Some Thoughts on Telemedicine – by Robert Nelson, MD

By The Sovereign Patient on September 1, 2014

"I believe we should work towards restoring these principles to preserve a really precious thing: the sanctity, privacy and respect of the direct, unencumbered Patient-Doctor Relationship. " Robert W. Nelson, MD -- Tel: 770-888-3771

“I believe we should work towards restoring these principles to preserve a really precious thing: the sanctity, privacy and respect of the direct, unencumbered Patient-Doctor Relationship. ” Robert W. Nelson, MD — Tel: 770-888-3771

Third-party free practices (DPC, cash-only, membership medicine, some concierge medicine) are a natural fit for a variety of electronic media that can be used to communicate with patients. Patients love it. It is what I call lifestyle-friendly medicine. It syncs seamlessly with how people currently live their lives and communicate with friends, family and business colleagues. So why not their doctor?

You’ve heard the saying, “all politics are local”. Well, all good primary medical care eventually becomes personal and local. Things happen to people’s health. Medical Boards set guidelines. Malpractice policies rear their ugly head. What if patient needs to be seen in person? They are a litany of what if’s.

Point of emphasis: HIPAA/HITECH still applies even if a practice does not take or bill insurance! Email, text, and non-HIPAA compliant video platforms are risky. If it doesn’t rain, the hole in the roof is not a problem, right?  Wrong!

Telehealth companies are springing like weeds in July. They are everywhere. They all say they are innovators and are about to change healthcare and promising doctors significant boosts in income just by sitting in front of their computer at home.

News flash! People are not buying in anywhere close to the quantities predicted based on survey interest. The video screens are not lighting up! I know, I have been on the ground floor of two well designed Telehealth platforms and I’ve made myself reasonably available. AND, in a 9 month period of experience between the two I HAVE NOT HAD ONE VIDEO CONSULTATION FROM A PATIENT THAT WAS NOT ALREADY MY PRIVATE PATIENT. To be fair, the potential patient base is only the whole state of Georgia!

So what going on? Do patient-consumers not use electronic communications as much as we thought? No, they use them plenty.

The problem is we (medical profession) are not using electronic platforms in the right way and when we do, we are not educating patients on the advantages and proper use. Traditional practices rarely use e-platforms because they can’t get paid and don’t have time (office too busy). Some DPC and concierge practices still believe they can use any platform (Skype, non-secure texting, etc…) and don’t have to worry about HIPAA violations: Not so. Also, we’ve anointed Telehealth as unwitting surrogate for personalized, convenient care. While it is convenient, much like walking into a local urgent care or ER, it can be a potpourri of unpleasant surprises and disappointments.

Bottom line: Patients are not stupid (anymore than doctors are sometimes) and they tune their shopping radar to match the services they seek. In this case it is medical care; not widgets or apps or data plans. Telehealth is not a YouTube video or the latest smartphone app. It is about leveraging convenient communication platforms with OUR patients so we are rarely ever out of touch. Patients will and do use Telehealth liberally when the person on the other end of the transmission is a doctor or provider they know, like and trust.

This is why it is critical that private practices, especially the small ones that can adapt quickly, start to use a variety of secure (think HIPAA) e-platforms and secure messaging services to stay in touch with patients. Someone is eventually going to do this right. It should be the doctors that are already providing great in-person care for their patients. Let’s just extend that beyond the office walls. We say we want to be true primary care doctors and take care of most of our patients needs. Let’s start by being available. Our patients deserve that.


4 replies »

  1. As Dr. Nelson has stated and gets it, what an enlightenment to hear. So as stated and this becomes “1” tool don’t stop there. Under the ParadigmMD umbrella of companies, Dispensing directly from the practice adding additional revenues, tied into your EMR, telemedicine in the backdrop for patient encounters & compliance issues along with the right billing & financing your practice CORRECTLY will afford the failing practice model to revitalize itself. Succession planning in the Mergers & Acquistions from a buy side or sell side, we have the answers as well. I’m available for any discussions, opinions or Consulting on these matters. With 40 years in an executive capacity, both in the public marketplace as well as private, I/WE have your solutions. Call 480-399-2877 & or

  2. Thanks for this information. As I open my new Direct Primary Care practice, I am exploring how telemedicine will play a part in my care of patients. I will say that I had a prominent malpractice insurance company representative tell me that HIPAA does not apply to cash only practices. Still confused…

    Eric Potter MD
    of Sanctuary Medical Care and Consulting

  3. Hello again Eric,
    Hope things are going well for you as you open your DPC practice. Be careful with those that say HIPAA does not apply to cash practices. It is really the HITECH part of HIPAA that you need to be pay attention to. There is also Federal and State aspects of HIPAA. While the insurers are not going to be breathing down your neck about compliance issues, you are still in the “supply chain” as it were when it comes to handling records. It is just as easy to be in compliance really without spending any more. There are a variety of secure and hipaa compliant apps and video platforms out there. Checkout Pingmd for secure texting and Medisprout for your video conferencing.

    All the best,
    Bob Nelson

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