Tomorrow’s Medicine

Telemedicine Start-ups Promise To Transform Health Care

Revolution isn’t too strong a word to use about what’s happening with this technology.

Thomas Morrow, MD

For the most part, the technology highlighted in Tomorrow’s Medicine is used in a small segment of the population faced with a specific condition for which that technology had an impact.

This month is different, as I review what is likely to become a structural change to the entire fabric of medical care: telemedicine.

Unlike most of the technology highlighted in Tomorrow’s Medicine, telemedicine is not really new. The first documented use may have been on March 10, 1876, when Alexander Graham Bell called out; “Mr. Watson, come here—I want to see you” because, according to some accounts, he spilled battery acid on his hand. But telemedicine is undergoing an amazingly rapid evolution, perhaps even a revolution. This revolution is the culmination of several major technology developments: microelectronics, digital photography, broadband width and speed, compression technology to enable high-quality video and, for many people (i.e., patients), the smartphone.

Bridging the gap

All of these developments build on the basic value of telemedicine: It bridges distance at the speed of light and so connects patients, and associated data to physicians in a very convenient way.

In May, the spring American Tele­medicine Association (ATA, founded in 1993) meeting was held at the aircraft-hanger sized Minneapolis convention center. About 4,000 people attended the meeting, which featured numerous speakers on a range of topics that face the burgeoning telemedicine industry and are integral to its growth.

One of the most remarkable examples of the possibilities of telemedicine came to light at the breakfast table, of all places. An orthopedist started to talk about how he serves a local prison. By using a telemedicine platform, he can view X-rays done in the prison infirmary, diagnose the fractures common to this environment and talk a cast tech, who is onsite, through simple reductions and casting—any time of the day or night, from the comfort of his home or office. Think of this: It costs up to $1,000 just to transport a prisoner from a prison to a hospital every time this occurs, and that doesn’t even include the medical care costs.

The ATA also featured exhibits—hundreds of exhibits—and this is where my techie side became excited. The exhibits included the usual suspects such as those providing broad access to physicians: American Well, Teladoc, MDLive. It also included a number of well-known Fortune 500 tech companies such as Medtronic, Cisco, and Phillips, all with refined, integrated, and expensive offerings. But I spent most of my time talking to the start-ups—the heart of Tomorrow’s Medicine. The following are vignettes of some of these companies and their wares.

Who to watch

Pokitdok: A pharmacy API platform that removes the “friction” and inefficiencies that plague health care transactions by auto­mating eligibility and claims processing for several telemedicine technology platforms.

Astia Health: A very small Wisconsin-based company founded by a physician. They have developed a complete, self-contained telehealth suite residing in a high-impact plastic suitcase. Think about how this “box,” using cellphone connectivity instead of an Internet portal, could be used during ambulance transport by EMTs, at job sites, schools, oil rigs, and even nuclear power plants. With its portability, it can be taken to the site of an injury or even used during transport.

Medibio: Demonstrating the eventual integration of telemedicine and the mobile health wearable sector, the company claims to have the first objective, quantitative test for stress and mental illness. By using circadian heart rate variability—with technology validated in Australia and under­going further study at Johns Hopkins—Medibio uses a complex algorithm to analyze cardiac impulses to predict stress level in time to do something about it.

Given the recent press concerning physician burnout, I for one would love to see how the Hopkins research is going.

WoundMatrix: A telehealth browser based platform used at the point of wound care (by patients, hospitals, wound clinics, and visiting nurses). Their system provides image-capture and analysis, measurement and data entry to aid in the management of complex wounds. Their intent is to improve wound care outcomes and develop better wound protocols.

Vidyo: A Hackensack, N.J.,-based company has developed what they consider a unique platform that provides “dynamic video quality adaptation” to any network environment. Basically, in lay language, Vidyo can handle a wide variety of lousy network video inputs to provide a usable video output for effective clinical care. They integrate with more than 20 telemedicine providers of hardware and software.

Ekodevices: A small company that has created a digital stethoscope device that can attach to most common old-school stethoscopes to amplify and record sounds, and transfer the files seamlessly. No need to purchase a dedicated digital stethoscope. For some clinical uses, the analog (meaning old school) form of listening is retained. Basically pull the rubber tube from the head of the stethoscope and insert the digital device, and you have a dual-use stethoscope!

Tytocare: An Israeli company that provides affordable consumer versions of common physician examination devices. They provide not only the devices but a step-by-step teaching platform for helping lay people actually perform remote examinations. Their kit comprises a high-definition digital camera that can be used (when paired with various attachments) to view the skin, eardrum(s), eye, mouth and throat, along with a stethoscope and thermometer. I would love to give one of these kits to each of my children for the inevitable 2 a.m. grand­parent/doctor croup or earache call.

The T-MedRobotics robotized tele-echography system.

T-MedRobotics: The U.S. distributor of the French company AdEchoTech. Awaiting FDA approval, this is a remarkable robotically controlled ultrasound device capable of producing abdominal, pelvic, obstetric, and urological ultrasound images. The “robot” ultrasound machine is positioned above the supine patient by a layperson. A technician at another site then controls the ultrasound probe to produce real-time, true hospital-quality images without having to transport the patient. Think again of how a remote clinic, hospital, or prison dealing with a patient with acute abdominal or flank pain could be screened for gallstones, kidney stones, ectopic pregnancies—the list goes on and on!

Fitango Health: This company has created several care management platforms, one of which stands out: A platform that aims to improve the care for pre- and post-transplant patients. It allows the opportunity for patient, family and different providers to join together to form a virtual “digital” care team. It also provides a connection with a variety of monitoring devices using a secure HIPAA-compliant, cloud-based white-label customizable solution for transplant centers.

These are just a few of the remarkable developments in telemedicine and point to where this new industry is heading. Further evidence that Tomorrow’s Medicine is helping to fulfill the Triple Aim.

Thomas Morrow, MD, is the chief medical officer of Next IT. He has been the founding medical director of five HMOs and a disease management company, a medical director at Genentech, and president of the National Association of Managed Care Physicians. You can contact him at

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