From the mHealthNews archive

Can telemedicine appeal to both consumers and providers?

By Eric Wicklund

History is filled with businesses trying to stand out in the crowd and differentiate themselves from their competitors. It's no different in telemedicine, where companies like American Well, Teledoc and Doctor on Demand seem to be taking up all the space.

The trick is finding something new or different to hook providers still skeptical of the consept's appeal. 

Two companies – one that's been around for a while and is changing its focus, and another that's still in beta – are looking for that niche.

For Zipnosis, the hook is an online questionnaire that a consumer fills out prior to the telehealth visit. This "adaptive interview" is designed to narrow down the reason for the visit and make the actual phone or video encounter more meaningful for both doctor and patient.

Jon Pearce, CEO and co-founder of the Minneapolis-based company, said Zipnosis was launched in 2009 to give consumers instant access to healthcare information via the iPhone. But the company is shifting gears now, he said, to create a better platform for clinicians to make the most out of their time. It promises to have a full platform up and running for providers within 90 days.

"Really, it's not telemedicine, but a service," he said. "We're not talking about technology but about giving clinicians more convenience."

Pearce sees Zipnosis as a triage system of sorts for providers, or a service layer that helps them maximize their online encounters. The adaptive interview helps categorize the consumer so that a physician can act more quickly – perhaps a two-minute phone call or online encounter to diagnose and treat a common illness, or a longer video visit to handle a more complicated case, or a "ZipTicket" – a digital boarding pass that enables a consumer with an urgent issue to get treatment at a nearby health provider.

Pearce said healthcare providers are recognizing the need to create an interactive platform for consumers, with convenience at its core. But that platform also has to make business sense and give the clinicians a way to improve their workflow, not complicate it. By triaging incoming patients, he said, Zipnosis acts as the buffer to the provider, pushing consumers to the quickest and most effective care platform and making sure the clinician's time is meaningful.

As evidence of the company's appeal, two health systems recently contracted with Zipnosis for virtual care service – John Muir Health, a Walnut Creek, Calif.-based health system with two hospitals and a collection of smaller sites around the San Francisco area; and Bryan Health, a multi-hospital system based in Lincoln, Neb., and serving Nebraska and parts of Kansas, Iowa, South Dakota and Missouri.

"Through our partnership with Zipnosis, we can provide affordable access to mainstream medicine in minutes,"  Brian Bossard, MD, director of Bryan Telemedicine, said in a press release provided by Zipnosis. "This innovative platform allows us to extend quality care not only where patients want to receive it, but also when. … If a patient can't be treated virtually, the system makes it easy to get to the next level of care - whether it's with our Urgent Care, office visit with an area physician or even emergency room. We believe this is the future of healthcare, and a solid approach to connect new patients with physicians."

"We know there are patients who seek to have many of their needs met online. Zipnosis allows us to meet the needs of those patients," George Sauter, Muir Health's chief strategy officer, said in a separate release. " It also integrates well with our existing online patient portal and uploads medical encounters into the patient's medical records, which provides a seamless experience for our patients and full visibility across the care continuum for our physicians."

Vytaliz is taking a completely different – and, really, a more hands-on – approach.

The New York-based start-up is looking to update the house call for the modern era, complete with an urgent care app that connects to the provider and a telemedicine platform that allows the visiting nurse to communicate in real time with a doctor.

Company founder Amer Alnajar says the service, in beta now in the NYC area, is consumer-facing, but will be targeted at health systems and health plans as the platform gains traction. It's designed at present to give consumers – from the housewife to the businessman to the vacationer or business traveler – access to emergency healthcare where the consumer needs it, while also keeping doctors where they're most needed.

After downloading the Vytaliz app, a consumer can then request or schedule a visit. This brings a nurse – equipped with an iPad and a basic emergency care kit - to the consumer to conduct a physical exam. The nurse then launches a videoconference with a physician, who can make a diagnosis and prescribe treatment and/or medications. The nurse can administer some of the more common medications for basic illnesses and draw some lab tests or administer IV fluids.

"A lot of this is just what we, as physicians, used to do," said Alnajar. "But this is something that doesn't exist out there anymore."

Vytaliz exists as a hybrid care platform, a telehealth platform with a personal touch, that may fit in well with the anti-automation backlash that's now playing out in the banking and airline industries. Alnajar sees this as a more cost-effective approach than the emergency care clinic, and one that maximizes the clinician's time by bringing him/her into the conversation only when he/she is needed.

Alnajar is quick to point out that Zipnosis isn't concierge care – it's not specialized care or extra care for someone who can afford it, but a "house call of the future." To that end, he's looking to partner with health providers and payers on pilots that will prove the platform's value – and, eventually, convince payers to reimburse for it.

"Most insurance companies don't reimburse for home visits" unless the patient is homebound, he said. "It's a matter, for us, of getting it, proving it and getting insurers to OK it."

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