Carena CEO

Ralph Derrickson

Healthcare conference-goers often head for home with new energy to take on challenges they were facing back at work. But one prominent attendee of the American Telemedicine Association annual conference, held May 14-17 in Minneapolis, came home concerned about a new direction the field was taking and its reaction to a study that cast teledermatology in a negative light.

Ralph Derrickson, president and CEO of Seattle-based Carena, was not cheering an announcement opening the door for more direct-to-consumer telemedicine contacts across state lines.

“We’re trying to build a better healthcare system, we’re not trying to sell telemedicine,” said Derrickson, a technology entrepreneur who also worked at Sun Microsystems and Steve Jobs’ NeXT Computer. His interest in healthcare was sparked after spending a great deal of time in hospitals when his two daughters were born premature.

“Entrepreneurship was exciting, but without a sense of purpose,” he said. “Carena, for me, is a mission.”

Derrickson said he sees virtual care as an inexpensive entry point for patients who may have difficulty navigating the healthcare system. He also sees it as an extension of that system rather than a stand-alone provider of consumer services.

“Our job as providers is to be stewards of the doctor-patient relationship,” he said, noting that Carena’s business model uses employed physicians whose compensation doesn’t incentivize fee-for-service volumes or discourage making prudent referrals if virtual care may not be the best option.

“Health systems recognize that healthcare must be treated far differently from an online shopping experience,” Derrickson wrote in a recent blog post. “By moving patients to a national marketplace, local health systems lose the ability to coordinate and respond on a patient’s terms while reducing costs and managing risk.”

A similar sentiment was offered by authors of the recent telemedicine study, published in JAMA Dermatology, that was the source of much debate at the ATA conference.

“We believe that DTC telemedicine can be used effectively, but it is best performed by physicians and team members who are part of practices or regional systems in which patients already receive care,” the authors wrote. “This allows telemedicine clinicians to view a patient’s existing medical records, communicate with existing healthcare team members, provide in-person follow-up when needed and be accountable for the care they deliver.”

The study was led by Dr. Jack Resneck Jr., vice-chair of dermatology at the University of California-San Francisco and an American Medical Association board member. It involved creating fake patients using stock Internet photos and assessed the quality of care offered by several direct-to-consumer teledermatology services.

The study suggested incorrect diagnoses were made, treatment recommendations weren’t followed, and patients weren’t told of their prescriptions’ possible adverse side effects and pregnancy risks. The report was posted online while the ATA conference was in session, and one executive in attendance described the study as “devious.”

But Derrickson defended the study and its methodology, noting that “our clients regularly secret-shop us,” and he predicted more of the same was coming.

“People are no longer asking, ‘Does telemedicine have a place?’ Now it’s ‘What is the right role and place?’” he said. “As it goes mainstream, more scrutiny will naturally come.”

The scrutiny is coming at a crucial time for telemedicine from both economic and political perspectives.

Publicly traded telemedicine provider Teladoc recently released its first-quarter earnings report. Though the company still has never turned a profit, its numbers were impressive. Compared to first-quarter 2015, revenue increased 63 percent up to $26.9 million as visits grew 61 percent, to 239,942 from 148,696.

Meanwhile, the ATA has reported that legislation facilitating the use of telemedicine is advancing in several states. A key exception to this rule is Texas, Teladoc’s operational base, where the state has restricted the practice of telemedicine.

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