Telemedicine, or telehealth has been steadily growing within American healthcare over the past decade, yet it is still evolving compared to standard care systems and well-established services and technologies. This study from JAMA revealed that telemedicine was steadily growing between 2005 and 2017 within insured US population and in 2018 there was a rapid increase in growth for primary care telemedicine. In 2016 and 2017 after coverage for direct-to-consumer telemedicine expanded.
The global shift in consumer attitudes toward personal data, telemedicine and access to medical information occurred as early as in 2013 according to a Cisco study. The results of the study demonstrated that nearly 73 percent of consumers were open to virtual doctor visits as opposed to in-person, and most (60 percent) were comfortable with being treated by a specialist using virtual technology.
What is telemedicine?
To answer this question, just remember the meaning of the first part of the word – tele – literally means "far, far off," in Greek.
The history of telemedicine dates back to the 1900s when a doctor in Australia used a two-way radio for medical advertisements. In the 1940s radiology images were sent 24 miles between two townships in Pennsylvania via telephone line. In 1959 the University of Nebraska established the first case of video communication for medical purposes – information was transmitted to medical students across the campus. Five years later they linked with a state hospital to perform video consultations.
The trend got a huge boost in the 1960s and 1970s when the Public Health Department, NASA, the Department of Defense and the U.S. Health and Human Services Department got interested in communication tools for remote healthcare delivery. In 1993 the American Telemedicine Association (ATA) was established to promote access to medical care for consumers and health professionals via telecommunications technology. The ATA actively works with Congress and other government bodies and supports legislative efforts to facilitate technology-enabled health and care management and delivery systems to make care provision more accessible and convenient.
What are telemedicine technology benefits?
- Telemedicine solutions allow care provision in isolated communities and remote or underserved areas.
- Telemedicine can be used in urgent care when the life of a patient literally depends on the timely and qualified actions of medical stuff.
- Telehealth solutions, such as remote patient monitoring apps, decrease in-patient time at hospitals and readmission rates, enable remote prescription verification and drug administration oversight, thus potentially significantly reducing the overall cost of medical care.
- Telecare helps save patients time and money of patients spent on getting to the doctor's office, as well as saving providers money on premises maintenance and administration costs.
- Telehealth is a good option for patients with limited mobility, for example home-bound patients, senior citizens or patients with Parkinson’s disease.
- Mobile collaboration technology facilitates getting qualified third party opinions in difficult cases while connecting healthcare professionals in multiple locations to share information and discuss patient issues.
- Telemedicine applications can be a good resource for medical education, allowing sharing best practices and access to the most reliable information.
- Last but not least, online doctor apps allow avoiding white coat syndrome, making some patients more comfortable and more eager to get professional consultation.
Disadvantages of telemedicine
Of course, telemedicine has strong points making it popular, but there are some disadvantages you should keep in mind before developing your healthcare apps:
- Healthcare facilities providing telehealth services must have telemedicine equipment on-site, which can be costly to set up and maintain. This point is especially important for smaller healthcare facilities.
- Telemedicine is not an option for those patients who prefer more personal or face-to-face communication.
- Certain types of conditions and illnesses cannot be diagnosed through telemedicine as they require face-to-face physical assessment.
- The biggest drawback of telemedicine is its reliance upon fast and stable internet or data connection.
What are the key drivers for telemedicine adoption?
Telemedicine software and the options it provides for patients and care providers makes telemedicine an efficient healthcare delivery platform. The today’s patients want to have 24/7 access to their doctors, and healthcare providers are able to use telemedicine to monetize remote assistance. What are the key drivers making telemed services more and more popular among patients?
First is the widespread availability of Internet and high quality video devices. We live in the age of smartphones and numerous mobile applications, which make our lives more convenient and simpler. Healthcare mobile apps allow choosing matched doctors from a rich assortment. You can see doctors’ stats, skills, qualifications and quotes of the patients he or she treated. For those who want to save their time and money, the opportunity to consult with a doctor using chat or video call is a good option.
Another reason is the Affordable Care Act, which provided health care coverage for about 16.4 million uninsured people in the US, but did not ease pressure on the already taxed system. Healthcare providers have to become more efficient to meet the increased demand. Telehealth providers can service more patients in less time.
Reimbursement laws are also a driver for the spread of telehealth services. The population is aging, the prevalence of chronic diseases is rising and more healthcare services are needed. Thus, 24 states have already adopted telehealth parity laws, which require that private payers reimburse telehealth under the same terms as face-to-face visits.
Provider shortage is looming in the US, as the population is expected to increase by nearly 12 percent (from 321 million to 359 million people) between 2015 and 2030. This makes telemedicine a key technology for efficient use of available doctors.
Telemedicine insurance coverage – what are the Medicare and Medicaid options?
Telemedicine is considered a regular healthcare service, thus, in most cases it should be billable to patients’ healthcare insurance. The largest US insurance providers offer certain insurance plans, which cover certain telehealth services.
For example, Medicare Part B (Medical Insurance) covers certain telehealth services. Medicare telehealth coverage refers to office visits and consultations that are provided using an interactive 2-way telecommunications system (with real-time audio and video) by a doctor or certain other health care provider who isn’t at your location.
Medicaid policies also include those with some type of reimbursement for telehealth. The scope of these policies varies among states:
- 49 state Medicaid programs reimburse for some form of live video
- 20 state Medicaid programs offer reimbursement for remote patient monitoring
- 9 state Medicaid programs (Alaska, Arizona, Illinois, Minnesota, Mississippi, Missouri, Oklahoma, Virginia and Washington) reimburse for all three
- 32 states will reimburse either a transmission, facility fee, or both
- 15 state Medicaid programs offer some reimbursement for store-and-forward, not counting states that only reimbursed for tele-radiology
It should be noted that private insurers also deal with telemedicine – 34 states and the District of Columbia require that private insurers cover telehealth the same as they cover in-person services.
The state of the telemedicine market
As of 2015 the telemedicine global market was valued at around 18 billion U.S. dollars. In 2017, according to Stratistics MRC, the Global Telemedicine Market is accounted for $21.56 billion. The market forecast by Statista says that the market is to grow significantly by 2021, its value in the US only is expected to be more than 41 billion U.S. dollars.
There is a growing demand for telehealth services. According to a survey by American Well, one of five healthcare services consumers would prefer to switch primary care practices to a practice that offers telemedicine. The key drivers for patients are time saving, convenience and reduced costs of video visits.
Telemedicine in mobile apps
The healthcare mobile apps market is growing – according to a report by Zion Market Research, the global mHealth apps market value reached almost USD 8.0 billion in 2018 and is expected to generate around USD 111.1 billion by 2025, at a CAGR of around 38.26% between 2019 and 2025. Accessible healthcare is a point of interest of many stakeholders. Telemedicine platform development is profitable and will continue to be profitable, taking into account the reasons mentioned above.
The most popular types of remote clinical services provided by telemedicine companies
- Telepsychiatry (telemental health), which is “a subset of telemedicine, can involve providing a range of services including psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management” as defined by the American Psychiatric Association.
- Telehealth primary care (online doctor’s visits)
- Teleradiology, which is “transmission of radiological patient images, such as x-rays, CTs, and MRIs, from one location to another for the purposes of sharing studies with other radiologists and physicians” as defined by Wikipedia.
- Telehealth nursing, which is conducting nursing and delivering care in a remote location.
- Remote patient monitoring, which allows collecting and transmitting patient’s data.
- Teledermatology (remote dermatology services)
- Teleophtalmology, providing eye exams using live video calls or “store-and-forward” technology.
- Teleoncology, the care to patients with cancer using live video calling and photo sharing.
- Teleobstetrics, which is a provision of prenatal care
- Telerehabilitation, which provides video consultations for the patients who need physical therapy.
The best teleheath apps
What are the best apps on the market and what are the features that made them so popular? There are a wide range of top-rated telemedicine apps. Various rankings name different sets of apps, though some apps appear in almost every ranking you can find. According to this analysis, which compared 10 telehealth providers' Google Play and App Store downloads over a four-and-a-half year period, the list of most downloaded telehealth apps includes the following healthcare apps for patients – AmWell, Doctor on Demand, and MDLive.
MDLive (rated 4.7 stars by iPhone and 3.3 stars by Android).
This HIPAA and PHI compliant platform allows patients to connect to medical and pediatric doctors and access behavioral health therapy services and psychiatry. MDLIVE offers fast, easy, convenient access to a doctor for non-emergency issues when your primary care physician isn’t available. Average wait times are under 15 minutes to consult with a state-licensed and board-certified physician.
The platform is also providers-friendly and allows joining their team of telehealth practitioners. The platform also provides telehealth focused trainings to providers and practitioners. Additionally, the platform is cloud-based and this helps medical institutions enable teleconsultations to improve patient wait times and save caregiving costs.
Amwell: Doctor Visits 24/7 (rated 4.7 stars by iPhone and 4.3 stars by Android)
Amwell is the direct to patient HIPAA compliant app and service from American Well, one of the biggest companies in virtual medicine and telehealth. The Amwell app offers quality medical care on demand. This doctor appointment app allows scheduling appointments, often with next-day availability. The features of the app include video conferencing with licensed physicians.
Doctor on Demand (rated 4.9 starts by iPhone and 4.7 stars by Android)
This HIPAA compliant healthcare app is available to everyone, with or without insurance. The service is set up to treat a wide range of illnesses and conditions - from sexual health issues to urgent care, mental health, and chronic conditions like type two diabetes. The app’s providers are licensed physicians, psychiatrists, and psychologists, and they can treat hundreds of issues online through video.
What is common through all these apps? They allow fast and easy doctor appointment scheduling, secured live video chats with board-certified doctors, and drug prescriptions. How are healthcare apps like these developed? There are certain stages common for every healthcare app development.
Telemedicine platform development stages
To create a telehealth app or platform of your own, you have to go through some important stages of development. Telemedicine apps require a great deal of responsibility as your app will directly influence the health of the people who use it.
First of all, evaluate your idea – will it be useful, will it meet demand, will it be unique enough to compete with rivals in the market? What can you do at this stage?
· Conduct a business analysis. Is there a demand for your prospected app? Who is your buyer? What is your target audience? Find the problems your target audience wants to solve and define the solution.
· Conduct market and competitors research. Find out the market leaders, discover their strengths and weaknesses, research their app ratings and consumer reviews. Find out the features that will make your app competitive.
· Make your unique value proposition. Your app must be different from competitors; it must have useful features and obvious advantages over existing apps. Almost every telemed app offers a doctor video chat feature, but you can make yours unique with high-quality video chat, user friendly UX and seamless functionality. Another important area is doctor and patient information – your telemedicine app must provide comprehensive information about doctors (their qualifications, ratings, patient reviews) and patients (secure access to patient’s EHR).
Then, you can proceed with the creation of a prototype app, testing it and getting feedback from potential users. A prototype allows you to test your app and find out details that need to be changed or even removed. A prototype app can show your app’s strengths and weaknesses and only after that can you start designing your app’s UX and continue with developing a high-fidelity prototype, which can be tested by users to get feedback.
Find out the marketing channels you can use. These channels allow potential users to know about your app, as well as become inspired to use it. Find out the channels which are the most popular among your target audience – social networks, web portals, etc. Choose the channels where your target audience is concentrated to get the best results.
Make sure you know all the laws applicable to your app. The U.S. has strict laws related to the management, storage and transmission of protected health information (PHI), the core of which is the Health Insurance Portability and Accountability Act (HIPAA), and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which changes the payment system for doctors who treat Medicare patients and opens certain possibilities for telemedicine apps development, improvement, and updating as well as for implementation of telehealth technology in healthcare facilities.
Next stage is system architecture and development, which is related to the full scall app development and which includes:
· System Analysis & Design
· Architecture & Data Security
· Front & Backend development
· Mobile Development
· Embedded Development
· Quality Assurance & DevOps
And the last stage in product cycle is business growth & operational services, which includes the stages necessary for successful post-launch operations:
· Help desk setup & support
· Localization into 70+ languages (if necessary)
· Recruitment & team extension
Archer’s experience in mHealth app development
Archer Software has been working with healthcare clients for 17 years. We have obtained a lot of experience creating mobile applications, web services, online platforms, and software in the healthcare industry. Our team has helped a number of clients make sure their online communications platforms earn HIPAA-secure status. Archer Software’s HIPAA Expert certification is updated every year.
Among our projects in the healthcare domain is a project for a national healthcare communications technology company that develops mobile, on-demand, HIPAA-compliant systems that unify healthcare professionals within and between organizations by simplifying communications to accelerate, consolidate, and control information sharing. MD Chat application (both web and mobile), which Archer developed from scratch, offers secure, HIPAA compliant, point-to-point, real-time access to healthcare professionals – physicians and other specialists – via any computer or mobile device. The app features chat with doctors, chat history and secure data transmission. The doctors can be chosen from a catalogue, which includes only board-certified doctors. The search option is organized by doctor’s name and specialty.
How are such apps developed? In principle, the cycle is described above, but here we’ll add some details. When we speak about healthcare apps, we should remember that most apps are governed by HIPAA law, thus developers must strictly follow the requirements of the law. The law imposes strict requirements for application architecture and security procedures (especially for data and backups encryption). So the certification process comes first, and it takes the lion’s share of development time (approximately 3-6 months). Then, the developers proceed to client-server development and ensure secure transmission and storage of instant messages, and realize navigation features with full text search as required by law. The next step, which usually takes 3-6 months depending on the app’s complexity, is the development of the mobile app in full and front-end features, such as user registration feature, log-in feature, contact search feature, chat feature, chat history storage feature, full text search, and attachment transmission feature.
Another project developed by Archer is non-HIPAA covered. It is an evidence-based treatment recommendations platform. Health Outcome provides chronic orthopedic patients with an online exercise program and recommendations based on information from 40,000+ patient treatment outcome records combined with a non-invasive methodology from spine experts. The platform is built to capture the voice of the patient and store reviews. Users have access to the aggregated success rate of relevant treatments for their injury or condition to find all treatments other people have tried or recommended by health experts, ranked by treatment outcome ratings personalized by filtering based on age, sex, weight, fitness level, as well as pre-existing conditions. The app also has the feature of healing progress tracking.
When developing a platform like this, you have to create a reliable database of symptoms and treatment alternatives. The key feature is a relevant search, as there are numerous variants of search queries, you have to include every possible keyword and search rating features.
Another project developed by Archer is related to teleoncology. Varian is the next generation cancer coordinated care product of radiation oncology treatments and software. Their medical devices include linear accelerators and software for treating cancer and other medical conditions with radiotherapy, radiosurgery, proton therapy, and brachytherapy. The interface is dedicated for both medical teams and patients, and includes:
· Patient Portal
· Halo Web
· Mobile versions for Patient Portal and Halo Web
· Reusable HTML and CSS templates, patterns and assets
The HIPAA and HL7 compliant platform allows online specialist consultations and expert consensus in text chat format. All application features are dedicated for oncology treatment and rehabilitation. This web-based system is HIPAA compliant and allows collection and storage of patient medical records (EMR).
The peculiarity of this very project is its back-end – for reasons of safety and diagnostic equipment connectivity it is not cloud-based. All servers are situated in the clinics using this system. The system allows connection to the clinic's equipment, thus the data communications interface is developed for all the equipment, which transmits data directly into the system, where doctors can view patient’s data (including the option of remote access and viewing).
A project like this one is quite a complicated and time-consuming undertaking. First, the technical requirements for the system have to be outlined, taking into account all the peculiarities of diagnostics equipment. The team of medical consultants and developers has to consider every possible detail, which may influence platform usability. The key feature of the project is direct interfaces for connecting medical equipment – it took a lot of time to develop communication protocols for all necessary medical equipment. Another feature is doctor accounts empowering communication between healthcare professionals, viewing the data collected from the clinic's equipment, and commenting on the images in a separate information layer. One great challenge for the development team was the UX, which had to be standardized for every single piece of equipment.
What else you should keep in mind while developing a telehealth app? Possible risks
Additionally, law requirements for medical apps include certain requirements for hardware. The medical facility itself must have the necessary infrastructure/equipment to provide telehealth services. If your app features high-quality video chat, it implies a high server load owing to the large volume of transmitted data. This means you’ll need streaming services. As a rule, a ready template is used and customized, which can take up to 3-6 months. High-quality video communication also means you’ll need server infrastructure, which can also be costly.
And, of course, there are financial risks related to the development of a new product, thus careful project evaluation is no less critical than the creation of the app itself. The best way to minimize financial risks is to try selling your project before launching.
Healthcare software development requires a thorough and highly-skilled team because the quality of the application directly impacts the well-being of its users. Our team of professional developers has a deep understanding of HIPAA certification procedures and is keen in healthcare apps development. Contact us to evaluate your telehealth business idea and develop a telemedicine system of your own.