Why Telemedicine Is Not A “Internet of Things” Solution

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Infographic: Do People Trust Telemedicine?

Medullan’s Dutch Dwight talks about the state of telemedicine and the virtual direction its headed in healthcare. 


Dutch Dwight

As telemedicine teeters on the edge of an explosive state of expansion, so many questions come to mind, including how it will transform healthcare delivery as we know it. With value-based reimbursement and a push to serve the underserved growing in the U.S, telemedicine stands to gain a lot of traction and quickly. Still, it’s important to remember the flesh and blood human elements driving this transitive development of reform.

The acclimation to virtual visits in the newly emerging healthcare ecosystem is surely underway, however, true and total integration of telemedicine services may take a while. It won’t happen overnight and it won’t happen without keeping the human motivations of healthcare in mind, according to Timothy ‘Dutch’ Dwight, vice president of business development at Medullan, a digital health innovation firm based in Cambridge, MA.

In a recent article regarding the next generation ACO model, Dwight stated that telemedicine is not an “internet of things” solution:

Remember, the vast majority of these households are reachable only through land lines, not wireless. These critical access hospitals could become the true test beds for innovation and investment. These patients want to be touched. They are not averse to relationships with people. The more you touch these patients and help them, the more they will respond and the lower the cost of care will be. In the end, healthcare is about people and communities of people helping each other.

Thus, we looked to explore these ideas further. What will it take virtually and collectively for telemedicine to succeed in healthcare. Is telemedicine and other tech trends just a fad of reform, or are they truly here to stay and truly transform? Here’s Dwight’s take:


When talking about the Next Generation ACO model you stated how telemedicine is not an “Internet of Things” solution, implying that there is major importance in the human element of medicine. Can you elaborate exactly what you mean by that statement, and what has led you to that perspective?

Telemedicine meets three simultaneous needs:

1. It enables scale for a poorly allocated workforce management problem.

2. It allows physicians to make incremental money.

3. It provides a service to a patient at the same time.

Human Factors Oriented determined that a face-to-face patient interaction improved outcomes versus just talking on the phone. Some studies suggest that 65 percent of the people utilizing telemedicine are happier with texting (SMS) rather than a virtual face-to-face appointment. If users prefer to use text, and enter information into the system, then the system can be optimized through the use of semantic web tools to provide the doctor better clinical information prior to the engagement, then close with an informed face-to-face virtual meeting.  This use case still does not take readings from a device to the virtual meeting interface to enable the provider with ‘better’ information. That is what I mean by “telemedicine is not an IoT solution.”


Traditional health-care providers can be slow to integrate new technology. Almost half of doctor’s offices polled in 2013 still used paper records, according to a survey from the U.S. Department of Health and Human Services. Other recent surveys have found that only 2 percent of patients nationwide have access to video visits with their primary care physician. Less than half — 45 percent — even receive a traditional phone appointment reminder. Does this mean the telemedicine “boom” we are seeing isn’t going to be easily integrated or embraced as the health community would like us to believe?

Transformative solutions involve data platform and optimization tools, which enable the appointment information to be combined along with the clinical and the latest personal outcomes information in near real time to reduce the overall cost of care. Robo calls will be leveraged for certain clinical interactions via telemedicine appointment setting.  If the telemedicine solutions adopt applications like Health Navigator, which marries natural language processing (NLP) with pre-encounter check-in processes, this will improve the value and speed of the encounter with the provider.


We are seeing some evidence that the nature of some technology, like consumer wearables for example, is having very little impact on actually improving outcomes. Will telemedicine services produce similar disappointing results because of the virtual limitations, do you think?

It took many years to have land line phones to be well adopted.  Cell phones were started in the early 1990’s, we are now 25 years into cellular technology. Wearables are not going away. The inhibitor may partially be blamed on the old line institutions: government, entrenched monster medical device companies and humans’ natural tendencies to wait until the price and value intersect for mass adoption. Telemedicine’s largest inhibitor for adoption has been the governments’ reluctance to allow physicians to bill for the service.


Similar question: Do you see virtual telemedicine services and/or centers as a thing of the future to serve the underserved? Bottom line, won’t it still be hard to close those socioeconomic gaps because technology is not widely accessible nor will the population be motivated to continually visit virtual care centers to monitor and manage chronic conditions? I mean isn’t the reality here that those gaps exist for other reasons that technology alone cannot remedy?

Presently, the ‘underserved’ receive free everything: phones, taxi rides to the doctor’s office, social worker site visits. Telemedicine will reduce these high costs if the ‘underserved’ collaborate. I believe that the rural or critical care hospitals will provide a larger value to these populations as you look into the future.  They already manage populations over large distances.


Let’s talk about the actual physical limitations of telemedicine. At the end of the day, doesn’t a physician have to place his hands on his patients to serve them adequately. What if there is something beneath the surface that he can’t see but he could feel?

That’s the physicians call. They are trained in these ways.


What do you think will really be revealed from this boom in telemedicine? Do you think we are in for a sobering surprise here? Because, right now, there’s a lot of enthusiasm riding on these telemedicine initiatives…

Naturally, telemedicine will continue to grow because of the problems outlined in answer one. Uber has not stopped growing for similar reasons.  Telemedicine companies are trying to combine Salesforce with clinical care management solutions and having a tough time bridging the quality of the interaction.  Salesforce is an internal operational management tool to track the interactions with a client and are designed to optimize the nurse line call center operations.  The telemedicine business model will also change.  Keep an eye on the utilization and billing methodology to see who survives – PMPM or a SaaS oriented, always on model?


Lastly, what do you think the ACOs who are newly embracing telemedicine will reveal to us about the challenges and advantages to telemedicine? Is this going to be something better executed by consumer focused entities like Doctors On Demand vs. a regular ACO?

Each entity needs to embrace the technology based upon valid care quality and revenue versus cost offsets. A great example is Dartmouth Medical in NH. They have placed large bets on this tech.  


Any additional thoughts or insights you would like to include on the matter? What’s the main message you want to get across to our readers regarding this issue?

Historically, this risk adverse industry thinks that the ambulance chaser is right behind them.  They have institutionalized whiplash!  Crying HIPAA stops people in their tracks.  It works well if you want everything to stay the same.  The value of the telemedicine movement is that it brings change to an industry wherein the cultural attitude and desire is always to do better and ACOs are incented to make it happen. Nice match!