Telemedicine is not a new technology.

In fact, we’ve been doing telemedicine for almost 20 years at ClickCare. As you may know, we started by pioneering in a School-Based Health program at local underserved elementary schools. That program used newer technology — including some digital cameras — but really, the success of it was related to the approach and openness of the providers, patients, and families involved.

Because the school nurses and the pediatricians were so oriented towards caring for their young patients as well and as holistically as possible, they were open to trying new approaches. As participants saw the success of the program, it became broader and more organizationally supported. And honestly, at no point was there any conversation around reimbursement or policy — it was just one more way they cared for their patients.

All of the providers that use iClickCare today approach it similarly. While telemedicine is increasingly common, it’s certainly not the default. And so providers or hospitals that incorporate the tool do so as a conscious choice. Reimbursement improves; political and organizational support expands; but through it all, providers carry on with the tools and approaches they think will help their patients the most.

I was interested to read a report in JAMA, however, and extended in Fierce Healthcare, looking at how telemedicine use is expanding (or, in some cases, not), and how reimbursement laws relate to these adoption phenomena. Parity laws demand that insurer reimbursement be the same for telemedicine-based care as for in-person care. These laws have been adopted in 64% of US states. In confluence with this, there was a significant uptick in telemedicine usage among primary care physicians between 2015 and 2017. For more rural areas, mental health services seemed to be higher usage than other specialities. While in urban areas, primary care telehealth was more common.

This is all in line with the expansion of both telemedicine and reimbursement that we’ve seen. Parity laws demand that insurer reimbursement be the same for telemedicine-based care as for in-person care. That said, one interesting fact stood out: “the data showed a negative association with states that enacted comprehensive parity laws mandating reimbursement for the services.”  Perhaps that is because those states struggled the most with adoption in the first place — but either way, it’s clear that adoption “from the grassroots” may be more effective than approaches that aim to implement telemedicine starting at the policy level.

With any shift in practice, there is always a combination of technological, personal, psychological, and societal factors that need to come together for the technology to be incorporated into use.

For instance, simply inventing the telephone doesn’t create a culture that calls your friends. A combination of phone lines, social change, and early adopters combine with the new invention to lead to a society that talks on the phone.

On the one hand, telemedicine is becoming increasingly widespread, generally. There is increasing consensus that telemedicine can contain costs, increase access, and cut healthcare provider burnout. It’s not surprising that so many providers, patients, and payers are incorporating the technology into how they “do medicine.”  On the other hand, telemedicine implementation isn’t a matter of policy or a “snap of the fingers.”

Ultimately, telemedicine adoption must come from providers and patients. There is no way to legislate or demand creative ways of caring for our patients.

Learn more about how to implement telemedicine in your organization, economically and quickly, with our Quick Guide to Hybrid Store-and-Forward Telemedicine: 

In our community, there are two nonprofit community hospitals and one Catholic hospital. All are excellent. Each has slightly different founding values and ways of operating. All three have a strong heart and soul, which has been more or less apparent at different times depending on leadership.

So a recent article exploring the shift in how Catholic Hospitals have approached their values and leadership — and the effect that can have — certainly caught my eye.

Catholic Hospitals used to be run, of course, by nuns. Increasingly, however, as the Fierce Healthcare article describes, “Catholic hospitals are much more likely to be run by lay executives who don’t serve as a human embodiment of religious roots.”

There may be multiple positive aspects of this shift. Perhaps the hospitals are able to serve a broader base of people with a greater diversity of religious backgrounds or values. Perhaps the lay leadership is stronger in some technical aspects of running or managing the hospitals. But the author of this article points out that the shift away from hospitals’ original values “can actually hurt their bottom line, as Catholic hospitals lose the loyalty of community members who sense an erosion of the values that were long integrated into their care.”

In other words, although it may seem that the immediate effect is one of broadening and strengthening, there may be side effects — as of any strong medicine — that outweigh the positives. As the author concludes, we in medicine are in a unique place that is at the intersection of art, science, morality, and human caring. Indeed, “hospitals are seen as more than just a business – they are often seen a reflection of the overall health of a community.”

I don’t have a detailed understanding of the specifics of Catholic hospitals and how these shifts to lay leadership have affected them. That said, I have found on a personal, business, and medical level — that when you dilute or don’t lead with your values, it may seem practical but leads to negative consequences.

Collaboration is about declaring to ourselves and our colleagues that we have a unique perspective, unique skills, and unique values as individual providers. We’re not a generic “healthcare provider” that can be swapped in for any other provider. If that were the case, any provider could provide the same care as any other — and collaboration would be far from necessary.

Let there be no mistaking it: when we lead with our values, and care for patients from our unique set of strengths, weaknesses, and values — we are more interdependent with our colleagues and we end up with a more unique role in the process. For providers who want to see themselves as invincible, this can be uncomfortable. But, as with the example of the hospitals, there may be immediate, short term benefits to diluting our values and trying to be all things to all people — but ultimately, it results in weaker care.

In fact, I think that is one reason that iClickCare, and telemedicine-based medical collaboration in general, is so effective. When we are able to collaborate, to reflect on cases, and to lead (and treat patients) with our values, we get better results. As the article author emphasizes, “There’s benefit in continuing to cultivate the essence of local hospital’s unique personality and roots, even as the benefits of system affiliation are stressed.”

It takes courage to practice medicine from your own unique perspective and strengths, rather than from an imaginary “generic” place. But the rewards are great — and so is the care.

For more stories of courage, medicine, and medical collaboration, download our Quick Guide to Medical Collaboration:

Medicare is a crucial part of our healthcare system. Although some providers feel themselves unwilling or unable to accept Medicare, the reality is that 44 million people are beneficiaries. It impacts those people, as well as our healthcare system as a whole. This is important because the whole healthcare system tends to lean towards Medicare's policies.

So a new proposed rule affecting telehealth is practical, crucial, and fascinating to explore. 

Just recently, Medicare announced a new proposed rule for public comment and review that would greatly expand payment for telehealth. 

The full proposed rule change can be found here, but the general shift leans heavily on Medicare Advantage plans and is summarized as follows: "Under this proposal, MA plans would be permitted to offer – as part of the basic benefit package – additional telehealth benefits beyond what is currently allowable under the original Medicare telehealth benefit. In addition, we propose to continue authority for MA plans to offer supplemental benefits (that is, benefits not covered by original Medicare) via remote access technologies and/or telemonitoring for those services that do not meet the requirements for additional telehealth benefits."

The explanation and rationale for the shift includes this insight: "The healthcare industry has made significant advances in technology that enable secure, reliable, real-time, interactive communication and data transfer that were not possible in the past. Moreover, the use of telehealth as a care delivery option for MA enrollees may improve access and timeliness of needed care, increase convenience for patients, increase communication between providers and patients, enhance care coordination, improve quality, and reduce costs related to in-person care."

Not only is this a powerful positive development for medicare beneficiaries as well as healthcare providers who use telehealth -- we believe this represents an important philosophical shift. Telehealth is not an "an additional benefit" -- it's one of the many tools that healthcare providers have at their disposal to provide excellent care to all patients. This proposed rule is an important step away from that "special benefit" status of telehealth -- and towards it being just one more tool in our toolbox. 

Further, it is recognized that significant savings can come from the use of telehealth, as well as increased access by people who may be in rural, underserved, or hard-to-reach areas.  

The commonsense of telehealth seems to be slowly eroding the granite barrier of Medicare’s policy toward payment for telehealth.  As you know, there are significant restrictions about who, where and how a patient could benefit from technology applied to day-to-day care. Currently, live video conferencing from specific sites is the only reimbursable use of telehealth for Medicare recipients. We, of course, are strong believers in using technology to shift time as well as shift place. Hybrid Store-and-Forward Telemedicine®, for instance, uses asynchronous collaboration -- you respond on your own schedule -- so that both the patient and provider can solve problems without always using expensive hardware and having the interruption of scheduled appointments.

We understand CMS’s concerns about the potential for fraud and agree with the concerns. However, in our modern society with a fragmented health care system, collaborative and coordinated care has benefits that outweigh the risks.

For providers who care about good medicine and thoughtful healthcare, this new rule is an important development -- and likely shows the direction that reimbursement and medicine in general is headed. 

To learn more about Hybrid Store-and-Forward Telemedicine, including reimbursement issues, download our white paper: 

As the world changes, our regulations and laws often scramble to keep up.

Whether it’s Uber being challenged in individual cities or schools struggling to adapt to children owning cellphones, the legal side of life often lags behind our technology, our culture, and our needs.

So it shouldn’t be surprising that telehealth regulations face similar challenges across states — but the consequences are indeed challenging for those who do direct-to-patient telehealth.

A recent article in Fierce Healthcare looked at a few examples of recent telehealth challenges arising from state-to-state regulatory differences.

As they report, “Whether a medical professional can treat someone via telehealth—and if so, how—varies widely by jurisdiction, since medical practice is regulated at the state level.”

For instance, court cases involving doctors seeing patients via telehealth touched on:

• The administration of medical abortions
• Prescription of controlled substances
• Etc.

Further, doctors and patients often run into challenges when the intended telehealth patient didn’t have access to the Broadband internet needed to access an electronic visit with a doctor (thus limiting care in the very places that telemedicine could be most useful.)

These challenges are real, and important to explore. That said, it's not necessarily the case that the challenges are inherent in using telemedicine across state borders.

The regulatory issues presented in the Fierce Healthcare article all boil down to the challenges inherent in a doctor seeing a patient electronically.  But “telehealth” is NOT synonymous with doctor-to-patient online visits. As we’ve written about extensively, the umbrella term "telehealth" includes the use of many different kinds of technology to care for patients. A doctor seeing a patient via an online platform is only one version of that.

In fact, the challenges of videoconferencing or electronic visits are the very reasons that we created iClickCare to revolve around medical collaboration among healthcare providers, NOT between a single medical provider and a patient. There are many reasons that a short, technology-supported visit between a healthcare provider and a patient via videoconferencing may not be adequate to provide strong, holistic care of that patient. There isn't a useful archive of the visit; other members of the care team can't be involved; there is often little longitudinal knowledge of the patient; and care is infrequently holistic. The regulatory issues inherent in a “visit” like that are only one aspect of the shortcomings involved.

As an alternative, telemedicine-based medical collaboration allows providers — regardless of location — to collaborate on a case. It also means that if a provider in California is consulting with a provider in New York about a patient in California, the provider in California remains responsible for that patient. And that is “responsible” in all senses, legally and otherwise. Telemedicine-supported medical collaboration allows the flexibility and location independence that telehealth promises. But it doesn’t put the sole responsibility for a patient in the hands of a provider who is 300 miles away and has interacted with them, once, on Skype.

As we step forward into this new age of telehealth, telemedicine, and technology, it's important that we don't simply replace our old system (one-on-one doctors' visits, for instance) with a technological version of that old system. Our patients deserve more imagination than that. And we deserve the ease that can come from a tool that really works to help us deliver great care. 

A new article in the New England Journal of Medicine takes a controversial stance on the topic of whether an in-person doctor's visit is always "Plan A."

Perhaps, the author argues, we are moving towards a time when patients will be better served by a model in which in-person visits are actually the "last resort" of care. 

Our take? Yes and no. Read on...

In "In-Person Health Care as Option B", Sean Duffy and Dr. Thomas H. Lee advocate for a new framework for healthcare visits. Rather than seeing telehealth visits or other virtual options as "in the meantime" approaches or ways to cut costs, they argue that perhaps patients can be cared for better when in-person visits become much rarer, only used when absolutely necessary.   

They describe the analogy of a tech support ticketing system, as might be used at your favorite software company. Perhaps a patient would submit a "ticket" with their concern or medical issue... it would be handled first via telehealth means (even automated or low level support at first)... only being "escalated" to an in-person visit if absolutely necessary. And the ticket wouldn't be closed out until or unless the initial complaint was resolved.

The technology is there, the authors contend. “Smartphone penetration of the mobile-phone market increased from 17% to 81% between 2009 and 2016.” And the reality is that in many ways, our medical system is already moving in this direction: "At Kaiser Permanente, for example, 52% of the more than 100 million patient encounters each year are now “virtual visits.”

One important point that the authors make is that doctors are often approaching care this way currently -- but with improvised methods that aren't really meeting the provider's or the patient's needs. True enough: “Virtual visits are more convenient, but there’s a difference between recreating an in-person approach with digital tools and designing the safest and most efficient way to achieve an optimal outcome." Further, if doctors are simply using text messaging, email, or informal photos to replace a visit, that's not a safe or sustainable way to replace the richness and HIPAA-compliance of a real visit. Also, improvised approaches tend to be lesser replacements for in-person care, rather than innovative ways to save money AND get a better result.

Although we agree that there is a lot of potential to rethink how we approach clinical visits in healthcare, we also worry that the authors' approach isn't appreciating some of what can be lost if telehealth approaches aren't designed thoughtfully.

For instance, the example of the tech support "ticketing" analogy would fall severely short of our goals for any medical visit. Sure, the patient's complaint needs to be addressed. But medicine is more complex than software.

So any approach to increasing the use of telehealth solutions also must:

• Support medical education.
  This means that simple videoconferencing or "e-visits" likely aren't sufficient, as they don't create an archivable, searchable, teachable record of the encounter.
  
  
• Provide holistic care to the patient. 
  Support not just solving the immediate problem, but truly caring for the patient -- which doesn’t always just mean solving only the problem the patient presents with.
  
  
• Enable providers to collaborate effectively.
  It would be a tragedy if telehealth caused a further silo-ing of providers across specialities and across the continuum of care.

Healthcare needs innovation, certainly. And technology will be a crucial part of any solution that stands a chance of survival moving forward. But we advocate for approaches that truly support access, education, and collaboration -- not just completing a ticket and checking off a box for a patient.

To learn more about alternative technologies for telehealth, download our Quick Guide to Hybrid Store and Forward Telemedicine®: 

As we’ve written about recently, the opioid epidemic is at staggering levels, and touching millions of lives every year in the US.

While these are complex cases, the truth is that treating addiction is not something that exists as distinct from treating any patient — since any patient can experience addiction. And a recent article in the New York Times put a spotlight on how our medical education may be failing to prepare doctors effectively to treat patients with addiction. 

The doctors, professors, and administrators in our medical education system are incredibly dedicated, and manage to adapt to a rapidly changing healthcare system. Some of the most satisfying work in my career has been my work with medical students and residents.

That said, there are always components of medical education that feel neglected, whether that's nutrition or alternative medicine. The care and treatment of addicted patients is no different, except for the staggering scale of the problem. In fact, addiction is contributing to 623,000 deaths each year in the US. And a new article explores whether our medical training is contributing to the shortcomings in how we care for these patients.

Realistically, the article documents what we're all aware of -- it's uncommon that there is sufficient training or support for doctors in caring for addicted patients. Most medical schools offer some training about opioids, but they rarely go very deep. New initiatives are aiming to create fellowships in addiction medicine -- but more trained fellows won't help the myriad of patients seeing providers in other fields who need solid training in how to care for them. But we also felt that some important perspectives were being left out of the conversation as represented in this article and the common ways of thinking about treating addicted patients.

5 things we know for sure about medical education and the treatment of addicted patients:

• Medical education can’t stop at graduation.
  It concerns us that the conversation about education around caring for addicted patients is understood to be limited to medical school. In contrast, we've always had three core principles at ClickCare: access, collaboration, and education. We've baked education into every single aspect of how iClickCare works, since we believe that medical education should be a lifetime goal -- both as teachers and as students. The opioid epidemic is changing rapidly over time and so our medical education has to keep up -- it can't get stuck in decades-old coursework. Allowing teams to archive and search cases for education (using a tool like iClickCare) is crucial to this process.
  
  
• "Problem patients" are everyone's problem. 
  All healthcare providers face different pressures. But we believe that when you decide to become a doctor, we believe that it's no longer ethical to see complex patients or cases as "not my problem." One of the suggested solutions to the training gap is to create "addiction medicine" specialists rather than increasing training around addiction for all doctors. Is specializing in addiction really the way to go?  Perhaps, all that does is let the rest of us off the hook for a very human dynamic that can happen to any patient and that we all need to be able to treat and recognize.
  
  
• We must teach each other.
  We have different strengths and weaknesses. And in an increasingly complex medical setting, trusted collaboration and complementarity is crucial. The care and treatment of addicted patients is a great example of why healthcare collaboration -- whether supported by Hybrid Store-and-Forward telemedicine or through another means -- is so important.
  
  
• Chronic diseases need special treatment.
  Addiction, like Diabetes, is a chronic disease. And patients suffering from chronic diseases need true care coordination, long-term collaboration within an integrated care team, and a truly team approach to their care. Addicted patients are no different, and we must find ways -- together -- of treating them as effectively as any other patient.
  
  
• There must be space for ambiguity. 
  As the New York Times article says, “although medical training typically urges students to come up with absolute answers, treating these patients often means getting comfortable with ambiguity.” Addiction is a delicate, nuanced challenge that requires providers to be able to handle ambiguity at an emotional and an intellectual level. That said, out tools must also be able to support and handle ambiguity. Rather than a text message which demands a succinct answer, telemedicine-supported medical collaboration allows more space for ambiguity because there is more space for nuanced conversations. Photos, videos, complex conversations, and multidisciplinary teams are all components of supporting complex care for complex cases. 

We know that many of you are "on the frontlines" of caring for patients with addiction every day. And we certainly hope that you're able to find the tools you need to evolve as a healthcare provider within that -- teaching, learning, and caring for patients.

To learn more about Hybrid Store-and-Forward® telemedicine, download our white paper for free:

Everyone in medicine is under financial pressure these days.

For many rural clinics and hospitals, that has meant closing or consolidating. And for people in rural areas, that has meant limited access to care or extremely long drives to receive care. For instance, this article tells the story of a new mom in Missouri who was making regular 200-mile trips to be with her newborn twins in the NICU. Then she’d drive back home to be with her 2-year-old and go to work.

Rural medicine, whether in remote areas or in places like Native American reservations, has always come with its unique joys, gifts, and challenges. But the more medicine evolves, the greater the pressure on these rural providers and hospitals seems to be.

The New York Times reports, “At least 85 rural hospitals — about 5 percent of the country’s total — have closed since 2010.”

One doctor commenting on the article describes the situation from his viewpoint: “The main issue I’ve seen working in health care is consolidation of smaller systems into larger collectives. Smaller rural hospitals are bought by the larger systems, which in turn buy out practices, and end up owning everything in a three to five county radius — sometimes more. The system shunts patients to their main facilities and either closes or cuts back on services offered at the smaller hospitals. It’s not surprising, because it is a balancing of limited resources in a for-profit system, but it does leave the most vulnerable without access to care.”

Certainly, these pressures are a reality. And many providers and patients are dealing with that reality on a daily basis. But these articles also led us to wonder whether there are other solutions to these challenges, beyond the 200-mile drive to care for a newborn.

We’ve worked with many providers, clinics, and hospitals in remote areas who find that by using telemedicine, they’re able to dramatically expand their offerings and capabilities, while decreasing costs.

For instance, with hybrid store-and-forward telemedicine, even a more bare-bones staff is able to get consults on cases that they’d normally have to send to a much larger care center, many hours away. Furthermore, the staff is able to coordinate care for patients so that they may be able to avoid unnecessary visits to distant centers.

So although telemedicine can't fix everything — a woman in labor still usually needs a maternity ward that's closer than 100 miles from her home — there are creative ways of working within these new constraints. And telemedicine, care coordination, and medical collaboration are three tools that may help. 

To learn more about hybrid store-and-forward telemedicine and how it can help in rural settings, download our free guide:

There has been an increasing trend towards consolidation in the healthcare field. Hospital systems buy other hospital systems, with the promise of cost-savings, improved results, and better data-sharing and interoperability.

In many ways, this is common sense. If we’re all part of the same organization, or even under the same roof, it stands to reason that we will be able to share data and collaborate more effectively.

Unfortunately, though, this doesn’t appear to be the case.

Using data from the 2014 American Hospital Association (AHA) annual survey and the 2015 IT supplement that included more than 2,000 hospitals, researchers found that consolidation enough wasn’t enough to improve interoperability.

In fact, it took several additional circumstances for interoperability to improve: centralized organizational governance, a specific business model, and an integrated insurance offering. 

Of course, achieving interoperability and data sharing is a hugely complex endeavor that can take time to come to fruition. It's not a race, and there are many precautions and complications that arise.

That said, I find it fascinating that even merging with another organization doesn't necessarily make it more streamlined for healthcare providers to collaborate, for data sharing to happen, or for interoperability to be a reality. 

My take on why? I believe that true data sharing and healthcare collaboration only come about through intention and through workflow changes on the part of healthcare providers. Yes, the organizational structure affects it. Yes, EHR interoperability plays a role. Yes, being under the same roof can make collaboration simpler than being in separate buildings. But ultimately, healthcare collaboration comes down to the choices that individual healthcare providers make. It's the choice to ask a question of a colleague, regardless of how that question gets asked. 

That's why we're so passionate about hybrid store-and-forward telemedicine® (like iClickCare) as a tool for healthcare collaboration. It doesn't require being under the same roof, or in the same organization, or even using the same EMR/EHR to collaborate, share information, and coordinate. It doesn't require that everyone in your organization use it or that everyone is "on board."  It just requires a 30-second download and then as-you-have-time consults with colleagues. Everything is archived so you can find it later -- and it won't conflict with your EHR. 

The above study certainly demonstrates that we can't wait for large structural shifts to practice medicine in ways that we think are right, and useful. We have access to the tools and structures we need now -- it's just a matter of acting on that.

We're all aware of the opioid epidemic in the United States.

We've seen the tragic photos of lives ripped apart. We've scanned the news describing the huge dollar amounts committed to resolving the problem. And we've experienced the complexities of treating an opioid abuser as healthcare providers.

But the truth is that our approach to care, treatment, and policy around this disease is lagging behind the realities of the epidemic. And as healthcare providers, we play one of the most important roles in preventing and treating the disease -- and caring for its sufferers.

Certainly, there are bright spots when it comes to the opioid epidemic. As Fierce Healthcare reports, “Data from the Medicare Part D program show fewer beneficiaries are receiving high amounts of opioids, but a watchdog agency says usage 'remains concerning,' while urging insurers to further restrict at-risk patients with lock-in programs. However, 1 in 3 Part D beneficiaries still received at least one prescription opioid, and the overall level of opioid use 'continues to raise concerns.'"

Chemical dependency is not solved by other chemicals.  In the long term, many changes are needed and extensive, ongoing support is vital.  This includes the extreme burden placed on the providers themselves. Dependency is not an inpatient disease. It is not an outpatient disease. It is not family therapy. It is not joblessness, nor hopelessness. It is pervasive and knows no time schedule. It is difficult to treat for the provider, and a lifelong challenge for the patient.

If there was ever a time and need for universal healthcare collaboration across the entire spectrum of providers, patients and families, it is now, with this disease.

A single episode of failed access, of telephone tag, or of failure to educate –– results in the crashing down of years of rehabilitation. But who has the time or resources or skills to be available everywhere, for everyone, all the time?

A dramatic, gripping, thoughtful, and open Perspective piece in the New England Journal of Medicine by Audrey M. Provenzano, M.D., M.P.H., once read, becomes nearly haunting. She describes her feelings about caring for a patient with addiction:

“Already overwhelmed, I did not want to take on patients with needs that I did not know how to meet.”  She finishes the essay with a sentiment common to all who practice medicine: “I wish that I’d listened more closely. I wish that I had not been afraid.”

Dr. Provenzano articulates beautifully the loneliness and isolation a healthcare provider can feel in treating such a complex, multifaceted disease. Yes, a tool like iClickCare can smooth and facilitate the healthcare collaboration that bring many types of services and providers into one case. But perhaps equally importantly, a tool like iClickCare can alleviate the loneliness and isolation that the providers themselves feel. And that's not just a "nicety." That's a core part of ensuring sustainable care for the patients they are treating. 

As a company, we're finding ways of contributing to the opioid epidemic, using hybrid strore-and-forward telemedicine to facilitate the complex care needed. And as fellow healthcare providers, we certainly stand with the providers on the front lines of navigating this care every day.

If you're facing complex patients or opioid abuse in your practice, try iClickCare as one of your tools: 

Many people, and most hospitals, identify money as the “missing piece” for the many projects they want to take on.

You would do that kitchen renovation, were it not for lack of funds. Your organization may add that new patient wing, but only if the fundraising goes as planned.

For decades, telemedicine — and digital health more broadly — existed in a very similar way. The field tended to feel resource-constrained and undervalued societally. There was so much we wanted to do, if only there were the money for it.

Recently, it has looked like that is changing — but is it for the benefit of medicine as a whole or not?

Looking at the business side of our arena, it seems as if investors are catching on to the potential. Rock Health has released a new report showing that “Investors sunk $3.4 billion into digital health companies during the first six months of 2018, nearly matching the record-setting $3.5 billion during the first half of 2017.”  Investors are investing more total, and more in each deal — the average deal size is currently $17.9 million.

Mostly, I think, this is a very positive development. Telemedicine has lagged behind so many areas of investment. And the truth is that investments in this kind of technology and workflow often have incredible benefits, financially, medically and socially.

Further, it looks as if this investment may be more considered than impulsive, with repeat investors leading the way. “Rock Health analysts noted that there have been more repeat digital health investors than new ones since 2016, a sign that the field is attracting experienced firms with long-term goals rather than 'tourists' attracted to the hype of the digital health industry.”

All of that said, I do think that intensive investment carries its risks. The cycle of invent, test, traction and sell can lead to a pace of growth that may not be sustainable. Is there a place for responsibility, measured growth, and stability? Excessive investment, poorly considered, at too fast a pace, usually only benefits a few -- and then only in a limited way. (We can all think of the example of the disillusioned startup founder with limitless wealth but deep dissatisfaction.)

Digital health may be a trendy field, but ultimately, it all boils down to a single patient, talking to a single person caring for him or her, and each of them working together to pursue the messy art of health. This isn't a process that can be rushed, forced, or even "optimized" in many cases.

Ultimately, I think that both the risks and the rewards of this kind of investment can be instructive to healthcare providers and hospital systems. Investors have sophisticated vetting mechanisms and the fact that money is pouring into this space, is important information that may indicate where hospital systems should invest too. That said, just as nationwide investment should allow for reflection, organic growth, and ethical considerations -- I believe that investment at the organization level should allow for these "slower" considerations too. As long as patient care improvement, and not resistance to change, leads the way

To learn more about one of the most important sectors of digital health, download our Quick Guide to Hybrid Store-and-Forward Telemedicine: