare resources that are already stretched thin. The silver tsunami is an exemplar of the healthcare crisis in America in particular. Our dedication to healthcare capitalism in a market that lacks price transparency and value presents enough of a challenge; however, our reliance on high-tech cures has produced a system that carries twice the cost with outcomes half as good.

Tenets to Turn the Tide of the Crisis

First, patients and their families need to have the tools to be able to partner with their physicians. With limited access to providers, patients feeling fearful or anxious about a new malady turn to the ever-accessible Dr. Google. However, information without context is not the answer. Furthermore, family members who are often willing to help care for their loved ones can be excluded from conversations (intentionally or not). HIPAA is in dire need of a revamp that would include ways to make family members more active participants in the care of their loved ones.

Second, healthcare providers need better tools for communication and collaboration. Contrary to popular belief, the most expensive thing in a hospital is not the MRI scanner or even the cost of surgery. It’s the people. Fax, phones, and pagers—the staples of medical communication—were essentials in the 1980s. Other industries have moved on- but medicine remains stuck in the past.

Third, healthcare professionals must stop thinking of technology as a surrogate for care. America’s reimbursement models incentivize the latest drugs, surgical procedures, and devices instead of focusing on what people really want—information and, ultimately, reassurance that their doctors and nurses are going to stay close and help navigate a treacherous journey. We have placed far too much emphasis on cutting-edge technology. What patients really want is reassurance.

Telemedicine: Enabling Reassurance

For most people, the term telemedicine conjures visions of televisions where doctors and patient meet on a shaky video stream—nowhere near as good as in-person care. For me, the definition of telemedicine is much broader. It involves the use of modern technology—software and hardware (including mobile devices)—that allow people to come together. This could be a patient seeing their doctor over their computer, or various healthcare professionals consulting about a patient, or devices in your home that help keep patients well by reminding them to take medications or keep up with physical therapy. In assessing whether telemedicine is a worthwhile pursuit, we must consider all of the data. Was greater cost avoided? Did the patient avoid admission to a hospital, or did their wellness improve? Did the healthcare institution lower the patient’s costs? These are all relevant metrics.

4 Buckets for Collaboration

I’d like to propose a new framework for thinking about telemedicine. This framework comprises offerings with immediate relevance, as well as opportunities for future growth.

Self-Serve Care

This is an evolving concept. Think of it as a personalized Google search, an intelligent bot that interacts with patients, helping them reach a diagnosis and develop a treatment plan. Doctors are not excluded from this opportunity; rather, they are involved, meeting with the patient after the bot. Babylon is perhaps the best known offering in this space, but other companies like CloudMedx (which I advise) and Microsoft are also building effective “bots” in this space.

Direct-to-Consumer Telemedicine

The direct-to-consumer (DTC) model has (unfortunately) received the most attention from telemedicine investors. Teladoc, AmericanWell (disclosure: I’m an investor), DoctorsonDemand, and MDLive are all examples of companies whose their primary revenue stream comes from is DTC telemedicine. The thinking behind DTC care was that patients would replace expensive emergency department visits with less expensive online visits for simple problems. However, instead of streamlined patient care, the DTC model has become somewhat of a requirement for hospitals looking to compete for market share without much to show in the way of better outcomes or cost reduction. As suggested by a report from the Rand Corporation, DTC has increased costs. This is in large part to a new class of consumer- a patient who would not have come to see a doctor but is willing to click for care. 

Provider-to-Provider Medicine


When it comes to sick patients, no one person knows everything. Doctors and nurses need help. The increasing complexity of care requires a team-based approach, and video is a part of this space. Secure texting linked to relevant clinical information (not possible with iMessage, by the way) makes up the majority of this opportunity.


Of the 4 opportunities, I’m most intrigued by spaces. We spend hours picking out paint, chairs, walking flow, but opportunities to enhance people integrating spaces with technology- this is typically an afterthought.

Spaces refers to seamlessly integrating telemedicine (and other technologies) into the places where healthcare is provided. This allows the people providing the care to work more efficiently. Patient’s television, whether they’re watching it at home or from a hospital bed, becomes an opportunity to meet a doctor or consult with family. Or perhaps weight scale information is managed by a patient’s cable company, so the patient’s nurse can monitor vital signs. Another innovative spaces application is a clinic built for initial consults, but patients are followed-up remotely, reducing space and staffing needs. These are just a few examples.

I will expand on these four areas in a future blog. But each one has a common goal: enabling patients and families to participate in their own care, while enhancing communication between patients and providers. A new drug or device isn’t going to bend the curve. Perhaps telemedicine, deployed for the right reasons, can help put a little humanity back in healthcare.

Reader Interactions

Leave a Reply

Your email address will not be published. Required fields are marked *