Could Telemedicine Show the Way Forward for EMR?
The increased adoption of telemedicine in the wake of the COVID-19 crisis could fulfill the promise of improved care and collaboration that Electronic Medical Records (EMRs) have never fully delivered on
By Sid Thekkepat, Venture Architect Director and Dr. Gunnar Trommer, Managing Director and Partner, BCG Digital Ventures
The COVID-19 pandemic is shaking up the healthtech space, as digital responses have quickly become a key avenue for delivery of healthcare to communities practising social distancing and adhering to contact restriction measures. New possibilities for market disruption are emerging, with the COVID-19 crisis notably triggering rapid change in the telemedicine landscape.
This article will consider how the disruption in the collaboration layer during the COVID-19 pandemic could act as a catalyst and enable new players in the telemedicine space, including traditional teleconferencing applications, to fulfill the promise that Electronic Medical Records (EMR) have failed to deliver on.
The Failed Promises of EMR
EMR was tipped to be a game-changing innovation in the medical sector in the United States. An EMR system files the digital medical records of patients for a particular clinic, service or hospital, in compliance with HIPAA and other regulatory requirements. From a patient perspective, most EMR systems also have tethered portals that enable the access of data, making appointments and facilitating communication with physicians. EMRs received $35 billion in subsidies under the promise of being the platform that would improve patient care and coordination, enable collaboration and streamline services.
While they act as data repositories and have significant uptake (over 80% of office-based US physicians), EMR systems have been unable to deliver on its original promises for a variety of reasons including lack of interoperability, high costs and poor usability. In addition, major EMR players have been accused of blocking information flows and operating closed ecosystems, which in turn curtails the ability of third party applications to innovate in the space. This means that despite their high uptake, more than 50% of EMR systems are believed to either fail, or fail to be properly utilized by healthcare professionals.
How COVID-19 Transformed Patient-Provider Collaboration
The recent shift to telemedicine practice indicates that the COVID-19 pandemic has the potential to disrupt healthcare delivery. With patients unable or unwilling to visit doctor’s offices over the last three months, virtual and phone consultations have been the primary means of continuing the essential services normally provided through clinical practice. The increased pressures on healthcare services in responding to the pandemic should also be considered here. Primary care doctors are the first line response in this pandemic, fielding questions from patients concerned about potential COVID-19 symptoms. Telemedicine has facilitated this work and in many cases, allowed for more efficient triaging of patients. Nearly half of physicians are seeing patients through telemedicine, up from 18% in 2018. A recent study from Massachusetts General Hospital found that 68% of telemedicine patients gave a 9/10 or 10/10 user rating on a patient satisfaction scale. This high level of patient satisfaction, compared to satisfaction rates found with EMR indicates that the telemedicine product provides a good foundation upon which to build a platform and an ecosystem.
This drastic shift in collaboration mediums could open up new opportunities for tools and potentially platform businesses. A good analogy is the shift from reliance on email to Slack within large companies; Slack has catalyzed the use of messaging and chat rooms to build out a collaboration hub that as of 2020 has over 2,000 apps. Software in other categories (e.g. developer tools, file management, sales and marketing) all integrate into Slack — which is positioning itself as a platform to reshape the future of work. Could telemedicine disrupt on the same scale and alter the landscape of healthcare delivery?
The Key Players in the Battle of the ‘Collaboration Layer’
While the rise of telemedicine is clear, the unexpected outcome of COVID-19 has been the platforms of choice used by patients and practitioners to collaborate.
Telemedicine businesses like Amwell have predictably seen a high rate of adoption and EMR players have also rushed to launch new telemedicine services to ride the wave. However, traditional conference systems such as Zoom and Facetime have also taken on a key role in the delivery of digital health. During one week in April, Doxy, a lightweight telemedicine startup, which does not integrate into clinical workflows had over 139,000 new providers sign up. The trend is presumably a result of brand recognition, familiarity and accessibility, and a smooth user experience for both practitioner and patient. This unexpected shift indicates an emerging path in the battle to own the collaboration layer between patients and physicians. There are multiple scenarios in terms of which players might emerge as the go-to collaboration hubs. As with the previous analogy drawn between these disruptors and the rise of Slack, these collaboration hubs could then integrate into relevant data sources (e.g. EMR, Remote Monitoring data, patient apps) and other workflow tools (e.g. billing) to reshape how care is delivered.
The first scenario that could play out involves telemedicine players. Businesses like Amwell could capitalize on this boom, with companies adapting their platforms and highlighting their capacity regarding privacy, data security and secure networks. In addition, they could ride the tailwinds of proposed regulation that will allow third party apps to access EMR data. This could result in telemedicine apps becoming the go-to platforms for healthcare practitioners seeking a ‘one-stop-shop’ for consultations, records and add-on services. This would likely apply to services and disease management that are more predisposed to virtual care, for example primary care or follow up visits that do not require a physical examination.
A second scenario that might emerge concerns EMR players who have scale to leverage. EMR platforms could modernize and improve their UI to match the standards set by tech upstarts. The performance and accessibility of EMR systems for healthcare practitioners and patients alike will require a dramatic updating of EMR systems and a shift in focusing on providers. Facilitating efficient billing and data entry is not enough to win out in this ever-shifting market. EMR platforms need to assess how they can integrate with the user-friendly telemedicine options preferred by physicians and open up their platform to complementary partners, while simultaneously appealing to the UI/UX of the newly empowered patients.
A third pathway could be driven by payors, who are the most incentivized to drive efficiency and collaboration in the system and could leverage telemedicine to deliver better care at lower costs. Already, we’re seeing large payors like Humana partner with telemedicine startups to launch new models.
Finally, this new spotlight on user experience could best position the tech players to succeed. Healthcare innovation could finally take centre stage, with the market prime for further disruption from the next line of Silicon Valley startups turning the corner. Put simply, the best innovator wins. This scenario equally could play out with existing teleconference systems — the onus is on Facetime, Skype, Zoom, Google and other competitors to appeal to the market, demonstrate its ability to integrate with EMR systems and offer end-to-end security concerning medical data. Just nine months ago, BCG posited that if adversity were to disrupt the healthcare market, the key tech giants would be well poised to take a leading role. Amazon is one such player to watch; in the last two years, it has partnered with JP Morgan and Berkshire for a new healthcare partnership, acquired pharmaceutical delivery company PillPack, achieved HIPAA compliance with its Echo device and launched its own in-house telemedicine service for employees.
Looking to the Future
How the battle will play out remains to be seen. What is clear is that telemedicine has taken on a new and key role in clinical practice. Patients are newly empowered, and in the post-COVID-19 era will expect a continuing high standard of care with this new-found convenient, easy and fluid user experience. Physicians will need to respond to this demand, and will only adapt to user-friendly, efficient and efficacious software.
The space is ever-evolving and the next twelve months will be a litmus test to see which key players emerge as the winner and the best-positioned platform to reshape healthcare delivery — whether that is traditional teleconferencing apps, existing EMR systems, specialized telemedicine apps or healthcare outsiders from the app economy. It seems likely that the winner will be the solution that provides the most seamless experience for users — both patients and healthcare professionals. Tech giants are well positioned to disrupt and capitalize on brand familiarity and their superior UX capabilities, making them an attractive option to back in the business of healthcare delivery. They may well be the ones to watch in the competitive battle to dominate this space.
