Stay Home

AliveCor just announced AliveInsights, an integrated telemedicine solution that lives on top of AliveCor’s smartphone ECG. AliveCor is advertising that a cardiologist will read one’s ECG within 30 minutes.

Everyone is fighting to reduce costs through telemedicine. Beyond regulatory issues, the greatest challenge has been delivering medical devices and equipment to patients’ homes so that doctors can receive that data. AliveCor is making interesting moves in this space by providing an integrated telemedicine service with their ECG hardware.

How and when will all basic medical services be delivered remotely? I see two distinct models emerging.

HealthSpot has been making waves recently for setting up a private "health station" or "health kiosk" that costs less than $15,000 to install. Right now, they’re piloting the kiosks in ERs and a few retail clinics. I suspect their vision is to install the kiosk in every retail clinic and school throughout the country. The kiosk only consumes about 44 square feet and can be operated by a medical attendant for just $30,000 – $40,000 / year. The kiosk includes a stethoscope, otoscope, dermascope, thermometer, BP cuff, scale, and pulse ox reader. It can support most simple PCP visits.

HealthSpot isn’t employing physicians, but selling these kiosks to provider organizations so that the providers can extend their reach virtually through HealthSpot. This is interesting because there could be HealthSpot kiosks in Maine with Mayo Clinic branding. Although this makes sense for prestigious provider organizations in the short term, I can’t help but think that this practice will ultimately lead to a dilution of brand and prestige in the medium to long term. It will become increasingly more difficult for patients to recognize brand value when most provider interaction is virtual.

American Well, Teladoc, Ringadoc, and others are taking the more extreme view that patients shouldn’t leave their homes at all. They are also employing or contracting with physicians directly as opposed to selling into existing provider organizations. This model presents the challenge of getting equipment to patients in their homes. I suspect this problem will solve itself in the next 2-3 years. Amazon, Google, and others are investing an enormous amount of capital and resources in bringing same-day delivery to the masses.

I can foresee a future in which the tele-mid-level providers will see patients virtually, determine what additional equipment is needed, and rent the necessary equipment to patients for a follow-up visit later that day, or at worst, the next day. Amazon and Google would gladly support this model to drive enormous volumes of shipping traffic. If the at-home diagnostics suggest more serious complications, the mid level would loop in a higher level provider or specialist.

I’ve spoke to HealthSpot’s CEO Steve Cashman about this threat. For now, HealthSpot is taking baby steps, but recognizes what may become an existential threat. I’m sure they’re planning for this future. It will be interesting to see how things play out in the "stay out of the hospital" telemedicine space.

Kyle Samani

Kyle Samani is a healthcare technology entrepreneur who is passionate about healthcare and technology startups.

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