PART 4 A SEVEN PART SERIES ON HOW HEALTHCARE IS TRENDING. AND, IT’S RIGHT IN THE PALM OF YOUR HANDS. _________________________________________________________________________

Why Telemedicine is changing the healthcare landscape and redefining the meaning of a Doctor’s “Office” visit.

By Steve Okhravi, MD, MBA, CPE _________________________________________________________________________

PART 4

Speeding Access to a Wellness Conversation is the Solution in the Doctor/Patient “Office Visit.” It builds efficient, productive relationships. Once we realize that enabling the conversation more elegantly via mobile and robustly technical solutions, we realize the healthcare conversation can, in fact, happen anytime, anywhere. And, the conversation can help grow the relationship because the old barriers: a) Appointment setting; b) Travel to-and-from the physician’s office; and c) Waiting for the physician to become available, etc., etc., we see a whole new window of opportunity to grow the relationship, enhance the conversation and close the service gap…to make it more universally available for consumption. This premise puts the patient’s needs first.

In short, the interconnectivity of the patient/doctor interaction is aligned rather than on the Doctors turf and singularly dependent on the Doctor’s calendar. There is no separation of church and state. The relationship and power is equalized in the optimized totally mobile Telemedicine experience. The experience is influenced heavily by the medium through which it’s communicated. And, it’s already in your pocket!

The Smartphone App  —  the new standard where we can turn to for “everyday” healthcare.

This, actually, distills the matter to its essence: On one side of the table we have a patient need. On the other side of the table we have physician’s agenda and their practice environments. The model is untouchable. Right?

One can only wonder. We know that patients prefer not to wait for access to the Doctor. Understandably, they want healthcare when they “feel” they need it. Also, Physicians love to practice medicine; they enjoy helping people feel better. The General Practitioner hangs out a shingle and encourages the patients come to them at a scheduled time. So, therein lies the potential disconnect. The old standard is all about gaining access to the Doctor, pending his or her availability and traveling to a practice location.

What do patients do?

Patients trust the Doctor’s instincts. They should know best. Right? The patient goes through the paces to fit the physician’s predetermined parameters for access and they are led through practice process. A little sheepish, wouldn’t you say?

Obviously, during the course of a “visit” or “session” the practice staff and physicians will do what they do best: have the patient present their symptoms and respond accordingly pending their medical knowledge, past experience, current research, an examination, vital signs review and the patient history provided or previously recorded. They do all the work, so they and their collaborators (medical partners, pharmacies, labs tests suppliers, etc.) take the process as rote and continue the pattern of the when-and-where-care determination. Physicians have the bio-medical-scientific-intellectual credentials to make a difference in the patient’s wellness.

Separately, tech companies supply content that provides instantaneous results (intelligence) that meet the demands of the public via their ever-present mobile/wireless connections.

The difference between those two entities (when-and-where-care and tech suppliers and the results they display) is simply that, a chasm. However, in cooperation the power of both provides enormous dividends to the patient. It’s a win, win, win situation. The traditional, inelastic-to-change bricks-and-mortar “Office Visit” model medicine works extraordinarily well for certain indications and symptoms. No doubt. But the lion’s share of routine symptoms presented can be vetted and (perhaps) effectively managed via the new standard—Telemedicine conversations. The old boss meets the new boss: And, in

this model, the patient service quotient climbs to the top of the food chain. Isn’t that nice for so many…at anywhere, and at anytime. Democratized medicine!

Quick recap: Doctors practice medicine on their turf. Tech companies provide instantaneous results via mobile technologies. Limitations regarding one can be eliminated by harnessing the power of the other. Amazing. Things are quite straightforward with this new standard. What about sharing this knowledge, enabling the adaption of the Telemedicine technology and changing the landscape of practicing “everyday medicine”?

The Mobile Device App —  where we turn to for Knowledge and…Healthcare? Physicians are always learning new stuff: it’s a prerequisite to practicing medicine…Continuing Medical Education… Now, before we safely assume that Doctors want to change a fundamental way that they practice and “see” patients, let’s ask questions.

The first question is: What do patients and physicians want to learn? But it’s difficult to draw a straight line between what we want personally and what we’ve been conditioned to: a) expect, b) adapt to, c) consume, and d) how likely are we to change our behavior when it comes to healthcare.

A better question: What do all stakeholders think they want to learn about? Where is the common ground and benefit for all parties? Is it sustainable? Is it scalable? Is it simplified enough to remove (rather than present) barriers to success? The strongest reason we do things is the idea that we follow the default— It’s the pre-existing choice!

The most interesting question to explore, then, is: What did they have to learn about so far? Where do they look for answer?

Two prominent examples that come to mind are: a) Knowledge institutions (medical colleges) and b) Knowledge curators (bloggers).

Medical colleges are official institutions (governmental or not) constructed to facilitate educational activities on topics that are, practical and realistic for a physician’s career. Their value (and relevance) lies in their ability to give you a credible medical practitioner’s certificate.

Their main value is the credibility of the paper they hand you at the end of your studies and their continuing commitment to learning. Let’s not forget, medical colleges are institutions with history, brand reputation and success rates to maintain. All this is going on while we live in a world where… 1) Quality knowledge is democratized and freely available, and 2) People care about results or quality services in addition to the assurances of one’s medical credentials and abilities (aka-- certifications).

In reality, medical colleges teach physicians about the practical side of their career, potentially marginalizing a vital part of today’s information age/mobile society reality. The practical and realistic issue of practicing medicine is a time-tested tradition of scientific evaluation, testing, observation, historical healthcare review, etc. Diagnoses’ are made, therapies are prescribed, follow-up reviews are scheduled and so goes the process.

Practically, the majority of the physicians graduating from college have seen traditional medicine grow in scope, technologies change and practices enabled by electronic medical records…and so on. And, these graduates assimilate and internalize the enhanced accessibility tools that enable the aforesaid. Certainly, the newest breed of Doctor is a child of technology and mobility. Yes, they know how to approach, diagnosis, practice medicine or manage symptoms. But, what’s next? Well: mobile medicine, of course.

Let’s return to the initial question: What have they learnt about so far? The answer: how do we enhance their access to intelligence, manage this intelligence remotely, efficiently and presumably grow their practice by a combination of the above.

This creates a foundational framework in medical student’s logic and likelihood for adaption to and the technological impact on everyday medicine. So, telemedicine IS principally a sound practice and deeply entrenched in the psyche of the new guard.

Everyday medicine can be practiced anywhere, anytime. In the next generation of physicians this is a given practice parameter. It’s the aforementioned: Logical adaptation of the technology immediately at hand to speed the access to the conversation between patient and physician. Enhance the relationship. And, we can grow/serve the “community” of the health conscious masses. It’s designed to close the physical gap

between the consumer of healthcare advice and the provider. It’s fast, efficient, effective (for certain, everyday, indications and symptoms).

Even hardcore, old school, practitioners (who primarily focus on the inherent value of the one-on-one, eye-to-eye patient interaction) are affected by the mobility context and have realized they need to adapt to the technology they use everyday (or become irrelevant and obsolete).

But, entities are diehards. Some are still inelastic to change. They need a pathfinder to provide the platform, the roadmap to the new technology so they can jump on board. And, say, they were waiting for the “right time”, the “right opportunity” to participate in a program with “legs”. A program they can be proud to participate in because it doesn’t interrupt the “patient experience”, is a viable way to practice, and a viable business-responsible way to get involved in the conversation about wellness.

Meanwhile, there is another form of education for the health conscious, this time it is related to business, promotion, communications and technological adaptation. The knowledge curators (the bloggers) dominate in this area. They are the Sooth-Sayers. Perhaps, so much so, that the Bloggers very existence threatens the old order of editorial content originators.

The great thing about blogs: diversity of opinions, they’re free for everyone, you don’t have to lock into a committed schedule to read them and you can work on your own pace. It’s all good. Type anything in the search bar, you’ll probably find a few hundred posts about any topic, examined from various angles. In fact grab this content you are reading now, put in your own views and re-publish it from your point of view. References in order, this enhances the intellectual conversation on ANY topic, and grows the dialog, raises awareness on issues and (using social media) has the likelihood of going viral, eliciting sea change in trends/perceptions, mass behavior and best practices. Blogs (editorial content) can move a society.

The downsides of this blog-generated knowledge are conspicuous:

1. Howcredibleisthisknowledgeandhowdowefilterthesignal(usefulinformation)fromallofthisnoise(theincrementalvastnessofposts)?

2. Howdoyoustayaccountabletosomeone,soyoucanputthingsinpracticeafterconsumedandhavingprocessedthem,andhowdoyougetsupportifyouhavequestions?

From my experience, nothing read on the Internet should be taken for granted without further investigation (even this article). When the entry barrier to publishing is having an Internet connection, quality of content inevitably drops.

Just because someone can write about a topic (in an interesting way, most of the time), it doesn’t mean its true. You should not necessarily pay attention or change your behavior according to the precepts presented from the Blogger’s POV.

In a democratic society of free exchange in dialog, everyone can be an expert. And, everyone can (and does) analyze their experiences. This creates a comfortable echo chamber for today’s health conscious:

So, what does this mean: 1) Much is possible, and Telemedicine is not only practical, accessible, effective and efficient according to very specific criteria; 2) Physicians can make a living as a Telemedicine Practitioners (Without a doubt, my local health professional community colleagues have lined up to jump on board as soon as my DocChat APP and platform is launched); 3) Healthcare knowledge/access to physicians is enhanced by this technology; 4) The Solution is easily downloaded to your Smartphone, 5) It’s freeware: entry barriers are non-existent to sign-up, and have the functional access to the experience… the solution is virtually in the palm of your hand 24/7/365. 6) The cost of entry for a session can and will be relatively low; so calling it a democratic healthcare solution, an alternative to an office visit; a wellness tool designed for the masses is no hyperbolic positioning statement.

7) In fact: This premise is the REAL DEAL on Healthcare. This is one wellness solution that can generate the “conversation” necessary to help so many, anywhere, anytime… within 15 minutes. a) That said, where does this effort and investment come in? b) Who will participate to get these lofty plans for lifting DocChat off the ground?

Bloggers may “quote post” this essay, because they’re open to timely, relevant comment on issues that effect those interested in healthcare trends. They also may reflect on the idealistic overtones to these ideas. However, the most profound extension of this essay would be to extemporize on the best practices necessary to implement this timely concept in the real world as we go through: a) Beta testing; b) The iterations necessary to perfect the solution; c) Rollout DocChat out in various formats; and d) Scale: Go from local to national to global proportions.

Quick recap: Medical colleges are institutions constructed with the mindset to graduate physicians ready to practice medicine. They offer credible knowledge. Generationally, their graduates are less slow-to-change given their pre-disposition to technology: a boon for the adaption of “democratized” Telemedicine providers worldwide. They will speed access to the “conversation”.

The Conversation Grows Following up on the Conversational aspect of Healthcare, wellness and closing the gap on access to physicians--let’s study the old standard:

Bricks and Mortar Office Visits: Why do most Doctors practice medicine in an office setting? Because that seems the best way today to converse with, inter-connect with and practice their trade. It helps them find new patients, diagnose and treat existing patients and earn revenue to support their practice. It is one of the few remnants of the old standard of medical practice that has survived and still makes sense for patients and doctors alike.

Most physicians look for practice growth in conventional ways: referrals from other physicians, satisfied patients who refer family and friends, and physical signage at the location of practice, and, increasingly marketing, public relations, public speaking, health fair event participation, directories, review sites and interactive communications. They tap into a network of venues that is known to host similar healthcare “conversations” like corporate clients and trade organizations, senior care centers, and other places where health conscious individuals congregate (Conversation Centers).

In short, if a physician wants to practice, they have to build the business of the practice. Increasingly, mega practices are taking over the healthcare industry, which limits the individual Doctor’s practice role in business of running a practice for profit. This business building activity benefits everyone associated with the mega practice. There’s no real exposure practicing without reaching out into the community. After all, people go to a particular practice with a particular need given its geographical location and specialty, if any. The “healthcare provider’s patient experience” is tied to the larger practice; the various touch points that the patient comes into contact with as they go through the practitioner’s operation: initial contact, answering services, administration, appointment setting, greeting upon arrival for scheduled appointment, how long they wait prior to seeing the physician, the experience while attended to by the physician’s assistant

prior to actually connecting with the physician who attends to the patient. We also need to consider the physician interaction, treatment, follow-up correspondence and, tests/meds dissemination, etc. And, even the billing department adds to the experience, positively or negatively.

The real business win, the “mega-medical-practice” appears to have the upper hand in this flow in a brick-and-mortar model.

My point of view: no matter how functional the large bricks-and-mortar practice system is (because of the consolidation of venues in a network) there are an increasing number of patients that simply need a medical opinion on a common ailment. The result: there is somewhat of a void that is difficult to satisfy for daily patient needs; to grow a patient-centric practice and build a business that levels the playing field. This is not going away unless we look for alternatives. Telemedicine provides those options. An App Functionality to ease access to Doctors fills that gap, simplifies the process and lowers the overall cost in time, money and distance between consumer (patient) and provider. Presently, there is less emphasis on: productive online interactions with accessible physicians / personalized conversation in living rooms / crowd-funded, crowd enjoyed, crowd-vetted solutions that result in healthcare sessions on demand / custom-made live experiences for individuals who simply need a Doctor’s opinion in unexpected places, at unconventional times---on their terms within minutes of the need arising.

Making a viable business of this thing called Telemedicine for “everyday illnesses.” The notion that interactive technology can be impersonal is ingrained into the healthcare community. It’s not a surprise why most patients hesitate to take control of their healthcare environment, let alone make a conscious effort to dominate it by dealing with everyday healthcare concerns via a Smartphone Application. Patient response, hypothetically: “Maybe that works for music downloads or a social media outlet… but, can I manage my not feeling ‘just right’ today via an App?” Physician response, hypothetically: “Can I practice medicine and earn a living this way?”

To establish a credible business model to operate this way (using New Standard Interconnections) providers in cooperation with the tech/EHR companies have created somewhat complex, feature-rich engines, options and possibilities. There are several models active; some have received considerable funding through various sources.

We see:

• Time-for-money exchanging revenues

• Brand-related revenues (capitalizing on “name” brand’s i.e., Dr. Phil)

• Patronizing (third-party crowd funding)

• Real-time access to medical records for remote consultations

• An attempt to duplicate the “In-Office Experience,” on-line, on the phone In practice, most physicians earn revenue through traditional medical procedures, running tests, scans, X-Rays, Cultures, prescribing meds/devices, and so on: It’s a transactional model that runs parallel with compassionate care. This practice has its place and is similar to services provided by my multi-office Urgent Care practice based in NYC. There’s nothing wrong with that, for certain indications presented by patients. This model employs the solutions of tech companies to support the established model of practice operation.

The DocChat point-of-view: There absolutely are times and situations when this model shines. And, in fact, this complex model is absolutely necessary in certain situations. This model is also practically sustainable, scalable and patient-centric to the extent of the “conventional” parameters in place. Though, how will physicians build a real-time, patient consultancy for everyday illnesses that do not require being on-site, or to have instantaneous access to myriad historical patient records on the fly (HIPPA regulations abound for who sees what files) to be practiced, anytime, anywhere by the “assigned physician on call, on shift, and at the ready” business model instead? Well, one solution is to create a Platform dedicated to unparalleled availability, for all, with unprecedented access and delivering on the promise of a health consultation session in 15 minutes, to boot! That is the DocChat concept in a nutshell. Pare away the complications, simplify and provide access…all within the local regulations for practice.

Promoting Telemedicine/building a community/providing access to a consult fast. Things are pretty straightforward in this premise. Medical marketing today is a constant effort to raise awareness, communicate the facts is a straightforward manner, dispel misunderstanding, and differentiate against the noise around options and possibilities for the New Standard healthcare. At it’s most basic, this DocChat idea is about beginning and continuing a running “conversation” about individualized wellness advice. It provides guidance on what I keep referring to as everyday occurrences of specific symptoms; they are the sweet spot for a DocChat session. It’s where the App and platform works best, where we provide the most value in the shortest amount of time and

how we fill a gap in the current solutions: be they conventional and/or part of the New Standard/Telemedicine. In the pursuit of promotion, for want of a better term (patient education/market segregation?) I realize the relevance to state the DocChat intent and mission by using social media or blogs to communicate all that’s necessary to establish this niche and change behavior about the need for a bricks-and-mortar office visit. And, let’s remember, it is a niche, regardless of how large I see this offering’s growth potential. Remember, I opened this essay by saying 70% of all office visits could be handled via Telemedicine. The number, in retrospect, is staggering when you scale the transition from the old standard to the new standard, as an App-based solution.

Although the way to ensure this concept is heard by those tech-savvy patients who would benefit most (as early adapters who get the long tail logic of technology assimilation to the masses) it still comes down to human-to-human communication. It pursuit of a passive introduction to Telemedicine it seems that most Physicians simply exhaust their personal network and don’t go past that stage. I venture here to be that pioneer and I have the energy and passion to follow this calling with a select team of forward-thinking partners to help me get there.

My point of view: the noise in the digital world has increased exponentially. Everybody wants you to pay attention to something incredible (which, when it comes to App-based solutions and Start-ups is frequently, more sizzle than steak). So people choose to stop paying attention whatsoever if the launch is not carefully positioned, constructed, rolled out in phases to refine the solution and Managed for Success. I’d think of this effort as “Design for Manufacture.” That is: We will build this App to serve the audience, simply, elegantly, to the end goal of empowering patients to get better advice for their wellness at a lower cost in time, money while adding convenience and accessibility. Yes, I can be called an eternal optimist: But, how do you convince the world at large to listen to you when there is either too much information to consume or the information is complicated and therefore inaccessible? (Remember, the whole purpose for this solution was to ADD ACCESSIBILTY!) Here are the Telemedicine Operational Touch Points we will employ to spread the good word: a) Creating an exceptional product/service worth talking about (This includes: The App, The Patient Experience it triggers…The Healthcare Gap It Closes | The Constructive Conversation it begins | and, The Relationship it enforces) b) Being where attention is already (We will ride the wave of the information era) c) Connecting with influencers (Bloggers, health fairs, online forums, Featured in “New and Worthy” at App Stores, etc.)

d) Organic Growth from within Working with our contact list, patients, partners, colleagues, early adapters as our Brand Champions and New Standard platform ambassadors / Existing practice loyalty (community building) instead of constant growth / Improved “patient experiences” instead of transactional office visits (need a flu-shot, get a flu-shot) e) Collaborations with other partners, brands and established networks.

f) Time Management. The notion that Patient’s time is a valued commodity has always been a stronghold in the foundation of my multi-office NYC-based Urgent Care Practice. So too, is the DocChat principle based. There’s nothing confusing here. Physician’s value their time and want to practice efficiently to optimize and grow their practice, to: “spread the wealth of their knowledge to the most patients, as practically as possible, and to advocate wellness.” Healthcare professionals “get it”…that healthcare tactics like telemedicine ALSO take into consideration the patient’s time to go through the “consult” process.

The DocChat POINT OF DIFFERENCE: There seems to be no platform where patients tap into when it comes to organizing and prioritizing their tasks/time around their OWN healthcare conversation. I imagine that THIS IS DocChat’s SWEET SPOT. It’s THE secret sauce. This IS the Reason for Creating DocChat.

What comes close to an anagram for the DocChat Branded Platform is what I call: E-M-P-A-T-H-Y (Empowering Patients: Actively Talk Healthcare Yourself) …that is, everything around the patient “owning” the conversational process for a DocChat session. Via this Unique and Proprietary App, the Patient: a) Initiates the session b) Has the session on THEIR terms c) To meet THEIR needs, and d) Does so anywhere, anytime.

Now that’s EMPATHIC, Patient Care.

This is a happy patient outcome, because spending time on your own wellness—instead of delegating it to a process that is largely out of your hands (i.e., scheduling the bricks-and-mortar “office visit” for a common ailment)— can lead to frustration, lack of motivation for the “experience of the wellness consult” in light of a more advantageous new age of instantaneous information mobility, AND crowd-sourced intelligence. Ultimately, anything less than “instant gratification” in this context presents a lack of joy for the healthcare process of maintaining a conversation around an everyday occurrence of “not feeling up-to-par.”

My point of view: I get it… patients may feel disorganized around their healthcare, especially when they (or the loved ones in their care) are just not feeling particularly well. This lack of organization, time management, time “control” can render them even less satisfied when they go through the appointment setting process, reach out to a physician office for an appointment to be set in days (or weeks). This results in a feeling of being “all over the place;” and, out of control. I want control in my life. So do my patients. The DocChat App and Platform adds these controls, establishes a commitment and resource management (the timing and scheduling is patient or self-actuated) are what makes patient empowerment flourish and creates a proper balance in the healthcare conversation. It’s a sea change in attitude, process and balance of power in the wellness dialog. Interim Conclusions: a) “Outsourcing” healthcare conversations to technical solutions (Apps) can have the opposite perceived effect: The DocChat solution can be warm, empathetic and personal (not cold).

b) Help from fans—benefactors, patrons, partners Allocating tasks to friends of change is fully expected to help build an effective team around a patient-centric healthcare brand, help put a practical empathetic productivity system in place, and facilitate the patient experience of an anytime, anywhere consult.

c) Collaborations with partners outside medicine (technologists and communication experts in new media) …helps clarify goals, define roles and responsibilities, and provides answers to the many questions necessary to support the launch of a healthcare start-up built around a New Standard of Patient Care. (Smartphone Wellness Consultation/Telemedicine for Everyday Ailments)

If the Platform (the App, its’ practical/operational ability is to speed the access and conversation with a physician) is problematic, then the solution will never be effective and impede progressing the remote patient healthcare experience. Practical Goal: Hence, my clear objective and intent is to keep this DocChat solution simple, available to access in real time, and (always) delivered on the patient’s real terms (I.e., The anywhere, anytime consult). ___________________________________________________________________

So, the community, the need and the resources (once aligned) rise to the occasion: The Wellness Conversation is enabled. And, the Anywhere, Anytime Consult is launched. That’s the DocChat concept, plain and simple…(Cont’d on Part 5)

Dr. Okhravi's deep credentials have made him the perfect candidate for creating and leading Emergency Medical Care facilities in NYC. This novel Urgent Care facility is dedicated to the NYC communities that EMC serves. In his professional CV you'll find an uncanny blend of healthcare practice, process and work flow savvy, along with exceptional hospital, ER and business management skills. This convergence of skills formed EMCs best practices and stand-alone ER healthcare knowledge based on practical, progressive, efficient, and compassionate urgent care principles.