Need to See a Doctor? There’s an App for That

The other day I found an interesting “Groupon”-type offering in my inbox.  Along with the coupons for unlimited kick-boxing and the latest fusion restaurant there was a surprising offer for a service called Doctors on Demand.  This is a form of telemedicine which provides primary care/general medicine services while obviating the trip to the clinic. 

Telemedicine is certainly not new with its origins going back as far as the 1960’s when astronauts’ various physiological systems were monitored on the ground while they were on mission (recall the neurotic NASA doctor in the movie Apollo 13).  The technology and its indications have since evolved with it being employed in an array of circumstances where the expertise of a specialist is required but not readily available on-site – think ambulances (remote ECG interpretation) and evaluation of stroke.  It is also often used as a substitution for in-house resources as a cost-control endeavor.  As our firm Snowfish experienced through a recent project, remote radiology services can afford the opportunity to have images read around the clock without the need for in-house coverage. 

Whereas much of telemedicine has traditionally fallen within the realm of professional-to-professional, it has also been used to facilitate professional-to-patient interactions.  Using the telephone augmented with certain devices, heart failure has been monitored and pacemakers checked remotely.  Modes of video conferencing allow for post-surgical assessment and wound care.

Coming back to these newer services, one clear distinction is that they are more often patient-driven rather than initiated and organized on the professional side.  Essentially, a patient signs up for one of the services either as an ongoing subscription or fee for service.  When they have a need for a medical interaction (which ranges from acute events to monitoring chronic conditions) they will use a website or mobile app to put in a request for service.  This usually includes their reason for the visit, symptoms, etc.  The service should already have the patient’s demographics and medical history.

A medical professional (usually an MD but one site employs nurse practitioners as well) is supposed to get back to the patient within approximately 15 minutes via the choice of vehicle; phone or video conference.   What ensues is an exam which rivals an in-person clinic visit without the time and inconvenience associated with travel and dreaded waiting room.

In the words of Ron Burgundy of Anchorman fame, this is kind of a big deal.  Doctor on Demand is one of the latest services of this type.  For the last few years, multiple companies have started to provide virtual non-emergency clinic visits with private payers even jumping on the band wagon. Companies such as Cigna, United Healthcare, WellPoint, Aetna and Anthem are offering telehealth as an amenity to improve access and control costs.  With each passing year, the virtual clinic visit will become more commonplace.  Medical societies are realizing this with the American Academy of Family Physicians publishing policy regarding delivery of telehealth services.

At first glance, the therapeutics industry should consider five important factors related to telemedicine technology that can help continue effective business as usual along with new opportunities for value-added or non-therapy services.

1.   It is important to simply recognize medical care is going on in this alternative setting, and the clinician in fact may already be your customer.  These services employ a contracted panel of physicians who will take telehealth patients between appointments or at off hours.  It makes sense to learn who they are to better understand the true volume of the specific patient types or diseases they treat.

2.   Consider these encounters like “urgicare” or “minute clinic” type appointments, but even one further step removed.  It is extremely likely that the clinician taking the call does not know the patient and they are basing their information on the information history provided by them.

 

3.   Most often, patients turn to these services for non-acute issues such as rash, allergies, upper respiratory infection, and gastrointestinal upset.

4.   Review of the websites for these services note specific training on their websites in which each telehealth clinician undergoes, though the details were not clear.  Anyone familiar with patient assessment and care will know that remote examination requires unique skills.  There is the lack of two of the main senses – touch and smell.  The ability to listen is also diminished without the ability to use a stethoscope.   That said, the telehealth clinician needs to understand what can be handled via a virtual visit and what requires in-person attention.

5.   All telehealth service providers are allowed to prescribe medications barring Schedule I, II, III or IV narcotics or pain meds. 

Industry can use these new services as an opportunity to provide additional value to clinicians and patients as well as offer companion services utilizing this same technology.  Very adept at delivering education and training to the medical community, companies can offer courses which help beef up relevant assessment skills of telehealth clinicians so that they can better identify and diagnose the issue given the absence of touch and smell (particularly in the case of potential wound infection).  On the flip side, patient-directed efforts can aid in more effective communication of ailments and issues. Additionally, industry may harness similar technology to enhance adherence and manage a therapy’s benefit and side effects.

Lastly, though convenient, use of these telehealth services can impact continuity of care.  Strong communication between the telehealth clinicians and the patient’s primary provider is critical to ensuring adequate follow on care and monitoring. The services we reviewed tend to be EMR capable, however its utility is dependent upon the patient’s primary provider.   The fluidity of industry professionals amongst various clinical groups can help to facilitate that the communication channels remain clear.

So, between kick boxing and lunch at the fusion restaurant, I can get my sinus infection checked out but with some limitations.  Telemedicine is another small step for patient centeredness with giant implications for all.

Melissa Hammond, MSN, GNP is Managing Director at Snowfish, LLC, which specializes in commercial analytics for the pharmaceutical, biotechnology, and medical device industries. 

Has the “Gilligan’s Island Effect” Impacted You? What Can Be Done?

In the life sciences industry, pigeonholing or typecasting is very real among individuals and companies alike.  Job candidates cannot shake the perception of what they were in their old position.  Companies are only considered for the particular service or product they last provided, even if they have multiple core capabilities. 

I like to refer to this as the “Gilligan’s Island Effect” referring to the iconic 1960’s US-based show Gilligan’s Island.  For those who are unfamiliar or need a reminder, the show featured seven radically different individuals including the Skipper, his first mate (Gilligan), a movie star, farm girl, extremely wealthy couple, and professor went on a three hour tour and ended up on a deserted island.  Thereafter the entire premise revolved around the crazy antics of the group in their quest to return to civilization.  The show was wildly popular with the talent of the main actors driving its success with viewers.  Still, even though they were all accomplished thespians with talent to tackle various roles most were unable to disconnect themselves with their characters.  This resulted in extreme difficulty for the show’s actors to get other jobs following the show’s ending.  Blame it on re-runs, but in actuality, they were indeed typecast – unable to shake the perception of who they were in the show.

A company may have particular core competencies, be it strong science, innovation, analytic skills, or marketing.  However based upon a particular service or product provided to a customer or customer group the company may be perceived as having expertise limited to that specific entity.   For example, Snowfish has worked successfully with a number of companies to profile their KOLs.  The same expertise in creative analytics also has applicability to various other areas such as gap analysis, market assessment, publication analysis and planning, and competitive intelligence.  Since those specific clients were only exposed to our talents in KOL profiling we were essentially typecast in that role, making it difficult to sell our other comparable services to those companies.

Another case is the medical device company that has a product which competes in the pharmacotherapeutic or biologic space.  That is, it could serve as a device-based alternative to drug therapy. Prior technologies marketed by the company were used for indications for which surgery was the only option.  Thus, the company was viewed as only able to provide such types of therapeutic solutions.  The success of the new device necessitated targeting and engaging new customer segments not traditionally focused on by the company – non-surgeons/interventionalists.  Now, this company had many attributes which would make it well-respected by any physician: it has been producing therapeutic medical products for decades, has demonstrated strong science, conducts well-designed clinical trials, very few product recalls, and is a leader in innovation.  Still, non-surgical physicians have a hard time viewing a device as having the ability to treat a condition traditionally managed with drug therapy or the company having anything to offer them.  Like Bob Denver and the rest of the castaways from Gilligan’s Island, this company too is suffering from pigeonholing.  Their products are viewed as only valuable for surgeons and conditions that can only be dealt with surgically.

Once it is perceived, removing a professional stereotype is not an easy task.   Actually the ideal way is to avoid being typecast in the first place.  I have included a few tips below:

1. Position you or your company not for particular service or product but for a set of capabilities that can be translated to a number of areas and functions.  Define yourself by your capabilities as opposed to the specific area they have been applied.
2. People generally have little ability or desire to think abstractly, make sure you are able to provide concrete examples of how those capabilities will transfer to various disciplines and specialties. 
3. Don’t wait to branch out to other specialties or disciplines.  In the medical device company example, they should always be reaching out to non-surgeons even if they are not a main target.  Continually build your network.    
4. Upon launch of a particular product or initiation of service engagement, start looking at the next opportunity and identify/engage valuable champions in these other areas that you think you will need to target.   
5. Produce thought leadership pieces that demonstrate your core capabilities.

It is not clear if back in the 1960’s this would have helped the Gilligan’s Island cast, but it might be presumed that with a more proactive approach they could have escaped their on-screen personas once the series ended.  With the right amount of thought and positioning, you or your company can do the same. 

Dave Fishman is President of Snowfish, LLC, a strategic consulting firm which specializes in commercial analytics for the pharmaceutical, biotechnology and medical device industries.  Dave can be reached at info@snowfish.net.