A nice account of one physician practice ramping up a telemedicine clinic quickly in response to COVID-19.
Despite having an existing paid system (EPIC) which supports telemedicine visits and at least mentioning another free option (Doximity), this group went with Zoom. I know a few others who also went with Zoom for various reasons, most commonly the ease of use. The number of paid accounts varies. But it also goes to show that a practice can easily implement telemedicine when it becomes necessary or financially beneficial, which has been my argument against TDOC.
My hospital, very large academic center in Midwest, elected to use this App called Doximity for video visits. I also feel that the initial consensus amongst many of my colleagues is that telemedicine has a ways to go before it will become mainstream in communities with access to physicians. Some discussions and medical evaluation require to be in person either from a sensitivity standpoint or from a diagnostic standpoint. Also, If something is discovered in the visit, not being on site is problematic. Further, we can’t assess vital signs remotely in our current setups. Also, from a patient standpoint, there will be pushback for being billed for visits that some feel to be inferior in quality going forward. Additionally, if these visits are shown to be less effective from an outcomes standpoint when implement wide scale (as opposed to outreach to underserved communities), you can bet reimbursement will suffer. For all these reasons, I have stayed away from TDOC in favor of companies such as LVGO, INSP, NVCR when it comes to the medical space.
Despite having an existing paid system (EPIC) which supports telemedicine visits and at least mentioning another free option (Doximity), this group went with Zoom.
They went from Zoom to Zoom!
Note: A new Epic integration is now available in beta in the Zoom Marketplace. If setting up a new integration, we recommend using the Marketplace app. Learn more.
The Zoom integration with Epic enables the health care organizations to launch Zoom from within an Epic video visit workflow. Using context aware linking in Epic, a link to a zoom video session can be placed in an Epic appointment. This will enable Epic users to easily use Zoom and the Epic EHR in a streamlined side by side workflow.
I work for a mid-sized healthcare organization, operating in about 25 or so locations. When all this started, we evaluated a system (non-zoom supported). For the price, its was right. As we’ve added doctors to the system, patients to the system, as health systems across the world have, we are having significant connectivity problems (patients and doctors can’t connect, disconnect mid visit, etc). We jump on zoom to discuss those problems…and have no issues with those discussions.
We are now about to adopt a system (zoom is the backbone) for video-visits. There simply are no connectivity issues we have experienced using the zoom supported system. It is far superior to the non-zoom system we initially adopted from a connectivity standpoint (some of the doctors will tell you they like the functionality/features of the other system…but that’s a different issue and doesn’t matter if you can’t conduct the visit from start to finish)
ZM is our solution, long ZM.
The Zoom implementation in Epic is new and still in beta. But it shows the power of Zoom and its ability to quickly integrate into other systems. The main issue with Epic before Zoom (and I’m not sure but I believe Doximity) is that they are only one on one systems. If you need a multidisciplinary approach (multiple doctors) or added staff (nurse or PA) it required multiple calls. Zoom is the easiest to get people on a call with no pre-existing setup other than having a smart phone.
The Zoom implementation in Epic is new and still in beta. But it shows the power of Zoom and its ability to quickly integrate into other systems.
My point is that Zoom is the “go-to” teleconferencing service and as the saying goes, don’t fight city hall and don’t bet against the leader.
Earnings Jun 2, 2020 After Market Hours Confirmed
I wonder what kind of surprise this will be. Zscaler, Inc. (ZS) was up 29% on a nice surprise
Curious what your thoughts are on the upside of NVCR.
On the one hand… it is a company that has a massive moat due to the technology and patents. It has FDA approval for treatment of 3 different cancers, all of which are less common cancers. It has many more in the pipeline, including 3 in stage 3 that are very common cancers (pancreatic, ovarian, and lung). The treatment method itself is so much less invasive than traditional treatment methods (chemo and radiation), that it seems like a no brainer. The company is already profitable. Current treatments are covered by Medicare. The company is expanding internationally. The stock price is currently sitting 30% off its highs.
On the other hand… final results for the lung cancer trial won’t be reported until 2022 (prelim results this year), with the results from other trials even further out. We won’t be seeing earnings changes for this company from these treatments (if they get approval) for a number of years, and a large part of me thinks those funds could be better used in an equity that has shorter term growth potential.
To summarize: I’m torn.
Between my wife and I we have had at least three tele-med visits in the past two months. One used Zoom, the others used some sort of specialty medical software (I forget the name, but based on the name is was aimed at medical people). The only face-to-face my wife has had is with her surgeon (cancer), and with the chemo staff. I was recovering from surgery before all this happened (burst L2), and the past two “visits” with the surgeon were via tele-med. I did have to get radiology prior to the last visit (last week), but otherwise no in-person medical.
If something is discovered in the visit, not being on site is problematic.
I think for my situation, or reviewing blood work, it’s not a big problem. But sometimes you have to palpate a patient, and it’s hard to do that remotely. So I suspect tele-med is going to be self-limiting for that reason.
But sometimes you have to palpate a patient, and it’s hard to do that remotely. So I suspect tele-med is going to be self-limiting for that reason.
Right, but if you know you need the physical exam in advance, you schedule an in-person visit and, if you discover the need for physical exam, labs, x-rays, or what have you during the exchange, you just schedule that, most of which involves someone other than the primary care physician anyway and would happen no differently if the visit was in person or remote (except that you can’t just go down the hall for a blood draw).
No one is suggesting that tele-visits will take over all care, but rather that a significant percentage of visits are managed adequately that way and that this both manages the doctor’s time more efficiently and requires significantly less time investment on the part of the patient … with little impact on the quality of care.
I’ll tag in with another anecdotal post. I had my first telemedicine appointment with my allergist on Friday.
I’ve been taking allergy shots for about 18 years, so at this point, there isn’t much in the way of drama or revelations in my appointments. Typically, I would take time off from work, due to their limited hours, then sit for 15-30 minutes in the waiting room, then sit with the nurse and answer basic questions for a few minutes, then wait again and finally have a 5 minute Q&A with the doc.
They have just implemented Zoom for telemedicine visits. I connected a few minutes prior and the nurse went over the usual questions. Then the doc came on and asked all the same stuff they would ordinarily. Honestly, this kind of visit could have been done by telephone at any point in the last dozen years, with sporadic instances of in-person testing. The pandemic has prompted them to implement a solution for both convenience and risk reduction. They went with Zoom, mostly likely because it is easy.
Zoom, and telemedicine in general, definitely won’t replace all doctor visits. I don’t think that is the intent. What it does is allow doctors and patients to separate conversational visits from physical diagnostic visits. It is amazing how many visits really don’t involve hands-on diagnostics. Many just have perhaps a blood pressure check. What remains to be seen for me personally is how doctors offices differentiate between in-person and telemedicine when the patient has a strong preference for a physical visit. Time will tell.
In this space and adjacent ones, I’m long Zoom, Teledoc, Livongo and Phreesia.
…with little impact on the quality of care.
I agree. Often the MD asks a few questions, listens to your heart, and then writes a lab order. You get a call in a week to say your labs are OK, or you need to come in.
In a WFH scenario this would often work well. For people in an office, they likely wouldn’t want to discuss their healthcare where everyone else can hear them. At least three or four people could hear me in my cube farm. I often go outside to use my cell for medical calls (even before COVID) for that reason.
I don’t know if doctors will want to continue doing this remotely. Maybe give the patient the option? It does have the benefits you mention. In which case you may want to check out the medical versions of tele-conferencing. I assume they have to be HIPPA compliant, or jump through other hoops. One of my MDs used something called “doxy.me”. Aimed specifically at medical professionals and tele-med.