How cloud-based video is disrupting healthcare delivery

Telemedicine has been a market with a bright future for a long time but there are barriers to adoption due to cost, ease-of-use and reimbursement. Christopher Herot, CEO of SBR Health, is an innovator in the telemedicine space, who saw these barriers as opportunities for disruption, and is making it easy to get started and scale e-Visit programs to deliver care more effectively, and with greater operational efficiency. SBR Health’s automated call and skills routing management solutions allow healthcare providers to increase patient accessto care, reduce costs and readmission rates and extend service reach by delivering care virtually through video visits. In this interview, Chris describes how cloud-based video solutions are revolutionizing healthcare delivery by seamlessly integrating into clinical workflows to connect patients with doctors, specialists and membersof the care team in real-time, at any location and using any device.

Q: What role does video play in patient engagement, and how is it being used today?

People have known that patient engagement is key if you want to bend the cost curve in healthcare. The US spends twice as much as the most developed nations in the world on healthcare per capita, and we rank 18th in terms of life expectancy so clearly something’s wrong.

Until recently, there weren’t a lot of breakthrough ideas. One area that holds a lot of promise is applying things we’ve learned with online games and other interactive tools. We’ve learned what motivates people and that there’s no substitution for face-to-face interaction. What’s driving healthcare, more specifically health IT, these days is convenience and usability. With the widespread adoption of easy-to-use and low-cost video communications tools like Skype and Vidyo for both business and personal use, consumers are learning that real-time, interactive face-to-face communication is a very easy to use and efficient way to communicate and asking “why can’t I do that with my healthcare provider?”

Q: There’s a lot of excitement around the telemedicine bill referred to as the ‘Telehealth Promotion Act’ that proposes expanding reimbursement for telehealth services for federal programs and creates a federal standard for medical licensure in telehealth. How will this impact healthcare as we know it?

It’s time. There have been a lot of needless barricades in terms of using communication technology as a tool for conducting doctor patient visits but that’s only the tip of the iceberg. The real growth is going to come from transforming healthcare, not just automating, and doing away with the reimbursement, licensing and credentialing issues impacting telemedicine. Our theory is we can have a big impact on outcomes by not just automating traditional on-site visits but allowing people to interact in a more comfortable, frequent and less burdensome manner for both patients and providers.

Q: What have been the major barriers in using telemedicine, and do you think these can be resolved in 2013?

In the past, it’s been the reimbursement and regulatory issues. As far as technology, it’s been a cost barrier. Until late, there hasn’t been widespread consumer acceptance of face-to-face video communications. But now you have a whole generation of consumers raised on technology, and a generation of parents using technology to check on their kids.

Telemedicine has shown a lot of promise but as it’s required expensive equipment and highly trained people, progress has been slow. The future, call it telemedicine or something else, is letting patients and doctors connect with each other, regardless of location or device.

Q: The bill also includes incentives for hospitals to lower readmissions with telemedicine. What impact is SBR having on reducing readmissions? Are there any success stories you can share or relate to?

There was a recent meta-analysis done that looked at the impact of remote monitoring on the health outcomes of patients with chronic heart disease. By acquiring and transmitting real-time patient data to the care team, and creating opportunities for timely intervention, the remote monitoring programs were found to help reduce hospital readmissions and mortality rates, and also improve patients’ quality of life. The analysis demonstrated a high degree of variability with some interventions resulting in better health outcomes than others, so it’s too early to tell what the gold standard for clinical intervention is.

We’re just now at the point where we’re assessing the rate and process, and enthusiasm for adoption. What we do know is that both doctors and patients are looking forward to being able to more readily use these types of interventions.

Q: Do you anticipate more insurers will cover telemedicine in 2013? What is the argument for relaxing reimbursement constraints?

In my conversation with payers, they’re waiting for the data that indicates that they’ll save money or get better outcomes and not just a way for docs to get paid for something they used to do for free. More insurers are willing to pay on an ad hoc basis or to experiment. Everyone is waiting to see for the definitive results.

Q: Progress is slow but steady. As you’re on the forefront of change, what are your hopes and predictions for how telemedicine, particularly virtual visit programs, will help to advance and redefine care delivery today?

If you want to buy an airplane ticket, do your banking or find someone to marry you can use your cellphone, laptop, tablet, etc. The only thing you can’t easily do is use these same technologies to talk to your doctor. What I’m hearing from consumers all the time is that there’s a pent-up demand for bringing medicine into that same on-demand, low latency universe that we take for granted in every other part of your life. What’s been pleasantly surprising for us is a lot of the doctors are looking for ways to be more connected with their patients, and they really do care about providing a good experience for them. Contrary to how people look at doctors, there’s a feeling that medicine has become really impersonal, and what I’m happy to find is that doctors really want to do something about it.

Technology may allow us to deliver a more personal healthcare experience that will both make us feel better and get better.

Q: What is the easiest way to start using telemedicine, and what can I expect in return?

The implications for healthcare by incorporating video into the care delivery workflow are huge. By moving away from the expensive, hardware-based telemedicine systems to cloud-based video solutions that can be customized and require minimal change management, hospitals and healthcare systems are able to improve access to clinical resources, serve hard to reach patients, control costs, and improve patients’ health outcomes and overall experience. The world of healthcare is dynamic, and SBR Health is solving the problem of integrating telemedicine, specifically video, into clinical workflows to revolutionize care delivery to be more efficient and effective.


Why Innovation Requires Letting Go to Drive Change

This year’s 2nd Annual Digital Health Conference put the spotlight on efforts to advance healthcare innovation in New York and beyond. While the big apple is home to some of today’s biggest name celebrities like Tina Fey and Alec Baldwin, talk of progress on health information exchanges and the secure sharing of data, as well as new mHealth and telemedicine tools, was top of mind at the conference.

Featured over the two-day conference were keynotes with Dr. David Brailer, Chairman of Health Evolution Partners, and often referred to as the ‘grandfather of health IT’, and Stephen Dubner, journalist and award-winning author of Freakonomics and Superfreakonomics, as well as breakout sessions on some of today’s hottest topics in healthcare.

One of the most well attended and thought provoking sessions was the ‘mHealth Innovators Panel’ with Ben Chodor, CEO of Happtique, as moderator and Leonard Achan, Vice President and Chief Communications Officer at The Mount SInai Medical Center; Wendy Mayer, Vice President, Worldwide Innovation at Pfizer; and Martha Wofford, Vice President, Head of CarePass at Aetna as panelists. By addressing the goals, perspectives and challenges of using mHealth for care delivery, this hour-long panel offered key insights on mHealth’s potential to revolutionize the healthcare ecosystem from the key players in the market including hospital providers, physicians, patients, pharma, payers and programmers.

Q: How do you convince the C-suite that innovation is important?

Wendy: My team drives innovation platforms with a focus on transforming digital to support business and develop capability tools across the organization. With digital, you can innovate more quickly. Pfizer is still working towards a corporate digital strategy but has come a long way.

Q: How has innovation changed?

Martha: There’s been an explosion of applications. Now it’s more about navigating the ecosystem and connecting the best pieces brought to market.

Leonard: We’re further along now. Once you get the C-level support and get past the threshold of change, then you build trust and it’s easier to move forward.

Q: What’s the best innovation out there?

Wendy: Accessibility to healthcare beyond the local environment and the global implications of providing care and extending care more broadly.

Q: What’s the best thing about CarePass?

Martha: Allowing people to see a different future with data and get them there. We’re excited about all the things you can plug into mobile. You can revolutionize access to care around the world.

Leonard: The $7 trillion impact of mobile in low and middle income countries across the globe. A lot of more simple technologies will be transplanted from countries around the world.

Q: Why do people say they want mHealth but not everyone is using it?

Wendy: The existence of mobile technology in places where there is no alternative of care allows for quick adoption. Here in the U.S., the alternative is the person, the doctor. We have an immense amount of data from the traditional care delivery approach and less reliable evidence and data to allow doctors to let go and feel more comfortable with mobile. Mobile as a new means of communication is difficult to assess the impact.

Q: What advice would you give to startups?

Wendy: Do your homework around issues that pharma is dealing with. Vendors come in and talk about solutions that don’t connect to our business strategy. We’re looking for ideas that address our challenges and solve real problems.

Leonard: You have to do a lot of research ahead of time. We used to let everyone in. It was a disaster for entrepreneurs pitching to executives and not doing their homework. It’s important to understand the business goals. If you’re going to save lives and money, you have a chance but you really have to differentiate yourself.

Martha: CarePass is attracting developers with new solutions. We’re working collaboratively with other organizations to inspire innovation. We may be further along but not yet attracting the best and brightest. We want to create a community for developers to help us innovate and drive change.


The Virtualization of Care

This year’s World Congress Leadership Summit on Telemedicine features a great lineup of speakers. Joining innovators from major hospitals and healthcare delivery organizations, we’re excited to hear about the industry-wide interest and demand for telemedicine use in care delivery.

One of the more interesting sessions was the keynote panel discussion on the Joslin Diabetes Center’s ‘Joslin Everywhere’ diabetes mobile health initiative and efforts to virtualize the delivery of care.

Panelists included Chief Medical Officer Martin Abrahamson, Chief Information Officer Ed Charbonneau and WebCare Program Manager Paul Penta. The focus of their panel was on efforts to improve quality, extend their specialist reach by supporting providers at affiliate sites, improving clinical metrics and collaboration with partners in the healthcare field. Through the use of new and innovative tools to train and engage patients to promote better care management, Joslin is establishing itself as a leader in diabetes care and ensuring care anywhere and ‘everywhere.’

Stay tuned for more updates throughout and after the conference.

What’s wrong with telemedicine?

While studies have shown that successful use of videoconferencing and real-time communications can profoundly benefit patients and doctors alike, how do we define success?

Telemedicine has been in use now since the 80’s but due to complexity, specialized equipment, expensive network infrastructure and poor Medicare/Medicaid reimbursement policies, it remained limited to a small number of users. These challenges made it impractical to use televideo technologies for care delivery on a larger scale.

Today, low cost and ubiquitous technologies do exist that can facilitate a world in which videoconferencing has a place on the desk of every doctor, nurse and clinician. However, what is needed at the clinician level are applications designed specifically for the health care industry with televideo as a method of communications.

What does this mean?

As studies have shown that health care outcomes improve when truly collaborative communication takes place among patients, doctors and specialists, televideo is becoming more mainstream. But for televideo to be both successful and effective, televideo technologies must be user friendly, highly secure, low cost and fully customizable.

Is that all?

Fixing televideo goes beyond cost and complexity. While there are a number of innovative televideo technologies, there is still the problem of integrating televideo seamlessly into clinical workflow. The success of any technology depends only 10 percent on the technology and 90 percent on how the technology is integrated with existing workflows.

To deliver care successfully and effectively across the healthcare continuum, televideo must be mapped to existing workflows to improve patient and clinician use experiences and to minimize change management issues.

Change is good but it’s not always great.

To make televideo great, let’s start with improving the usability.



SBR Health Q&A: The mobile shift in healthcare

Everything is moving to mobile these days, and healthcare is no exception. Christopher Herot, co-founder and CEO of SBR Health, is a recognized business and technology leader who has spent years developing and evaluating video, mobile and real-time video communications solutions. In this one-on-one interview, Chris shares his thoughts and predictions for how mobile technology will transform the healthcare space and beyond. From how we buy care to keeping in touch with family, mobile’s intersection and influence on our daily lives is significant.

How have you seen this shift?

There was a time when every young ambitious professional had a day planner. The iPad is now the equivalent. It’s your phone, calendar, email, entertainment, and computer – your method of communication for everything. This has really transformed a number of industries. Retailing is now different. People can do comparison-shopping using their phone. It’s even changed travel to some degree. You can get your boarding pass on your phone and check into places on Foursquare. For the longest time, it looked like healthcare was not a tech-savvy field but this is quickly changing.

What role does mobile play in the healthcare space?

iPads are taking the medical world by storm. They’re just the right form factor for healthcare. Apple reimagined what you can do with a tablet and has provided for an entirely new experience. Doctors don’t want other tablets. They want the iPad.

Some thought early tablets failed in terms of usability based on size but Apple demonstrated it wasn’t just about size but more about the user experience. There’s something truly unique about being able to type medical information while looking at your patient. This increases physician-patient engagement.

What’s the benefit?

There’s proven clinical value. Tablets have given doctors better access to tests and other medical information. A recent study published in the Archives of Internal Medicine found that iPads help doctors be more efficient at ordering tests and procedures for their patients. My thesis is that iPads allow physicians to do more in real time and make healthcare more convenient.

The real and long-term benefit of mobile technology is in bending the cost curve in healthcare. This goes beyond getting doctors to accept lower fees and cut down on unnecessary tests. The bulk of the cost is to get Americans to stop eating so many donuts. The way you make people healthier is to make it easier and convenient for people to see their doctor. This will drastically cut healthcare costs.


The demand for mobile reflects where we’re at as a society. The doctor is not always in his office ready to take your call, and so many of us are on the go. Being able to get access to the healthcare system wherever you are – work, home, out and about – is really critical. To make that work, we have to be able to see the patient and share what we see with other people. Tablets are small enough to be portable but also have real data on the screen.

How will this be adopted?

It will happen fastest where the payment model is evolving away from the fee for service. You’re seeing this with concierge practices. Once you make it easier for patients and doctors to do a virtual visit, I expect the adoption will expand to other parts of the world. There are places like the payers and insurance companies who see this as a way to improve healthcare delivery. You’ll see this first in places that have the luxury of not having to worry about restrictions. Concierge and post-acute follow up are prime examples.

SBR Health is developing the technology that will enable videoconferencing and real-time communications to benefit patients and doctors alike. Healthcare outcomes improve when collaborative communication that’s convenient takes place among doctors, specialists and patients, and we’re working to make it as simple and secure as possible.