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Telehealth Looks to Digital Diagnostics to Improve Virtual Care

Telehealth providers are teaming up with digital diagnostic companies to extend point-of-care lab tests to virtual visits. The service improves the patient experience while giving providers another tool in their digital health toolbox.

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- With direct-to-consumer telehealth platforms popping up all over the country these days, healthcare providers are now looking at combining virtual care with lab tests.

Health systems and consumer-facing telehealth vendors see point-of-care testing and digital diagnostic services as the next enhancement to the virtual care platform. The idea that a consumer could not only see a doctor online for a nagging health issue, but also have labs and tests done from home, holds promise to ease traffic bottlenecks at crowded EDs and doctor’s offices and improve patient engagement and satisfaction with telehealth.

In 2016, healthcare providers spent $18.4 billion on point-of-care diagnostic testing services, ranging from pregnancy tests to blood and endocrinology tests, according to Kalorama Information.

"The driving force behind point of care innovations in the health arena is to provide expedited diagnosis where the patient is seen or in the patient's home," Kalorama publisher Bruce Carlson said. "New technologies are allowing POC devices to produce quantitative lab-quality test results that can be transferred automatically to an information system, a remote caregiver service for consultation, or an electronic medical record."

The latest telehealth platform to announce an integration is Doctor on Demand, which this week unveiled a collaboration with LabCorp and Quest Diagnostics to offer digital lab services to its patients.

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“Our mission is to improve the world’s health through compassionate care and innovation. By integrating with labs and upgrading our patient profile and follow-up care services, we’ve taken a major step in advancing the quality and range of services treatable via telemedicine,” Hill Ferguson, the San Francisco-based company’s CEO, said in a press release. “We’re providing a higher quality and better overall experience, giving patients the unique ability to build a relationship with a single doctor, always putting the patient first.”

At the recent American Telemedicine Association conference in Orlando, American Well CEO Roy Schoenberg said home-based testing and digital devices would greatly improve the virtual care platform by giving patients convenient access to more services.

“As [the] technology improves and more and more of these tests are valuable to the telehealth transaction, some of those tests become innovative enough and low cost enough to be able to do them in the home," Schoenberg said during a panel session. "All of these devices wouldn't exist unless telehealth had grown in the last 10 years so that it made sense for a company to invent a telehealth-purpose device.”

“The same thing is going to go for lab tests. You are going to see telehealth-purposed home kits for strep throat and UTI and a variety of diagnostic devices are going to surface, and that's going to be driven because of the telehealth industry,” he added.

Earlier this year, Teladoc announced a partnership with Analyte Health of Chicago. The deal allows Teladoc’s online doctor network to direct patients to Analyte’s regional locations, where technicians can collect and process blood and specimen samples within three days of the patient’s online consult. Company officials plan to make the service same-day in in-home in the future.

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Teladoc CEO Jason Gorevic said the partnership “enables us to bring the lab to patients during their telemedicine visits to further support quality measures.

Among the first to incorporate lab tests into the telehealth experience was Zipnosis, which launched its ZipTicket platform in February 2016. Described as a "virtual boarding pass that gives patients front-of-the-line access to in-clinic lab tests," company co-founder and CEO Jon Pearce said ZipTicket would help providers create a connected care platform.

"Health systems use our platform to expand access to care by leveraging their own clinicians, and with ZipTicket, we are further streamlining the process by improving the patient experience and increasing efficiencies," he said in a press release. "Unlike other out-sourced telemedicine providers, ZipTicket extends a provider's integrated care delivery model, resulting in better medicine, better patient experience and a more sustainable economic model." 

At the ATA conference, a separate panel discussion brought up strep tests as a potential advantage and barrier to direct-to-consumer telehealth. Bruce Rosenthal, MD, clinical associate professor of emergency medicine and director of IT & fast track services at UPMC Mercy, wondered whether some clinical diagnoses like strep throat could be properly handled by virtual care.

“This is one of the most difficult issues in [providing] acute care,” replied Peter Antall, founder and chief medical officer for American Well’s Online Care Group and a session panelist.  

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Antall said telehealth providers and health systems are working to develop partnerships with diagnostic companies to offer quick lab tests either at home or at nearby sites that are easier to access than the local hospital or lab. In the future, he said, they might also work with pharmacies to market home test kits, though that service is fraught with complications.

The challenge, then, will be in determining what lab tests can be handled on a digital health platform, and what tests should be confined to in-person visits.

Likewise, the method of conducting digital lab tests has to be considered carefully. Less than two years ago, HealthSpot touted its kiosks as a mobile lab through a partnership with Samsung Electronics, offering accurate results from a variety of blood tests in as little as seven minutes. But the company floundered and eventually folded, as its kiosks proved too expensive and didn’t attract the consumer business needed for sustainability.

Those still using kiosks, like American Well, Medex and the Veterans’ Administration, say smaller, more nimble platforms have great potential in retail areas, large businesses, remote locations like cruise ships, even health clinics and EDs. Their selling point just may be access to digital tools and lab services.

“This is going to be cheaper and more efficient for ambulatory patients who want to just go someplace and get checked out,” Medex CEO Charles Nahabedian said in a 2016 interview. “There’s a real need there for this kind of quick and easy … healthcare.”

Another concept is the online lab test, pioneered by genetic testing services like 23andme and AncestryDNA. Recently, Austin, Texas-based EverlyWell announced it has raised $2 million in venture funding to expand its direct-to-consumer diagnostic testing service. The startup, launched in 2015 in now active in 46 states, enables customers to order lab tests online, package their samples at home and then mail them to a nearby lab.

The acknowledged leader in the industry is New Jersey-based Quest Diagnostics, which was partnering with telehealth vendors more than two years ago to create digital diagnostic services. The company not only partners with health systems to facilitate digital diagnostic services, but maintains a consumer-facing business that offers lab testing without the need for a doctor’s order.

"In today's consumer-driven health care environment, people want to play a more active role in managing their own health and wellness, and our Patient-Initiated Testing service is another resource for individuals to empower better health," Steve Rusckowski, the company’s president and CEO, said in an announcement last November as the QuestDirect platform went live in Colorado and Missouri. "Consumers expect the most accurate and up-to-date diagnostic information to proactively manage their health so that they can make educated decisions, and we are pleased to begin offering this service to residents of Colorado and Missouri."

On a related track, mHealth companies are all over the idea of using the smartphone as a diagnostic tool – a concept gaining particular traction in developing nations, where access to healthcare is minimal and the need for in-the-field diagnostic testing is high.

That concept could be carried even further in cases of infectious diseases, like hepatitis, mono and HIV/AIDS, and viruses like the flu, Ebola or the Zika virus, where access to digital lab testing services could help healthcare providers diagnose cases more quickly, speeding treatment to those affecting and keeping them out of crowded clinics, doctors’ offices or hospitals.

Speaking to mHealthIntelligence.com at the ATA conference, Schoenberg said access to digital diagnostic tools – including lab tests and wireless devices - will not only help doctors on an acute care platform, but give them a leg up on telehealth’s next frontier: chronic care services.

“Urgent care is never going to go away,” he said. But providers have to look beyond that service in order to expand and scale up their telehealth platforms. And that means collaborating with patients who have long-term care management needs.

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