The Dimensionality of Ongoing Access

When I started CirrusMD, I did so on the supposition that ongoing conversations between doctors and patients rather than isolated visits would result in better outcomes. When I think of the way my friends and family interact with me when they’re sick, it’s always open-ended, so we can pick up where we left off. And the main way they reach me, day and night, is text.

For a century, physicians have worked in clinics and hospitals where they are directly inaccessible and patients endeavor to persevere through long waits for their attention. But this isn’t the way those who share a personal relationship with doctors interact with the healthcare system; instead, when they need advice or active treatment, it is always available. So let’s examine some of the necessary components of the conversations between those who enjoy constant access to a doctor, and doctors who attend to the needs of their friends and family.

A relationship: The first, and most important element for a doctor to successfully dispense care or advice is there must be a mutual trust with the patient. Whether the relationship is between friends, family, or co-workers, the patient in this sense trusts that the doctor has their best interests in mind and the doctor trusts the sincerity of the inquiry from a known source.

A means of communication: Any doctor dispensing care or advice outside the context of an established primary or specialty care relationship wants to help the patient close the loop within the care delivery system, and therefore not become the bearer of final responsibility for “off book” care. In my experience, unofficial care usually takes place either in-person, via telephone or email, or most often through unsecured text messaging.

In 2012, I knew that my industry was a long way from delivering ease-of-access and ongoing communication with doctors. So we built CirrusMD to replicate what was occurring in nature when doctors treat their friends and family, to bring everyone the best type of access to care.

As an ER doctor, I’ve observed a thriving urgent care industry feeding a market hungry for easier access to care; but that fundamentally fragments care. Then I looked at the national market for telemedicine, and found a massive delivery system in the hands of several companies that offer to link patients with a doctor for a one-time phone or video visit. These clinical workflows suggest that the encounter almost always ends with a cautionary statement to go get that checked out or see your doctor about that. If it was that easy for the patient to access care, they probably wouldn’t need the remote service in the first place. It makes sense, these doctors don’t have the ability, or incentive, to close the loop for patients in most cases and therefore dispense advice VERY carefully, with steep qualification and conservative plans of care. I’ve also seen that virtual care utilization rates seem to be up against a ceiling, which also made sense to me. Patients aren’t reassured by overly conservative, limited advice from an out-of-system doctor when something is bothering them, so they don’t return to the service.

CirrusMD recognizes the accomplishments of companies that have increased remote access and that the dimensionality of video is far superior to phone-only communication. We also believe that remote communication in the context of a relationship is the best kind, and doctors should have the resources to close the loop for patients whether through smart referrals, ordering diagnostics and following results, prescribing, or, in some cases, not prescribing and ultimately reassuring patients by keeping in touch to change the plan as needed.

We believe that all health care is local. As an extension of this, all telemedicine should be local, and managed as a coordinated service by the patient’s own home health system. So we built CirrusMD to be the next generation of telemedicine for integrated care. As a text-first clinical workflow, we’ve cracked the code for utilization, re-utilization and physician workforce scalability in remote care. The ability to share images and convert to video as needed, at the provider’s direction have truly replicated a best-in-class communications experience between doctors and patients. But the secret to our success isn’t just in understanding the way people communicate; rather, we’ve invested in creating care pathways that fit into existing infrastructure in health care with a keen interest in economic relationships and aligning interests. We’ve done the hard work to connect patients with a doctor on-duty who is a part of their local health system who can affect their care and keep in touch.