A New Twist on the Direct-to-Consumer Telehealth Trend

Jan. 28, 2015
In North Carolina, one doctor believes in the direct-to-consumer telehealth trend but not if it's a random doctor. Kevin Biese, M.D. explains in this Q&A why this kind of telehealth should be done within the confines of a health network.
The industry's growing interest in telehealth applications, in many ways, epitomizes a "spread the wealth" philosophy for healthcare. That's the way Kevin Biese, M.D. sees it. 
Biese is the emergency medicine residency director and an assistant professor of emergency medicine and internal medicine at the UNC School of Medicine in Chapel Hill. Having spent the better part of his career at academic medical centers, he understands the wealth of knowledge that exists within those four walls.
"When you're at a place like UNC you realize the incredible wealth of expertise that is all around you and are part of, but for some it's so hard to access. That's true of medicine in general. You want to be a part of making that expertise, the doctors available to [all] patients," Dr. Biese says. 
With an expertise in emergency geriatrics medicine though, Biese is concerned that "direct-to-consumer" telehealth is spreading many older patients thin. "Many of the services,  are just adding another doctor to the mix. That concerns me because it can get complicated. There is a high risk to the patient with medications being mixed," he says. 
This, and his strategic location in North Carolina, led Biese to TouchCare. The Durham-based company provides a telehealth application that connects patients, via a mobile video platform, with their doctors. It's not a random doctor. It's their doctor. Biese knew a few of the original investors/founders of the app, which recently received $4 million in funding, and got involved with its development. 
Biese recently spoke with Healthcare Informatics Senior Editor Gabriel Perna about using the app, the direct-to-consumer telehealth trend, and more. Below are excerpts from that interview.
Kevin Biese, M.D.
How do the encounters work?
You sign up on an app and then you can invite your patients to join and have them sign up. In the emergency department, I can put their email address in there if I want them to join and follow up with care. 
Here's an example, a ten-year old boy playing soccer twists his ankle bad, it's Sunday evening, he is at home. I know the patient. They contact me through the app and make an appointment. We do it online. The kid is sitting there with his dad. I'm looking at the kid's foot. I can tell no one is going to operate on it tonight. It might be broken but no one can operate on a Sunday night at 6 pm. I ask him to tell me where it hurts so I can see if he's OK, if not I can set him up with orthopedics the next day. And if he went to the ED, he'd end up in the same place but would save four hours.
I chart it through the UNC Epic system, just, as if I were seeing patient in front of me. Obviously the examination is limited compared to a physical one but it's not nonexistent. A lot of what a doctor knows I know by looking at patient. Sometimes I can’t always tell and then I ask him to come see someone. Lots of time I can and I chart appropriately.
What appeals you to this type of care? Most doctors I'd figure would want to see their patient face-to-face. Why get connected with a mobile telehealth app?
Because we can’t keep doing business the way we have been doing. We have to be more precise with the utilization of resources. There are a lots of time patients need me to be there in person. But there are lots of times when patients go through incredible hassle for a five minute conversation that didn't need to be done in person. Because of the level of expertise at a place like UNC, Duke, or Johns Hopkins, people are driving for hours for five minute conversations. For a lot of [patients], multiple visits are required. Well maybe the first visit is in person but the follow up doesn’t have to be. If we can do that better and more conveniently, we can save our resources for cases where you need to be in person. I am passionate about healthcare reform. Eighteen percent of our [gross domestic product] is not providing value. We need to be better stewards and telehealth is part of that. Telehealth done right. 
Would you do it if it weren’t your own patients?
I wouldn’t do it if I wasn't part of network that is providing continuous care for that patient. The North Carolina Board of Medicine has emphasized continuity of care with telehealth. I don't think you need to know the patient. You can establish a relationship with telehealth but you've got to have a way for the patient to follow up and get them back into system. It's dangerous to prescribe medicine from five states away and being like, "Good luck." The patients doesn’t always know their medical history. It has to be part of healthcare system. So the first visit can be telehealth but only if they are backed by the system. 
Some of what's going I believe is the siphoning away patients to provide some level of care through telehealth. I understand that it's hard to get good care from a doctor in person. I certainly don’t blame the patients. I see TouchCare as a response to that need and saying, "Great, let's make it easier healthcare providers to direct care through telehealth from our own network."
What do you think is driving this type of telehealth?
Healthcare is one-fifth of the economy. There are incredible financial stakes on the line. I think what drives someone like myself into it is my mom reads to her grandkids from seven states away, and that's totally normal. I love the institution I work at but I look at Harvard, UNC and realize we’ve got to do better of making this accessible. Medicine is just more challenging. Is hasn't caught up to obvious utilization of other technologies in my life. 

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