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Telehealth Reaches a Tipping Point: Adapt or Die

In the book The Road Ahead, written by Bill Gates in 1995, he had this premise: “If you imagine a world with unlimited computing power, bandwidth, and resources to miniaturize technology, you begin to see the future.”  There were two quotes from the book that I remember reading back then, both of which got me very excited.

“You’ll be able to carry the wallet PC in your pocket or purse. It will display messages and schedules and also let you read or send electronic mail and faxes, monitor weather and stock reports, play both simple and sophisticated games, browse information if you’re bored, or choose from among thousands of easy-to-call up photos of your kids.”

Remember that in 1995, the Motorola Startac phone was just released. The iPhone wasn’t released until 2007.

More relevant to the discussion of telehealth is how Gates described video conferencing:

“Small video devices using cameras attached to personal computers or television sets will allow us to meet readily across the information highway with much higher quality pictures and sound for lower prices.”

Imagine a world where telehealth is readily available everywhere to everyone in the United States. When we imagine a country where everyone, everywhere has access to care from their living room, you can see why telehealth is an imperative for every health system.

The Tipping Point

Televisits have the ability to be a game-changer in the way we experience medicine. The AMA says televisits could replace up to 70% of all healthcare visits. Almost everyone can see the potential. What I’d like to do is to make the case that the tipping point is coming sometime in the next 18 months.


The landscape is beginning to change. Just a few weeks ago, the VA finalized the work on a rule that overrides the state licensing restrictions. This way, clinicians can treat veterans anywhere in the country.

The rule is a critical piece of former VA Secretary David Shulkin’s “Anywhere to Anywhere” telehealth initiative. This is what is possible with the stroke of a pen, and you can imagine CMS making the same move in the not-too-distant future.

The Federal moves are not the only ones to consider, though.  At the state level, the American Medical Association is advocating for the Interstate Medical Licensure Compact. What is that, you may ask?

The Interstate Medical Licensure Compact (Compact) creates a new pathway to expedite the licensing of physicians already licensed to practice in one state, who seek to practice medicine in multiple states. The Compact promises to increase access to health care for individuals in underserved or rural areas and allow patients to more easily consult medical experts through the use of telemedicine technologies. The Compact will make it easier for physicians to obtain licenses to practice in multiple states and will strengthen public protection by facilitating state medical board sharing of investigative and disciplinary information that they cannot share now.

Twenty-two states have already adopted compact legislation and eight more have proposed legislation at this time. This represents a legislative tipping point.

American Medical Association on Interstate Medical Licensure
2017 American Medical Association on Interstate Medical Licensure


If you haven’t heard, 5G is going to change everything. This wireless technology will be profound, and every mobile carrier will be implementing 5G towards the end of 2018.

Just how impactful is 5G? Well, it is the equivalent of having a fiber optic cable connected to every single mobile phone. Check out the 2-hour movie download comparison below. This gives you an idea of what is just on the horizon for standard wireless speeds.

Mobile Speed Comparison

When I speak on this subject, I am often confronted with the challenge of How do we get this technology into the hands of those who most need it? This is the right problem to solve. It gets a whole lot easier when a majority of the country is blanketed with wireless 5G and a video-capable Android device is available for less than $100.

Public Pressure

Adoption is often cited as a reason not to pursue telemedicine initiatives.

The surveys indicate that between 50% and 65% of Americans would be willing to try a telehealth visit. This is the equivalent of a generic ballot in an election. You only get their proclivity to vote a certain way, but you do not get their actual vote.

Well, it turns out that the net promoter score (NPS) for telehealth visits is in the mid-70s, which is incredibly high. Apple’s overall NPS is in the mid 80s and Amazon is in the 60s, if that tells you anything. It’s not often that healthcare gets mentioned in the same metrics as these two companies.

Let’s face it: a 30-minute wait in the lobby followed by a 20-minute wait in the exam room is no way to treat a customer. High deductible plans have made patients into consumers, and that trend is only going to continue.

The Strategic Imperative

It amazes me to hear the special relationship argument in this day and age.

We had a special relationship with our local pharmacist, but he was replaced by Walgreens, CVS, and the local grocery store. We had a special relationship with the main street retailer, but first, we chose to go to Walmart and now we choose Amazon.

Now, we have a special relationship with our health provider. At least there is no way that bond can be broken… right?

New Models

If I had the choice of a primary care physician associated with the Mayo or Cleveland Clinic, would I go that route even though they aren’t local to me? You bet.

If I needed emergency care, I would still go somewhere local. For complicated issues, I would get on a plane and visit their facility. For most care, though, I would see them via my computer.

New Competitors

Imagine if Intermountain signed a deal with Marriott to provide video consults at all of the Starwood properties. Would that impact the local provider’s bottom line?

Telehealth represents a low capital way for existing providers to expand. In addition, low capital and high technology leverage is the stuff of Silicon Valley dreams. You could see billions chasing new models in healthcare.

Consumer Expectations

The more consumers use telehealth, the more they use telehealth. Think of it this way: it took you a little while to get used to the idea of ordering goods online via Amazon, but after that first experience, you were hooked. How many boxes a week arrive on your doorstep now?

If you wait until telehealth becomes the norm, you will have made the same mistake the record and bookstores made. This is one trend that you want to be in front of – not struggling to catch up to years from now.

Tipping points are opportunities for those that are prepared. Is your health system or practice ready for the telehealth tipping point?

Hope this helps. Please listen to our weekly show at This Week in Health IT and check out our 100+ videos with industry influencers on our YouTube channel.