Once a way for people in rural areas to access medical specialists, telemedicine is now being piloted by Rite Aid at its in-store clinics. Competitors Walgreens and CVS may not be far behind. Where does that leave traditional healthcare providers?
This article originally appeared in the May 2013 issue of Medicine on the Net.
Earlier this year, Rite Aid became the first retailer to enter telemedicine in a big way when it announced plans to roll out its NowClinic program to 58 in-store health clinics in Boston, Baltimore, Philadelphia, and Pittsburgh.
"Given the rapidly changing healthcare landscape, we believe that telehealth services such as our NowClinic will play an extremely important role in healthcare in the future," said Robert Thompson, executive vice president of pharmacy for Rite Aid. "Rite Aid's online care services provide customers with convenient, affordable, and efficient access to care."
Rite Aid has been dabbling in telemedicine since 2011, when it began testing NowClinic at nine stores in Detroit. The service allows health clinic patients to have a private, one-on-one consultation via video conference with a physician from OptumHealth—rather than a nurse practitioner who handles in-store visits. The 10-minute consultations cost $45, and physicians either diagnose a condition and prescribe medication or tell patients to visit an emergency room or see a specialist.
While Rite Aid is the first retailer to launch a telemedicine pilot at its in-store clinics, others are likely to follow in the highly competitive retail pharmacy business. Walgreens has a network of 700 Take Care clinics in its stores, and CVS has Minute Clinics in more than 650 locations.
"I don't think you'll see either Walgreens or CVS sit on the sidelines for very long," said Benjamin Forstag, senior director of communications for the American Telemedicine Association (ATA).
More than 3,500 sites
According to the ATA, there are currently 200 telemedicine networks operating in the United States using more than 3,500 sites. The association estimates that 50% of U.S. hospital networks now use some form of telemedicine and that in 2011, the Veterans Health Administration alone delivered 300,000 remote consultations for military veterans.
When telemedicine was launched a decade ago, the idea was to provide care for people in rural areas with limited access to medical specialists. The basic concept was to set up a video-conferencing system—often using a computer webcam—inside a doctor's office or health clinic to put patients in direct contact with specialists without needing to visit them in person.
Rite Aid's venture with NowClinic shows healthcare providers are ready to apply the telemedicine model to settings outside of a physician's office or hospital.
Merging technology with convenience
Another company looking to expand telemedicine into new venues is HealthSpot. The Dublin, Ohio–based technology firm unveiled its HealthSpot Station kiosk at the 2013 Consumer Electronics Show (CES) in Las Vegas after more than a year of testing the system with several healthcare providers in Ohio.
The 8-foot by 5-foot enclosed kiosks come equipped with a touch-screen monitor, audio system, and high definition TV screens, allowing patients to conduct a virtual visit with a physician.
"HealthSpot has built a solution that merges technology with convenience in patient care," said Steve Cashman, founder and CEO of HealthSpot. "Our innovation utilizes today's technology combined with modern medicine to diagnose and treat patients in ways that are affordable, convenient, and effective."
Before unveiling its kiosk at CES, HealthSpot ran pilot programs to test its concept with several partners in Ohio. These programs included a test involving 400 patients and 15 physicians affiliated with Central Ohio Primary Care, as well as tests with The Cleveland Clinic and the University Hospitals health network in Cleveland.
"Every pilot program was different," said Lisa Maughan, vice president of marketing for HealthSpot. "University Hospitals used the kiosks as part of a triage program to divert patients who didn't require emergency care away from their ERs. The Cleveland Clinic tested them in two of their Express Care urgent care clinics. But all of them had the same goals in mind of driving down costs while providing a new access point for care."
This year, the company began laying the groundwork to roll out its HealthSpot kiosks to new partners outside of Ohio. In January, it signed a partnership agreement with Teladoc, a telemedicine company that will provide HealthSpot with board-certified physicians to conduct virtual consultations. It also signed a deal with the Miami Children's Hospital (MCH); that organization plans to use the HealthSpot Stations as part of its Global Telehealth Command Center, which allows pediatric specialists to conduct telehealth conferences with children and their families and write e-prescriptions.
"We are innovating leading-edge mobile applications and telemedicine capabilities," said MCH senior vice president and chief information officer Edward Martinez in a statement. "In cooperation with HealthSpot, we will champion telehealth services as a long-term solution for transforming the future of primary and specialty pediatric medicine."
MCH plans to set up HealthSpot Stations at 10 locations in Florida and the Caribbean in 2013 to broaden its telemedicine services.
Grocery stores next destination
While HealthSpot has partnered primarily with healthcare providers in the early phase of its rollout, Maughan said the long-term plan is to deploy the kiosks in a variety of settings.
"We're talking to retailers right now to set up kiosks in grocery stores and other locations such as business parks," she said.
Unlike The Cleveland Clinic—which tailored the kiosks to fit its specific needs—the kiosks for nonmedical settings will have a standard consultation fee and a set of conditions that physicians will diagnose and treat. Maughan said having a standard business model will allow the company to expand more rapidly.
"We envision using a Redbox business model to expand into retail locations," she said, referring to the DVD rental kiosks located outside retail video stores in the United States. "With retailers, we're probably looking at a situation where we'll lease space in a store and share a percentage of the profits with them."
The growing acceptance of telemedicine among insurers should also help HealthSpot's expansion efforts. To date, insurers in 15 states provide reimbursements to patients for telemedicine services, and HealthSpot said that it's "working with physician networks and lobbyists in other states to push telemedicine legislation forward."
Sick at sea
While HealthSpot appears to be the first company to make a concentrated push into nonclinical settings for telemedicine, other companies have been using telemedicine in the workplace for more than a decade.
The ATA, which has been promoting the use of telemedicine and tracking its progress since the association's founding in 1993, said oil and gas companies have been pioneers in telemedicine.
"There are plenty of offshore oil rigs that have a telemedicine service available to their workers," said Forstag. "Instead of having to fly their workers off the rig or fly physicians on to rig, telemedicine consultations are used to handle most of the health problems workers have."
The shipping industry has similarly embraced telemedicine. Forstag said George Washington University in Washington, D.C., established a telemedicine service with major shipping companies more than a decade ago that allows maritime workers at sea to consult with physicians at the university via video conference.
"For the shipping industry, it's a great service because you don't want to have these sailors being transported off and on to ships to treat minor ailments," said Forstag. "And it's the same idea that applies to telemedicine being used in rural areas. It's a great tool to reach people who are not easily accessible."