Health care costs in Texas continue to grow year after year, but providers across the Cy-Fair health care industry say an emerging trend is poised to cut costs and time for patients and doctors alike.
Telemedicine is the process of delivering medical care to a patient who is not in the same physical location as the health care provider, using technology to communicate in real time.
Telemedicine in Texas so far has been mainly used for acute care—issues such as colds, coughs, urinary tract infections, pink eye and sinusitis. However, it has also proven to be useful when it comes to diagnostic procedures and follow-up visits to check in on a patient after a surgery, said Dr. Brian Bobb, the director of medical operations and consumer solutions for Memorial Hermann Medical Group.
“That’s kind of the next big step in this evolution—being able to provide ongoing care for those patients so they do not need to make that trip in,” he said. “There are still quite a few people who have trouble with long distances, especially with specialty care. This keeps those people from having to spend hours in the car, missing time from work or family.”
Providers in Cy-Fair that have developed telemedicine programs include CHI St. Luke’s The Vintage Hospital, Memorial Hermann Cypress Houston, Houston Methodist Willowbrook Hospital, Kelsey-Seybold clinics, Nightlight Pediatric Urgent Care and Texas Children’s Hospital.
Officials from the Cy-Fair health care community said the technology is being embraced by physicians and innovators, and the they believe the public is starting to warm up to the idea of telemedicine as well.
“We’re seeing significant market adoption, which is key,” said Stephen Spielman, senior vice president of the Houston Methodist Physician Organization. “We’re also seeing, most importantly, physicians get excited about what can be accomplished through telehealth. I think that’s a recipe for a changing paradigm.”
From 2015 to 2017, telemedicine visits increased at an average annual compound growth rate of 261 percent across the U.S., according to research conducted by the Brigham and Women’s Hospital in Boston that analyzed insurance claims.
In the longer term, the shift toward telemedicine could also bring changes to brick-and-mortar health clinics, allowing doctors to focus more closely on patients with greater needs, officials said.
History and implications
Texas has been behind the curve when it comes to incorporating telemedicine into the delivery of health care, Spielman said.
A change in state regulations made in 2017 through Senate Bill 1107 opened up the market to do more with the technology, he said. One consequential change was the removal of a rule that required physicians to have seen a patient in-person before seeing the patient digitally, he said.
Since those regulations were lifted, national telemedicine companies, such as Doctors on Demand and Teladoc—which connect users to board-certified doctors—have entered the Houston market, increasing the competition, Spielman said.
“As that happens, the market becomes more mature and educated with telemedicine,” he said. “That’s why I think things are really going to start moving forward here.”
In recent months, several health care providers with hospitals and clinics in the Cy-Fair area have taken leading roles in incorporating the technology.
Houston Methodist debuted its virtual care app to the public in March, the first of its kind in the Houston area. In June, the hospital system also launched a partnership with Walgreens that allows people to conduct doctor visits by phone or video, including uninsured people, who can use the serve for $59.
Memorial Hermann went live with its eVisit model in April, which allows patients to fill out a questionnaire online and submit it to a doctor for evaluation in real time. About 20-30 people have been scheduling eVisits per day over the first few weeks, Bobb said.
Insurance companies have largely embraced telemedicine, officials said.
“A lot of insurance companies offer it as a part of their packages now; that’s just how popular it’s become,” said Don Ryan, owner of Cy-Fair Insurance Group, an independent insurance brokerage agency in Cy-Fair.
An aggressive stance
Houston Methodist has been providing telehealth services in some form for four years, but Spielman said the hospital system has taken an aggressive stance on developing the technology, and its uses have evolved in recent months, including the MyMethodist virtual care app.
A user who downloads the app is presented with five to six different doctor profiles to choose from. After selecting a doctor, users answer a few questions about their symptoms before being immediately conferenced into the physician’s office.
“The process to set up in less than five minutes,” Spielman said. “For established patients, it’s like five clicks, and you’re in. The video visits on average last approximately four minutes. It’s all very much on demand and incredibly seamless.”
The process was refined through a pilot program in which employees of Houston Methodist used the platform for one year before it was introduced to the public, Spielman said. The app was so popular roughly 500 employees are still making visits per month. Meanwhile, about 100 members of the public have scheduled visits per month over the first two months the service has been available, he said.
Providers said one of the main steps in making telemedicine more mainstream is making patients feel comfortable and confident in the technology.
When it comes to pediatrics, parents might be more hesitant to rely on telemedicine, said Dr. Anastasia Gentles, chief medical officer with Nightlight Pediatric Urgent Care.
Nightlight, which has a Cy-Fair area location on Hwy. 290, began offering telemedicine services about a year ago. Gentles said the technology can be especially helpful for contagious diseases such as measles. She said being able to make a diagnosis through video can allow her to schedule an in-person visit with the child at a time no other children are at the office.
Gentles said many of her video visits result in the child not needing to come in for an in-person visit, saving parents time and money. However, she said a very small percentage of her patients have shown willingness to jump on board the telemedicine trend with their children.
“Most people when they actually experience it, they love it,” Gentles said. “The hesitance, I think, is people don’t know about it.”
The No. 1 reason people are embracing telemedicine is the convenience, Bobb said.
A study conducted by the Harvard Medical School and published in the Journal of the American Medical Association in 2015 found an average in-person doctor visit took roughly 121 minutes of time, based on data from the 2003-2010 American Time Use Survey. An average telehealth visit takes about 15 minutes—based on data from Amwell, the consumer telehealth app.
Taking note of the potential for cost and time savings, health care industry leaders said they are focusing on ways to expand use of the technology even further. The Texas Medical Center Innovation Institute welcomed 19 digital health companies into its 2019 accelerator cohort, which provides opportunities for health care startups to connect to the community and share their ideas.
The 19 companies are seeking to use virtual technology to tackle everything from mental health to oncology to hospital efficiency.
Among them is the Houston-based PreopMD, which founder Dr. Christina Obi said seeks to use virtual technology and telemedicine to improve communication and collaboration between the different members of a patient's care team during surgery. She described PreopMD as "a virtual perioperative command center" that has the potential to address issues of inefficiency and miscommunication that many health care professionals have accepted as the norm.
"What we've been finding in operating rooms across the country is that fragmented communication between a patient's care team ... causes lots of issues," she said. "This a problem that I've been dealing with since I graduated from residency. It's a common issue that we have all just learned to deal with, and everyone has their own compensation mechanism."
The next step for PreopMD is a pilot program that will take place later this summer at a surgery center in Houston, Obi said. After completing the pilot, studying results and gathering feedback, the platform would move into the market, she said.
Bobb said he believes the speed at which doctors have been innovating has been extraordinary.
“We can do so much more than we could even just a few months ago,” he said.
There are some limitations to what the telemedicine is able to address, Bobb said, especially when it comes to patients with critical needs. However, both Bobb and Spielman said they expect the shift toward telemedicine to continue and evolve to be able to address more needs. Bobb said the trend could ultimately lead to fewer patients needing to come into a hospital or clinic. The long-term results could mean smaller hospitals that can pay closer attention to sicker patients.
“When you’re able to take care of some of these things without a patient having to physically come in, there are resources you can use for the patients who do need that,” he said. “Our goal in the long run is to have a healthier society. Breaking down those barriers patients face in getting care will help us to do that.”