CMS Issues New Telemedicine Guidelines and Approves Seven New Procedures in Move to Further Encourage Telehealth Initiatives
What is more important? Seeing YOUR doctor or seeing ANY doctor?
Housecall was designed to be used as an extension to your provider. All of the other major telemedicine providers out there are designed to provide isolated care for minor health issues from any available doctor. American Well, Teledoc, and Doctor on Demand are all excellent companies that fill the telemedicine niche filled by the walk-in clinic in the face to face healthcare world. Housecall is different.
Housecall is designed for the patient with an ongoing medical relationship. It is designed to accentuate chronic care of some of the most common health conditions that plague many of us today: Hypertension, Diabetes, Obesity, Coronary Atherosclerosis, Congestive Heart Failure, Tobacco Addiction. It provides a platform for a quick follow up visit with your provider free of the lost day of work and the hassle of sitting in a crowded waiting room. It heightens the level of care you can achieve in today’s health care system by allowing you to be the keeper of your health data and giving you the ability to share that data directly with your provider. The Withings app, digital scale, and blood pressure cuffs are supported. The Jawbone app, Up band, and Up24 bands are also currently supported free of charge. Any app data on an iPhone or iPad can be shared with your doctor with a simple screen shot. Any picture can be sent directly to your provider and available for review at your telemedicine session.
We are growing rapidly. We add many new patients and new providers daily. If you want this kind of connection with your doctor and they don’t yet use Housecall, ask them to add Housecall to their practice. Don’t just connect with ANY doctor. Connect with YOUR doctor using Housecall today!
Telemedicine: Click and the doctor will see you now
Telemedicine: Click and the doctor will see you now
A fantastic review of the current state of telemedicine. Housecall is an app meant for a provider with a current established relationship with a patient. Its purpose is to extend care to the patient remotely in appropriate situations where a face to face visit is not necessary to render quality care. Ask your doctor to provide you with the opportunity to use Housecall for your next appointment!
Frequently Asked Provider Questions About Housecall
I pity the fool that does not bother to ask the question…
- How does this app work?
You must sign up as a provider and notify your patients of your availability to see them via Housecall. The patient can then make appointments with you through the scheduling portion of the app. A provider can also manage appointments through the web scheduling portal at http://www.iHeartDoc.com/Housecall. This web portal does not contain the video conferencing portion of the app, just the scheduling portion. It allows for your medical staff to help manage Housecall appointments much like any appointment is handled in your office.
- How do I bill for my services?
Housecall is covered by a growing list of private insurers but you must check with your local carrier as coverage varies widely from state to state. It is not currently covered through Medicare. Medicaid coverage varies from state to state as well. In situations where coverage is not provided you can bill the patient directly provided you notify them before providing the service. For Medicare patients you must have a signed Advance Beneficiary Notice prior to providing services to bill the patient directly for non-Medicare covered services. Credit card and insurance data is available through the app if the patient has filled out that data in their profile. No billing is done through the app. You must bill the insurance or credit card as you usually do.
- How do I document the visit? Is there an EMR in the app?
No EMR or documentation is done through the app. You use your existing EMR or dictate a note to document the visit just as you would during an in-office visit. The ability to archive the videoconference is not currently available but will be available in an upcoming version. The wellness and health data from Jawbone or Withings can be screen captured and printed if necessary.
- What health and wellness services are currently supported?
Withings is supported as well as Jawbone. Withings makes wireless scales as well as wired and wireless BP cuffs. Their Pulse activity monitor is not currently supported but we plan to support it in the future. Jawbone’s UP band is currently supported and provides exercise data, sleep data, and dietary data in graphic form. Any app on the patient’s iPhone can be captured via a screen shot and sent to the provider for review. This gives some support within the app for a wide variety of health uses and connected apps.
- What is the cost of the app for a provider?
The app services are free for the first 30 days for a patient or provider after initial app purchase. At 30 days, a provider must purchase addition time on the app to continue their use. Current cost is $9.99 per month via an in-app purchase. Discounts are available for longer range purchases up to a year of app time for $99.99 per year. Patient use is free.
- How do most providers use the app?
Most providers use the app in the same manner as a regular office appointment. The visit can be scheduled on an iPad or iPhone that can be used to conference with the patient privately in their office or an exam room. The provider can make notes in the EMR or chart during the visit. At the conclusion of the visit a nurse can arrange follow up visits via the app prior to the conclusion of the teleconference. Many providers have used the app for short visits after previous procedures or testing. It can also be used for rapid follow up of ill patients recently hospitalized to prevent readmission to the hospital.
- What kind of connection is required to use the app?
The app is capable of working on a cellular connection alone but the video quality can suffer from a noticeable lag with a poor non-4G signal. It does perform well on a reliable 4G cellular connection. For optimal quality, a good WiFi signal is preferable.
Housecall is FREE for two more days.
iHeartDoc’s Housecall app is free for two more days!
Download it now at https://itunes.apple.com/us/app/housecall-telemedicine-your/id677557566?mt=8
Frequently Asked Patient Questions About Housecall
- Why do I have to enter private information like my social security number and credit card information into my profile?
Private information is used by the provider to verify identity in the case of the social security information, and for billing purposes in the case of credit card information. You can share this with your provider online during your visit and just enter “1s” for the social security number. This will not be a required field in an upcoming version.
- Is my private data secure?
Data entered into Housecall is encrypted and stored on a secured cloud server. The video, audio, and data stream between you and your provider is an encrypted one to one session that requires authentication of an encrypted secret code in the background between the two parties to share data in a session. Any intercept of that data would not have the shared code and thus would not be a party to the shared stream. No security breeches have been reported using this secure format.
- Can I try Housecall without entering profile data?
Yes, we have set up a trial account so you can get a feel for how Housecall works. Use the username “Patient” and the password “patient” to log on to our trial account and explore Housecall before you ever spend your time entering your data into your profile. This account will not be useful for an actual provider visit however.
- Is Housecall HIPAA compliant?
- How do I find my doctor in Housecall?
We are rapidly adding providers to Housecall. Search the provider listing by name or search to find providers near you by pressing the location key in the upper right of the provider search screen and giving Housecall the right to use location services on your device. At present we are seeking providers to use Housecall for their patients. If your doctor is not yet using Housecall, on your next office visit take a picture of his or her business card with your device and send it to us at Provider@iheartdoc.com. We will get in touch with them to let them know patients are interested in interacting with them via Housecall. Let your provider know that you are interested in seeing them via Housecall! They can email us at Provider@iHeartDoc.com and we will be glad to get them set up on Housecall.
- How do I add a picture to send to my provider?
When you click “appointment” to make an appointment with a provider, you are taken to the screen that allows you to make an appointment on a certain date or time, send lifestyle data or send a picture to share with your provider. To share a picture you must click the picture icon on the middle, far right of the appointment screen. You are then taken to the picture gallery. You can add a picture to the gallery by tapping the upper right “add” icon. You are given the choice of importing a existing picture from your photo library or taking a new picture with your camera. Once you take or choose a photo, it is added to the gallery. You can add multiple photos to the gallery and send multiple photos to your provider for review. You must then tap the bottom left of each photo to choose it putting a “check” in the bottom left box and hit “send” at the bottom of the screen. You are then taken back to the appointment screen. To finalize your appointment hit “schedule” to complete the process. Your provider will then be able to review any photo prior to, or during your Housecall appointment.
- How do I send data from my Withings scale, BP cuff, or Jawbone Up band to my provider?
You must first add any connected devices to your profile account by giving your username and password for your Withings or Jawbone account in that section of your profile. Before you exit your profile screen, you must save it by tapping the disk icon at the upper right of the screen. You can test to see if it works by going to the “wellness” section and seeing if your data is imported. To send your wellness data to your provider for review, just click the apple wellness icon in the appointment screen when making a provider appointment. Save the wellness data for your provider by clicking the “save” icon at the upper right. You are taken back to the appointment screen to complete the appointment by hitting the “schedule” button. Your provider will then be able to review any wellness data prior to, or during your Housecall appointment.
- I have wellness data in an app that Housecall doesn’t yet support, or health data that I keep in a note on my device. How can I send that data to my provider?
You can send data from your iOS device from any app or program by taking a screenshot of the data. To do this you must bring up the data screen you wish to share with your provider. With the data onscreen, press and hold the large button at the bottom of your device while then pressing and releasing the power button at the top of the device. You should have heard the sound of a camera taking a picture. You just took a screenshot of your device. Share that like you would share any picture from your photo album with your provider. Your screen shot is located in your camera roll. This gives Housecall the ability to share data from any program with your provider.
With $245B spent on diabetes, telemedicine looks to cut the cost
Apps like iHeartDoc’s Housecall can make a difference! Insurance coverage for telemedicine empowers the patient to use their smartphone to collect their own data and share it with their healthcare provider. This is the future of medicine.
With $245B spent on diabetes, telemedicine looks to cut the cost.
Housecall App is FREE for a week!
Housecall App is FREE for a week!
iHeartDoc’s Housecall is free for a week starting April 19th. Go to the Apple iTunes page at https://itunes.apple.com/us/app/housecall-telemedicine-your/id677557566?mt=8 to download the app.
Give it a try as both the provider and patient by using Patient as the username and password and Provider as the username and password on each of two devices. You can get an appreciation of both sides of the app as both a provider and a patient.
The Doctor Will See You Onscreen : The New Yorker
A fantastic review of the challenge of telemedicine today.
The Doctor Will See You Onscreen : The New Yorker.
One night last summer, when I was working as a medical student in an emergency room, a woman pulled me aside. Her left eye was pink and looked painfully irritated. She had been waiting for hours to get it checked but would have to leave soon to catch a train home. How much longer, she asked, before she could be seen?
A doctor was able to evaluate the patient before she dashed out the door, but her dilemma struck me. We buy groceries, trade stocks, and chat with friends across the globe without getting out of bed. Yet seeing a doctor remains a fantastically old-fashioned routine: minutes of medical attention can cost hours spent in transit or in a waiting room. When the price of losing that time gets too high, we might not even bother to be seen.
There’s a potential solution to this problem: using technology to deliver health care remotely. That approach, known as telemedicine, involves locating available doctors over the Internet and connecting with them, at a moment’s notice, using video chat. Telemedicine lets you see a doctor whenever and wherever you want, freeing you to choose a doctor based on merit rather than location. It can also improve the quality of medical care and reduce costs.
Telemedicine works especially well for urgent care, which deals with issues that need prompt attention but can be diagnosed and treated without an in-person exam—respiratory illnesses or urinary tract infections, for example. But it has many other possible uses. A study published last month in Health Affairs focussed on an off-hours telemedicine service in a chain of Massachusetts nursing homes. When residents got sick, an outside physician could use two-way video-conferencing equipment to see them instead of going to the facility in person or transferring patients to a hospital. Homes that used the service regularly sent a smaller portion of residents to the hospital than those that didn’t. The cost savings for Medicare, which would have had to pay for those hospital visits, far exceeded the cost of the telemedicine service.
In 2010—around the time that the nursing-home study was being conducted—telemedicine seemed on the verge of a breakthrough. Milt Freudenheim wrote, in the Times, that telemedicine was “gaining traction as never before”; Bernard A. Harris, Jr., a venture capitalist, told him that Americans were arriving at “a gold rush of new investment in telemedicine.”
But there was a problem: many health-care providers weren’t on board. In the nursing-home study, for example, two of the facilities barely used their telemedicine services. Not surprisingly, their hospitalization rates were similar to those of facilities that didn’t have telemedicine capabilities. “Simply making off-hours telemedicine coverage available does not guarantee that nursing homes will use the service,” the study’s authors wrote. In this instance, the staff had no incentive to learn a new system. Avoiding unnecessary hospitalizations didn’t save them money—in fact, it cost them money. “As long as nursing homes pay for the service and Medicare realizes the savings that result, we suspect that the use of the service will be limited,” the authors wrote.
In the wake of the Affordable Care Act, the outlook may be changing. Health-care providers are forming Accountable Care Organizations, large groups that win bonus payments from the government for meeting certain standards of quality and efficiency but lose money if their costs exceed target levels. Bundled payment schemes pay providers a fixed amount to manage a given medical condition, in contrast to the traditional model that reimbursed a la carte for each service. “In the past, we were paid for the process rather than the outcome,” Thomas Nesbitt, the associate vice-chancellor for technology at the University of California Davis Health System, told me. Now, doctors have an added interest in improving their patients’ health efficiently. That makes telemedicine newly attractive. “Physicians see that they can manage their chronic-disease patients on a regular basis and achieve better outcomes, and get financial rewards for that,” Nesbitt said.
Policymakers are also warming to telemedicine. Medicare, which previously only paid for telemedicine in rural locations, <href=”#.uxkamf5rx4w”>extended its coverage this year to “the fringes of metropolitan areas,” according to the American Telemedicine Association. The number of states making telemedicine coverage mandatory for private insurance plans has also grown—from five in 2000 and twelve in 2011 to nineteen as of early March.
Interest and opportunity, of course, aren’t enough. There is also the question of execution—how to schedule virtual patients, document encounters, and ensure that health-care providers get paid. To simplify logistics, the U.C. Davis Health System has a telemedicine clinic that provides technical, operational, and billing support. “The physicians just show up,” Nesbitt said. But he acknowledged that, “eventually, if we want telemedicine to be more widespread, incorporating it into the normal workflow process is a barrier we will need to overcome.”
Meanwhile, for-profit telemedicine companies, which compete with hospital systems for business, are gaining momentum. “Since the A.C.A., we’re seeing a lot of interest in the area,” Bob Kocher, a venture capitalist at the firm Venrock, told me. Kocher, who is also a physician and a former special assistant for health care in the White House, recently took part in Venrock’s investment in a telemedicine company called Doctor on Demand, which launched in December of 2013. Startups like Doctor on Demand have the potential to offer what Clayton Christensen, a professor at Harvard Business School, calls “disruptive innovation”—innovation from smaller firms at the “bottom” of a market. Eventually, these firms can displace industry leaders.
In his book “The Innovator’s Prescription,” Christensen proposes that telemedicine can be disruptive if it is used to “extend care into areas of nonconsumption, where the alternative is no health care at all.” If competing against nonconsumption is telemedicine’s best bet, the people to woo are not payers, providers, or policymakers, but patients. That may be why Doctor on Demand is marketing its services directly to consumers. One of the company’s founders is Jay McGraw, the son of Phil “Dr. Phil” McGraw and the creator and executive producer of “The Doctors,” a daytime talk show about health and medicine. On his show, Dr. Phil recently demonstrated how the service might work. “If you wanted to see my throat…could I show it to you?” he asked a Doctor on Demand physician via video chat, aiming an iPhone camera at his open mouth. “What if you just need a prescription refill?…What about something like”—he feigned a cough—“Viagra?” The audience laughed and clapped.
As gimmicky as these tactics seem, Doctor on Demand may have tapped into a psychological truth: behavior change is as much about emotion as it is about reason. Simply recognizing the benefits of telemedicine isn’t enough; patients must want to use it. “It’s like going from buying clothes in the store to online,” Pat Basu, the chief medical officer of Doctor on Demand, told me. “The user experience needs to be good, or they won’t do it.”
Perhaps the user experience will never be good enough to replace face-to-face medicine entirely. Skeptics say that there is no substitute for human touch. In his 2011 TED Talk, titled “A Doctor’s Touch,” Dr. Abraham Verghese warned against losing the physical exam, stating, “We’re losing a ritual that I believe is transformative, transcendent, and is at the heart of the patient-physician relationship.”
Then again, as care becomes more accessible, the patient-doctor relationship could change for the better. By turning occasional encounters into ongoing dialogues, telemedicine could enhance, rather than diminish, the human capacity for connection. “A lot of people think it’s about the technology,” Nesbitt said. “But it’s really about a new model of care that the technology facilitates.”
Rena Xu is a student at Harvard Medical School and Harvard Business School. She has written for the Web site of the Atlantic and for the New England Journal of Medicine.
How To Share A Photo or Picture With A Provider in Housecall
Housecall – Image Data sharing with an Appointment
The following steps can be used for sharing a patient provided picture via the appointment screen.
1. Create an appointment in Patient login.
2. Tap the picture button marked in the above figure for sharing the picture. Add a picture from Photo Gallery/Camera and select the picture or pictures to be shared with a provider. (You can screen capture any iPhone app by holding the home button on the bottom of an iPhone and then pressing the power button on the top of the iPhone. This saves a photo in the Photo Gallery.)
Then tap the Send button to send the picture to the provider for review.
Note: Picture sharing also can be done after creating the appointment. That means fill the details for an appointment and then tap the Schedule button. Then select the appointment from the appointment list for getting the appointment details screen. From this screen the user would be able to share the picture as above.
3. For reviewing pictures in the provider login: The provider will get the scheduled appointment. On tapping the appointment, the provider will see the appointment detail screen below.
4. Tap the picture button marked in the above figure to view the pictures available to the provider for review.
5. The image is enlarged by tapping the thumbnail image and can be reduced by tapping the “X”.
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