Telehealth is undergoing a metamorphosis. From a market of relatively unsophisticated ‘one-size-fits-all’ low acuity solutions, a shift towards high acuity is under way.
This shift was discernible at the American Telemed Annual Conference and Expo (ATA2023), held earlier this week in San Antonio, as vendors – both well established and new market entrants – showcased an array of specialist solutions reflecting that move up the value chain.
The Signify View
ATA2023 is a reliable barometer as any of telehealth’s current direction. First impressions were of a quieter than expected show floor. This is perhaps no surprise for vendors, who in the current business environment must be more selective than ever about where they spend their marketing budgets. The competing charms of HIMSS in Chicago (a favourite of the large US providers) loom next month, while ‘trendier’ exhibitions such as ViVe (in Nashville later this month) and HLTH in Las Vegas later in the year are also vying for marketing dollars. Teladoc was conspicuous by its absence from the ATA show floor, and Philips (along with many other vendors) opted for smaller booths than usual.
But while the more sedate atmosphere in San Antonio confirms the end of telehealth’s frenzied, Covid-fuelled days, it also indicates a change in vendor focus. Mass market, low margin, low acuity solutions still have their place, but high acuity telehealth is forecasted to grow steadily to 2025 (see chart below). As a result, specialist solutions for a wider cross-section of healthcare needs are emerging, with several on show at ATA.
Broader, Interconnected Ecosystem
The main takeaway from ATA is that high acuity telehealth is now moving beyond its teleICU and Clinical Examinations and Medical Support roots. A broader, more interconnected ecosystem of different high acuity telehealth services is emerging (see graphic below) in which tele-sitting (observation), tele-nursing and solutions for non-ICU settings are gaining traction. Established players such as Philips, Amwell, Teladoc, AMD Global Telemedicine and GlobalMed are being joined by new vendors here, and ATA was an opportunity to engage with some of them and understand how (and where) their solutions fit.
Telehealth’s Interconnected Ecosystem
Necessity the Mother of Invention
Until relatively recently, high acuity telehealth vendors kept a narrow focus on solutions for teleICU, clinical examinations and medical support, in high demand during Covid. However, the post-Covid period has introduced fresh challenges for healthcare providers, not least significant cost pressures and chronic staffing shortages, and this is influencing the development of new patient monitoring methods and technologies.
While ‘tele-sitting’ is not a new concept per se, the traditional, simple AV monitoring platforms it relied on were basic and error prone. Those monitoring patients were often unable to decipher between ‘normal’ behaviour and behaviour that could be cause for concern. This led to problems with ‘false positives’.
AI has the potential to mitigate this problem, and care.ai, VitalChat and Andor Health were at ATA to promote their technologies in this respect. Established telehealth vendors like Amwell, AMD and GlobalMed are also moving into this space and building AI into their portfolios, often in partnership with AI vendors. For example, Amwell is integrating [AI developer] Solaborate’s Hello Care solution into its Converge platform, part of its shift from encounter- and cart-based monitoring to continuous ‘tele-sitting’.
Leading platform vendors and monitoring service providers such as Caregility, Equum and HiCuity are now promoting tele-sitting as a key part of their portfolios, and Philips says it is also moving into this area via partnerships with several of these companies.
Nursing the Industry Back to Health
Chronic nursing shortages are also driving developments in ‘tele-nursing’, and this was high on the agenda in San Antonio in keynote presentations, panel discussions and vendor marketing.
Although in its embryonic stages, vendors and service providers have high expectations for tele-nursing, and Philips, Caregility, Andor Health, AvaSure, GlobalMed, AMD and Amwell all see significant potential in it. Most already have clinical examinations and medical support platforms in place, and view tele-nursing as an attractive (and relatively easily achieved) new revenue stream.
Increased demand for tele-nursing services will also play into the hands of companies like HiCuity, who offer only monitoring services. Discussions with HiCuity during ATA emphasised the point that, while core services such as teleICU are growing, greater growth is being seen in newer applications such as tele-nursing.
Moving Beyond the ICU
Another trend observed at ATA are moves to apply teleICU technology in non-ICU settings such as med-surg units, step down wards, general wards and neonatal ICUs. Vendors have been pushing the message for several years that this route offers significant upside, although progress in developing and realising the opportunity has been slow. Philips remains the master of the teleICU universe (and continued to push the predictive elements of its established eICU solution at ATA), but other vendors present in San Antonio have ambitions to dislodge its crown.
Israeli start-up CLEW’s FDA-approved algorithms (which we explore in depth in this recent Insight), Turkish vendor Cieba’s eClinics Platform and AMD’s new AGNES Connect teleICU solution all generated lively discussion on the show floor. CLEW was very vocal about how it would erode Philips’ market share, the multinational countering this by insisting that it continues to win new customers and retain existing ones. If they are to seriously challenge Philips, it is clear that these ‘new’ market entrants will have to build trust among customers that they have a great solution and that they can scale.
ATA also saw a focus on predictive tools for use in high acuity settings. PeraHealth (now owned by Spacelabs) and Ambient Clinical Analytics are two AI vendors active in this space. During the show PeraHealth demonstrated how its predictive AI embedded into Caregility’s solutions is helping hospitals predict deterioration in patients, thereby improving ward management efficiencies.
New Expenditure Models in Focus
Another talking point at ATA was how to make teleICU more accessible to smaller hospitals. teleICU implementation is notoriously expensive, with high upfront hardware costs and the possibility of workflow disruptions during implementation. This has often been a barrier for smaller hospitals, who would outsource their teleICU technology implementation and monitoring operations to service providers like HiCuity.
However, teleICU vendors are now offering lower cost of entry to providers wanting to procure their own technology, moving from CAPEX to OPEX models where the cost of hardware implementation is absorbed in rolling monthly SaaS-based solutions. The increased general use of virtual workflows is also supporting this trend. To some extent this will present a challenge to these service providers as healthcare providers take advantage of this lower cost of entry to bring teleICU in house.
Window into the Future
In our ATA pre-show predictions (see them here) we said that vendors’ solutions would double down on supporting individual specialities, and in San Antonio this played out.
One obvious by-product of the shift to high acuity is increased competition within the new, interconnected ecosystem we refer to as the different players position themselves. Whether GE will be part of this new ecosystem remains to be seen – it launched Mural, its teleICU/remote clinical surveillance solution, several years ago, but was notably absent from the floor at ATA this year.
Moving from encounter-based, episodic models of care/platform to continuous monitoring platforms, and vice versa, will not be easy for some players in this new ecosystem. A shift in mindsets, and a reliance on ever more sophisticated technologies, will be required. But it is a path that must be taken, or risk being left behind.