Telemedicine as a Partner in Care Delivery

Telemedicine is a technology that can change the face of how we deliver care, but how can Partners weather the storm and ensure it stays ahead of the curve? Should they even bother facing the threat of digitization?

Healthcare delivery is a simple supply chain – and with that comes the threat and potential of digitization. One of the primary challenges within healthcare internationally is the requirement for high levels of skill across the chain, which limits the supply of labour as well as exponentially increasing costs of delivery[1]. Secondly, cost has skyrocketed over the last decade due to other external factors. Healthcare expenditure has been at the forefront of political conversation over the last years, especially as the US spent 3.2 trillion dollars on healthcare in 2015, the federal government being the largest sponsor[2]. Often healthcare is deemed an unchangeable market, requiring face-to-face care, and a specific flow of care; the combination of the two has led to a large amount of time being spent on reducing the costs within hospitals[3]. Digitization of healthcare via telemedicine disrupts this mentality and offers large healthcare chains to deal with concerns of costs as well as labor supply. Although not a new digital innovation, telemedicine can be as small as a nurse to call when blood pressure changes, or go as far as Medically Home, a start-up that offers services to set up a small hospital within your home[4].

Partners Healthcare, while having a robust technology department, is much more dependent on patients coming to their hospital to access care. Within the last year it has made a commitment to cut over $600 billion in cost, targeting a multitude of areas, including insurance, supply chain, care delivery, and research[5]. Partners, in this cost cutting strategy should take note of the impact that the growing market of telemedicine can have on in-hospital stays, an expensive portion of healthcare. Chronic diseases, for example, account for 85% of health care costs, but simple innovations can minimize this[6]. Brick and Mortar programs can be easily converted into digital technologies: managing End Stage Renal Disease (covered by Medicare) in the comfort of one’s home can diminish costs by 90%, by switching both the method of treatment and having a doctor on-call via mobile messaging[7]. Due to a new Medicaid and Medicare change covering some digital technologies, Partners can begin to change chronic disease care delivery systems to focus on management of these diseases, while still maintaining a similar payback rate[8].

Partners, in the short term, should, therefore, double-down on their Connected Health Department which focuses primarily on tele-monitoring. The department has many things in the pipeline, including an exercise app, and an Atrial Fibrillation monitoring system. In the short-term, therefore, focus should be placed on actually extending the services offered[9]. There seems to be a threat felt by the healthcare field that these technologies will cannibalize the in-house care, but because the cost of care has sky rocketed, chronic diseases have become highly predominant, and inefficiencies are maximized when treating these diseases, moving towards a digital solution could be hugely effective[10]. By either developing in-house apps, or partnering with apps that have already been rigorously tested, Partners could become the forefront provider for telemonitoring in Massachusetts[11]. In addition, the burden on the system for labour could diminish, changing the bottlenecks to other locations in the line of care delivery.

In the long term, threats will no longer come from managing chronic diseases, but instead start-ups like Medically Home. Telemedicine can offer a cheaper, more comfortable solution to going to a hospital for even emergency care. This approach is two pronged – monitoring can provide identification and prevention of treatment related errors, and prediction of problems before it occurs[12]. However, studies are sparser on safety of telemedicine that provides in-care home on discrete disease states[13]. As the field increases in volumes, small start-ups with higher risk profiles will be able to capitalize and move into that space, cannibalizing opportunities from larger hospitals like Partners. For this reason, research should move from a cautious regard to much more aggressive targeting of long term effects of telemedicine and the best implementation methods. Due to high regulation on medicine, a large national hospital chain will face higher scrutiny than many smaller companies, but placing a focus on novel safety research while innovations emerge will allow for quicker long-term implementation[14].


How can an organization with as much breadth as Partners diversify effectively into the telemedicine space, while still maintaining their focus on high quality care?

What factors would lead you as a user to opt into telemedicine over brick and mortar healthcare?

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[1] Kvedar, J.C., “Telemedicine is Vital to Reforming Healthcare,” Harvard Business Review, (October 7, 2015), accessed November 2017.

[2] “National Healthcare Expenditures 2015 Highlights,” Centers for Medicare and Medicaid Services, (2015), accessed November 2017.

[3] Kvedar, J.C., “Telemedicine is Vital to Reforming Healthcare,”

[4] Kvedar, J.C., “Telemedicine is Vital to Reforming Healthcare,” and Medically Home, “About Us”, (2016), accessed November 2017.

[5] McCluskey, P.D., “Partners HealthCare Cutting $600m in Costs,” Boston Globe, (May 12, 2017), accessed November 2017.

[6] Fogel, A.L. and Kvedar, J.C., “Simple Digital Technologies Can Reduce HealthCare Costs,” Harvard Business Review, (November 14, 2016), accessed November 2017.

[7] Govindarajan, V., “Telemedicine Can Cut HealthCare Costs by 90%,” Harvard Business Review, (April 12, 2012), accessed November 2017.

[8] Fogel, A.L. and Kvedar, J.C., “Simple Digital Technologies Can Reduce HealthCare Costs,”

[9]“Creating Solutions to Healthcare Delivery Challenges,” Partners Health Care, Connected Health, accessed November 2017.

[10] Agboola SO, Bates DW, Kvedar JC., “Digital Health and Patient Safety,” JAMA 315(16):1697–1698, (April 26, 2015) doi:10.1001/jama.2016.2402 accessed November 2017.

[11] Agboola SO, Bates DW, Kvedar JC., “Digital Health and Patient Safety

[12] Agboola S.O., Kvedar, J.C., “Telemedicine and Patient Safety,” AHRQ PSNet (September 2016), accessed November 2017.

[13] Agboola S.O., Kvedar, J.C., “Telemedicine and Patient Safety,”

[14] McLean S, Sheikh A, Cresswell K, et al., “The impact of telehealthcare on the quality and safety of care: a systematic overview.” PLoS One. 2013;8:e71238, (August 19, 2013) doi:10.1371/journal.pone.0071238, accessed November 2017


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Student comments on Telemedicine as a Partner in Care Delivery

  1. Implementing change in how healthcare is delivered could be challenging due to resistance among multiple stakeholder [1]. While working in a digital healthcare start-up (eConsult) that was focused on implementing patient contact with their own general practitioner, we identified a set of barriers. It is worth pointing out that in the UK there were relatively limited legal barriers e.g., licensing or reimbursement as compared to the US. Thus, the main barriers were related to patients’ and doctors’ acceptance of the solution:
    1. Physicians have been thought how to treat patient in a face to face environment. Thus, they might be feeling resistance to treat patients remotely as they can not examine the patient directly.
    2. Patients are used to seeing doctors face to face. As a result, they might feel uncomfortable getting treated remotely, without the doctor being able to examine the patient. Also, some patients, particularly elderly enjoy going to the physician and treat it as a social activity. Also, patients value being able to choose with which doctor to connect.
    3. People are often unaware about the possibility to contact doctors remotely. Educating them on the options and process, increased the implementation rate of eConsult. Thus, I expect that such approach could support usage of the digital solutions at hospitals such as Partners.

    In summary, I believe that educating patients and physicians on the options of digital healthcare delivery solutions such as telemedicine, could increase the usage. Making the solutions clear, easy to use and accessible, could strengthen the acceptance among both patients and healthcare providers. The admin and clinical team should be well-informed about the solutions and how they fit with the overall patient journey. Once they are aware, they can educate patients and thus reduce the resistance towards new solutions. Potentially, educating medicine students on how to work with patients remotely could increase the popularity of the solution.

    [1] Clemens Scott Kruse, Priyanka Karem, Kelli Shifflett, Lokesh Vegi, Karuna Ravi, Matthew Brooks. “Evaluating barriers to adopting Telemedicine worldwide: A systematic review”. Journal of Telemedicine and Telecare. October 16, 2016. Available online:

  2. Once upon a time, I was incredibly bullish on telemedicine and even did some preliminary diligence into the field as potential investment opportunities. However, the more I delved into it, the less convinced I was about its opportunities in the short-medium term. The main reason is not a functional one – it is highly functional and will go a long ways into reducing medical costs in the US. The main reason, as Monika points out above, is that it’s hard to get buy-in from people, in particular from the doctors.

    US physicians are highly conservative in their approaches, and they mostly take “do no harm” very seriously. As such, they are always trying to minimize catastrophic problems that may occur. This single philosophy makes the vast majority of them to be highly hesitant in adopting telemedicine. While many illnesses can be diagnosed remotely, there’s always a small chance that the symptoms are an indication of a much more serious problem. Also, in many clinical settings for easy-to-diagnose/treat diseases (e.g., urgent care), physicians can go through patients every ~15 min or so, and telemedicine will not cut down on that time much for the physicians. The combination of these two factors then make telemedicine penetration increasingly difficult. For example, let’s say a patient presents with a cough. Chances are, it’s nothing bad. It may be a cold or just allergies. In fact, it is highly likely that it’s one of those. But there’s always that small chance that it’s something much worse. It could be pneumonia or an infection, which requires more interventions. It can also be cancer or heart failure, which require MUCH more effort. The pushback here is that if the physician thinks it can be something more serious, they can always tell the patient and schedule an in-person check-up in the next few days. However, they’ll tell you that there’s still a non-zero risk of something bad occurring (e.g., that they can’t convince the patient to come in personally), and that it’s a risk they’re uncomfortable taking.

    Basically, that was a long-winded way of saying that there’s a mismatch between the primary beneficiary (patients’ time) and the people with the most decision-making power (physicians). After spending a large amount of energy looking into this field, I was eventually forced to give up as I couldn’t find an easy way to overcome the opposition from physicians. I’m still highly bullish on telemedicine, but I think it’ll be a very very very long march and that the inflection point won’t occur any time in the near future. What are your thoughts on overcoming these obstacles for adoption?

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