Telehealth is on everyone’s mind with the rapid need to create safe environments for doctors and patients to engage in the COVID19 era.
With a number of different platforms on the market, the choices have never been greater. To help doctors and practices to navigate the marketplace we have road tested the best of them to provide a practical comparison to help with your decision making.
At Hoxton we know that productivity, security and cost are important factors when building practice infrastructure. So feel free to contact us to discuss your telehealth challenges or to find out about our range of outsourced administration support services.
The Video-conferencing and Telehealth Landscape
The main players in this field are: Zoom, Doxy.me, Coviu, BlueJeans, Webex, Microsoft Teams and Google Meet. These are complete conferencing platforms with a variety of features and workflows built in to make person to person contact seamless and even facilitate payments in some cases.
Video telephone calls can be managed through Skype, FaceTime and WhatsApp and Google Meet.
Features vs. Practicalities
Committing to feature rich environments comes with a cost that, in most cases, delivers better user experiences for both the doctor and patient. At least as importantly, when using these optimized work flows medical secretaries will find appointment schedules and download-free set-ups much easier to navigate. This can substantially reduce the administration cost of managing telehealth.
In road-testing these platforms, we were looking for easy to use platforms, where control of the communication was in the hands of the doctor or practice and that few special skills, new tools, equipment or software was required. We have provided a concise comparison of different platforms tested in a table below, separated for small and medium to large practices.
As a starting point, popular video telephone apps like Skype, FaceTime and WhatsApp are practical because many of us have them loaded onto our mobile devices already. They’re not so easy to use in the desk-top environment. Patients who don’t already use the chosen app may require tech-level support from medical secretaries to load the software onto their device prior to the scheduled meeting.
Another complication using these platforms is that they are designed for friend-to-friend communication, requiring sharing of email addresses or phone numbers. Many users are aware of the time wasted waiting for patients to share information or accept requests to link in Skype, for example. Sharing of this contact information from doctors to patients leaves the communication door “open” for patients to return the favour later, messaging or calling doctors at unscheduled times.
While usable, and many cases free, we consider these ‘video telephone’ apps do not meet our efficiency or privacy needs for a sustainable and efficient telehealth platform.
Bespoke Telehealth Players
Healthsite, Doxy.me and Coviu are easy to navigate for the host (clinic and doctor) and patient. One of their main strengths is that the patient does not have to download and run software in order to participate in the tele-consultation. The only technical requirement is that an up-to-date web browser must be used. In all three, appointments are easily scheduled and telehealth calls are initiated using a simple web link that would be emailed directly to patients. All calls occur within the web browser (Chrome, Firefox, Edge).
Coviu and Doxy.me both have free trial periods. A number of different subscription models exist, but not surprisingly, the more you pay for these platforms the more add on features and options are available. The fully featured premium products feel a bit pricey against the competition. Full features are visible to all users, but are not operational for entry level subscribers. Coviu, in particular, dangles these blocked features regularly which can be annoying. Both platforms offer lower prices for annual subscriptions, but with no lock in contracts it is currently possible to move between platforms as features, needs or prices change over time.
Healthsite hasn’t launched their demo or trial periods yet. Their subscription model is simple, with three pay levels according to the number of users. 1 to 2 users costs $100 per month, 3 to 5 users costs $200 per month and six or more users costs $350 per month.
Both Coviu and Doxy.me are well organized and are particularly useful for busy clinics that have a high number of telehealth consultation, particularly with their waiting room set-ups that are considered premium features. Other higher level features include adjustable hours of operation, patient self-scheduling, customisable patient intake forms, questionnaires on call exit, and SMS arrival notifications could really enhance the user experience at both ends. Healthsite doesn’t currently offer the waiting room experience of Coviu, but does have intake forms and an on-line booking portal for no extra cost.
Scheduling patient consultation in these platforms is straight forward, but may be prone to error unless administration workflows are strict. The Healthsite and Coviu scheduling process allow a date, time and duration to be nominated at included in the patient email confirmation. It’s important to note that patients are sent a unique URL tagged for their appointment. This requires administration input in the platform booking process.
One potential administration advantage with Doxy.me is that their telehealth appointments operate through doctor specific URLs. This means that administration staff do not need to spend time working within the telehealth platform to book patients. They simply send patients a standard appointment invitation link, different for each doctor. These standard links can be saved in proforma emails or text messages in the medical practice software. While the manual data entry for time and date of appointments in Doxy.me feels prone to error, the administration burden is certainly low given that they need not access the platform. This advantage also is also available in the free version of the software.
None of these platforms attempt to replicate the Practice Management Software appointment book, so where integrations have been built users will benefit from mush enhanced workflows. Healthsite nicely integrates with Best Practice, Medical Director and Zedmed with natural workflows from the appointment book for doctors and nice integration with the payment systems for administrators. This includes medicare batching and out of pocket credit card payments, with an entirely reasonable fee of 1.8% commission.
Coviu integrates with Halaxy and a number of allied health software. It still feels very ‘new’ and the promise of ‘soon to be released features’ such as Medicare batching for bulk billing hints at greater things to come. Patient payment options are available in both Coviu and Doxy.me but are not particularly efficient at this stage, as they don’t interface with many medical software packages for direct reconciliation. For entry level subscribers the host (doctor) needs to ask for the payment during the consultation. The in-app payment platforms is where these products will be making most of their money, with commission costs on Coviu taking a massive 4.5% of revenue (on top of subscription fees) and Doxy.me above 2.9%.
The Corporate Conferencing Options
Microsoft Teams, Zoom, Blue Jeans, Webex and Google Meet provide useful video conferencing platforms, with reliable video connections. The biggest difference with this batch of highly developed platforms is the absence of a useful waiting room experience, and this has a big impact on doctors’ time efficiency. We estimate that without a waiting room, busy doctors booking 5 or more patients per hour could lose up to 15% of the productive time skipping through meeting bookings. Starting out Zoom Free and Webex Free are good options to start with if price is a factor. Both have easy sign-up processes for providers and patient and a straightforward invitation process through email. Zoom Free and Webex Free are based on one doctor per account so each doctor in the practice would need to be set up with their own individual account.
Administration staff should complete this registration process if they will be making the bookings. Some clinics assign a universal password to all doctor’s accounts so administration staff can register and invite patients to appointments.
Webex and Zoom both have desktop-apps that require downloading, but operate just as efficiently through browser based web-apps. At the time of the appointment the doctor simply logs in through the to Zoom or Webex web-app or desktop app. They will either find the patient in the virtual meeting room ready for the consultation, or will have to wait for the patient to log in – perhaps checking to see whether or not other patients have already joined other scheduled meeting. This is where the time loss comes from.
With regards to support we found Zoom to be ahead of the others with their training and reference guides, live and recorded webinars and chat-bot answers.
Google Meet allows users to join pre-scheduled meetings from calendar events, choose a link, enter meeting code and even dial in from their phones if the invitation includes a phone number. Google Meet integrates Google Calendar and Gmail and lists participants and scheduled meetings. Patients need to have access to Google, or download the application on their mobile device.
Our next recommendations for clinics happy to invest in more features are Zoom Pro, Webex Start (1-9 users per license) or Webex Plus (1-50 users per license). All are particularly good value at the moment and come with administrator rights, reports, notifications and screen sharing with patient.
Blue Jeans is another sophisticated video-conferencing platform that is highly developed for corporate meetings and multi-license users. In integrates with Microsoft product including Outlook. Its feature-heavy environment makes it feel less user friendly than other options and many of their best features are redundant to telehealth requirements.
For practices who already have Microsoft 365 licenses, Microsoft Teams provides a great, native option that integrates nicely with Outlook for a small additional of less than $10 per user per month. It would require a champion administrator with the team to coordinate and create doctor profiles and appointment rules. Keep in mind that doctors would need to share their individual outlook calendars with the administration user.
We like the calendar sharing capabilities of Webex, Blue Jeans and Microsoft Teams with their simple interface with Outlook and also with Google Calendar for Webex, Google Meet and Blue Jeans. It’s really important here to make sure that with the international based platforms such as Zoom, Webex and Blue Jeans, the default calendar is set to the correct time zone. We have experienced this error first hand.