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Healthcare Revisited

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Defining telemedicine vs telehealth

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Why do we bother distinguishing between Electronic Medical Records (EMR’s) and Personal Health Records (PHR’s)? I mean both of them are, at their core, just healthcare content management systems. Why do we spend all this energy distinguishing between them?

The obvious answer is that while the two solutions are certainly related technologies, they are designed to meet two very different needs, and are pointed towards two very different audiences. EMR’s are tools used to help clinicians manage and share content with other clinicians. PHR’s are there to connect with patients. Since this is such an obvious difference to anyone familiar with healthcare, why is it that we don’t bother to make the same distinction in the case of telemedicine vs telehealth?

There are two very different uses, two totally different audiences that these two solutions are directed at. By lumping them together, we’re failing to use either of them as well as we should. That means we’re doing a disservice to both groups of users, the same way we would be doing if we tried to lump EMR’s and PHR’s together and use them interchangably.

There is certainly some similarity between telemedicine and telehealth. They both use technology to remove the geographic barriers to providng healthcare services. Sometimes, they even use similar technology, but that doesn’t really matter because the technolgy is just a channel. In the end, what healthcare consumers are “buying” when they use either telemedicine or telehealth is the service and expertise on the other end of the line.

In healthcare, there are two different kinds of clinical services that can be provided; care delivery and consultation. Each type of service has a different consumer. When a patient comes to a provider seeking care, and we respond with diagnosis or treatment, that’s care delivery. In that situation, the consumer is the patient themselves. But sometimes, the clinician doesn’t have the answer themselves. This is when consultative services come into play. Whether I’m looking to a radiologist for a read on a CT scan, or asking a stroke neurologist for their help in deciding to treat a stroke patient with TPA, If one clinician is asking another clinician to collaborate and share their expertise, that’s a consultation.

The same way that EMR’s are the right tool for clinicians and PHR’s are the right tool for patients, TeleMedicine lets clinicians connect with other clinicians to remove the geographic barriers to consultations, TeleHealth connects patients to clinicians, and makes it possible to deliver care regardless of distance.

Why telehealth is so scary…


I’ve been hearing quite a bit lately about how telemedicine (connecting providers to other providers for virtual consultations) and telehealth (connecting patients to providers for virtual care) are exciting new technologies, but that there just isn’t enough return on investment (ROI) to justify the cost of implementing them. The truth is, there’s massive ROI potential from this kind of care model, but existing providers simply don’t have much motivation to pursue it.

Telehealth is scary to existing healthcare systems, because it fundamentally changes the paradigm of how healthcare is delivered. In order to provide modern healthcare, we’ve always had to create massive “care factories” (also known as hospitals). Existing healthcare players have become pretty good at operating these care factories under the existing system’s rules. They are pretty happy with that situation, also, because the ridiculously high costs associated with building and running these factories protect established players by creating incredibly high barriers to entry into the healthcare industry. It’s also meant that the hospitals have become a vortex, sucking providers, services and patients into their field of influence.

Telemedicine and telehealth remove geography as a barrier to care. That means that suddenly, it’s possible to push out healthcare to the patients, rather than centralizing providers and pulling patients to our giant, expensive care factories. That’s incredibly disruptive! Read the rest of this entry »