Interview: ATA's Jon Linkous talks wireless health

By Brian Dolan
11:52 am

Jon Linkous, CEO, American Telemedicine Association"The single fastest growing medical device we have in this country is probably the iPhone," Jon Linkous, CEO of the American Telemedicine Association told Mobihealthnews. "I have discussions about the iPhone every single day."

Linkous also explained how the telemedicine industry has grown from "white labeled" (literally) corporate video conferencing solutions to the rapidly growing wireless health market we know today. The interview touched on wireless health's place in the national healthcare reform discussions, physicians' fear of telemedicine, generational shifts and the types of start-ups knocking on ATA's door. Read on below for more from the interview with Jon Linkous, CEO of the ATA.

(AND: If you want to hear more from Linkous and other wireless health thought leaders, join us at the Everywhere Healthcare event at CTIA Wireless & IT in San Diego this October.)

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Mobihealthnews: What is the American Telemedicine Association (ATA)?

Linkous: The ATA was created in 1993 by a group of doctors who were using video conferencing links between larger health centers and rural clinics. Both the field of telemedicine and the ATA has taken off from there. Today, we have a broad and eclectic membership so we like to say we are part trade association and part professional association. That means we have clinicians, physicians, nurses as well as hospitals, institutions, government organizations, corporations, providers. That includes any one from Verizon, Intel, UnitedHealth Group to Qualcomm plus a lot of medical device groups, too. It's intentionally broad-focused -- both our membership and interests. We do a lot of education work, which includes our annual conference, advocacy in Washington and elsewhere. We also have special interest groups, about 15 different member groups in various areas that provide networking, education and we are starting to create practice guidelines related to healthcare.

Telemedicine includes a number of different enabling technologies, including landline telephony, broadband wireline, wireless networking and others. Can you briefly take us through how those technologies have evolved since ATA's founding, and how that has changed the industry?

It's been an amazing trip. When we started out most of telemedicine was a large video conferencing box that was primarily used for corporate video conferencing that [telemedicine groups] would paint white, literally, they'd paint it white and put a red cross on it and call it medical equipment. It was large, cumbersome, very expensive and required broadband hookups, which were also not cheap. The [connectivity requirements back then were] multiple T1 lines or ISDN just to get this to work. Because of that, the industry was largely government grant focused and there were some other applications, but not too many. From there these systems got smaller and more efficient but they were still focused on video conferencing.

And now telemedicine has moved away from video conferencing?

Telemedicine never moved away from video conferencing, it has just expanded beyond it. That traditional focus was probably 90 percent of what we did, but now it's probably in the minority of solutions. Less than 50 percent of a lot of the services that are currently provided. Much of the industry has moved to "store and forward" solutions like email, basically, or others that don't require a live video feed. For clinical applications the largest use of this has been in medical imaging like radiology, because so much of radiology is outsourced. Consumer applications include looking at blood sugar levels and recording that so you have it somewhere ensconced in an electronic health record that can give you a historical look at it.

From those days it quickly went to a point of smaller and cheaper applications, but today the single fastest growing medical device we have in this country is probably the iPhone. I have discussions about the iPhone every single day. Today I was talking to two different clinicians from different parts of the country who were talking about how they were using the iPhone and using it for different applications. The thing that is really transformative about what we are involved in is that we are moving outside of the clinic, outside of the hospital and even outside of the physicians' offices to putting healthcare into the hands of the consumer.

One of my tasks is to run as fast as we can to keep up with the pace of change. As you well know, writing about [wireless healthcare], if you were to take a month off you would be lost. It's amazing. Back in the days of telemedicine where it was video conferencing out of a box using a traditional doctor and you look at [wireless healthcare] today, it's a huge long runway between them. It's challenging to keep ourselves on point and keep up with the times.

It seems like this year in particular there has been a lot of momentum for wireless healthcare. Any sense as to why?

Timing is everything, of course. The generational change has been a big mover. We now have people who are users of these [wireless] technologies who are suddenly interested in healthcare. An 18-year-old may not be interested in healthcare but a 45-year-old probably is. The 45-year-olds of today are far more technologically savvy than a 45-year-old was in 1994. Couple that with the fact that these technologies are so much more available to create portable healthcare applications and that has led to what has been, in fact, a tremendous year for these applications.

Does the ATA believe wireless healthcare should have a place in the ongoing federal healthcare reform discussions?

We are based in Washington, so when you look at national healthcare reform in the U.S. or the provisioning of healthcare anywhere in the world, it's an interesting challenge because one role we believe is an important one for the ATA, is to examine the marriage of traditional healthcare and some of these new applications that are coming on. No one really knows what that is yet. We know that if you go to a hospital and have an appendectomy, you can bill for that and insurers provide certain codings and then they discharge you. If they discharge you and you are using a cell phone or something else like your own computer to have you scars looked at for wound monitoring, like a computer program that guides you to the next steps for recovery, is that part of the healthcare system? Is that paid for in the same way? Does that go into your EHR in some way? How does that track? How does it fit? What if you need prescriptions? How does this interplay? We don't know that yet.

If you have diabetes and you're told one of the things you need to do is lose weight -- well, there are obesity programs which are becoming very common through these different types of consumer applications. Is that part of the healthcare system? Even in the halls of Congress, where they have been focusing almost exclusively on healthcare for the past twelve months, those are issues that have not been though through yet. How does a hospital or your local physician feed into that? Physicians, for some reason, are still late adopters of technology. When you look at banking -- we are all using ATMs and online banking. The last time I saw a teller face-to-face was years ago, but we are still going to doctors offices and still handling it pretty much the same way we did 30 years ago. It's that transformative nature that's really facing us that was created by all those technologists.

I can wager a guess as to the answer, but does the ATA take a stand on those questions? Should these solutions be a part of the healthcare system and how?

Absolutely, we believe they have to be. We have to be inclusive and expansive when we look at the ways we do healthcare. We cannot limit it to the way we do it today. We have to design a healthcare system or our approach to providing healthcare that enables and takes advantage of these new technologies. Other fields like banking and entertainment jump right on these technologies -- I'm sure you get your movies online now. It's not like it was a few years ago. Those industries have not only taken advantage of these technologies but that have gone after them to make their industry much more consumer-focused and consumer-driven. In healthcare we are just starting to grapple with that. That is a key role for ATA: to tackle that issue. That's why we just reshaped our board of directors in this past year to bring in some leadership that represents people outside of the traditional forms of medicine.

Is the ATA just U.S.-focused or international?

We have had an international interest for a long time. Even of the hospitals we represent, at least half of them have some kind of a link with some other country using telemedicine. We are the American Telemedicine Association, that is our name, but about 15 percent to 20 percent of our membership is outside of the U.S.

Do you think there is too much hype around this market?

There is a lot of hype and a lot of applications that are neat and fun but they'll never go anywhere. Boy, isn't that true of every type of technology, though? That's fine. We have maybe 3,000 or 4,000 companies in our database and by next year probably 500 will have gone away but then another 500 or 600 will have started up. That's all part of a dynamic market. There is a lot of hype there but there is also a lot of reality. They key is knowing the difference.

OK, that's my next question -- what's the difference?

Well, that's the real question isn't it. I can say that at least once or twice a week we have someone come into the office with a great new idea that can do something like take blood pressure and send it off to some other location, and it will be an idea whose idea came some 20 years ago but it just occurred to them. We also have people coming in with great, innovative ideas from a technology standpoint but they don't understand the business side of it to take it to market. There are lot of great ideas out there that are just lacking the ability to finance it. In healthcare it's a real tough world, because you have to look at reimbursement, consumer pay, employer pay and all that plus regulation from the FDA and the FCC.

Is ATA involved in regulatory issues?

We are intimately involved. We are working with all five committees on the Hill that are working on health reform right now. It's crazy that there are actually five committees, isn't it? We get a lot of pushback though. Many legislators love the technology, while regulators are wary of it because the budget office thinks all this new technology is just going to bust the budget if everyone has access to healthcare. Well, yes, if you do it the traditional way, you might have problems, but you have to be open to looking at it different ways. It's a challenge for the regulators and for people in public policy. What I have seen in Washington and other parts of the country is that there are two types of people: the healthcare people, who are kind of interested, and you have the techies, who are pushing broadband policy and they are beating down a door getting to us. They want to know what needs to be done to get [telemedicine] out the door. The healthcare people are saying, "Well, maybe, I'm not so sure, let me think about it." It's an interesting mix when you put all these people into the same room.

The healthcare types then are slower to adopt technology?

The healthcare people are just cautious, because telemedicine can be very threatening. If you look at applications like Wal-Mart's clinics that are using telemedicine, that's taking business away from some primary care doctors. If you look at technology that can port healthcare to where the patient is, all of a sudden, in some areas where you have a pediatric cardiologist who has a nice little market around where they live, all of the sudden has pediatric cardiologists coming into their market electronically. So it increases the competition and that's one big reason why phyisicans are wary of it. In the clinical application you can see this already in radiology. A lot of hospitals are outsourcing their radiology now because a radiologist does not need to be in a hospital they are looking at a digital image. They could be right next to you or in Australia -- it doesn't matter. If you outsource it, you don't have to work with a local radiologist, you could work with a radiologist anywhere in the country. Radiologists have had some discomfort with this.

I think that this is just the tip of the ice berg. That's just a clinical example. Just wait until we have health care going to the person. It's a real challenge, it's really revolutionary, and, gosh, it makes it so much fun.


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