tele-expertise! – e-health innovation


Ticket co-written with Baptiste Truchot co-founder of Omnidoc.

After the teleconsultation which is struggling to find its place in the sector of medical consultation, has also entered into the common law of Social Security, tele-expertise.

For the teleconsultation, the departure is very modest with in mid-March 2019, 7,939 acts of teleconsultations supported by the Health Insurance, about 200 acts per week in 2018. Sensitive acceleration with 700 weekly acts since mid-February . General practitioners are in the lead (40%) and especially health centers (20%) (CNAM statistics).

Since February 11, the teleexpertise is supported by the health insurance.

Now doctors can be paid when they give or ask for advice to a colleague.

The stated objective of the health insurance is to promote the exchange between health professionals and to reduce the access time to a specialized opinion, particularly in the areas most affected by the medical desertification. It also wants to regulate a practice that is today carried out informally through often insecure channels.

This new medical act, which is inserted between the first and the second recourse, could profoundly modify the course of care. Telexpertise is today a service requested from the specialist. The requesting doctors are thus limited to the most critical cases and it is sometimes long and difficult to obtain an answer. Now that it is being repaid, this practice could become much more systematic.

It is indeed the possibility, for the patient and his doctor, to obtain a specialized access much more quickly. This can help to better guide the patient, to answer certain doubts, to avoid certain displacements and even medical errors. For the specialist physician, this could make it possible to promote exchanges with general practitioners and to better prioritize requests for urgent care.

The promises are many, but there are several brakes. The remuneration for this new act is modest: between 5 and 10 euros per request (depending on complexity), between 12 and 20 euros per response. Then it is not enough to exchange a text to be able to rate a teleexpertise. You must first ask the patient for authorization and check his eligibility. Only one third of patients are eligible at first (ALD, rare diseases, under-endowed areas, EHPAD, prisoners). The exchange must be via secure messaging (MSSanté, Apycript) or a platform respecting all the rules in terms of hosting health data. Finally the act must be traceable, in particular a report must be added to the patient file.

These rules could hinder the development of teleexpertise. But some platforms are trying to lift them. This is the case of Omnidoc available since February 2019, this platform accessible from a computer or smartphone, makes it very easy to achieve paid remote expertise. Omnidoc relieves the doctors of the administrative and accompanies them in all the stages of the teleexpertise, from the verification of the eligibility of the patient to the invoicing, passing by the generation of the report. The platform is free in the case of exchanges between corresponding doctors. It also offers a fee-based feature that allows institutions or groups of private physicians to collectively manage the need for specialized advice in a territory.

"We can not change the remuneration of health insurance, but we can facilitate everything else. It only takes a few seconds to register and apply. It is possible to contact a regular correspondent or ask for a connection with an available doctor, "explains Baptiste Truchot, its founder.

Other startups offer to accompany doctors in the telexpertise.

Avis2Santé, created in 2016, offers a tele-expertise offer for a year, whose subscription varies between 59 euros to 116 euros per month for the user whether required or requesting, depending on the services used and space storage of the required data.

More recently, the Postelo startup has also developed a telexpertise offer for liberal doctors and healthcare institutions. It is free for requesting and paying doctors for the required doctors.

Regional initiatives, financed by the LRAs, had already emerged before the act of teleexpertise became part of the nomenclature. This is the case of Therap-e (Normand'e-santé) in Normandy or MonSisra (GCS SARA) in Auvergne-Rhône-Alpes. These platforms should gradually adapt to the new regulatory framework and could in the future be extended to the entire territory.

Health insurance, meanwhile, plans to make a balance in 2020 and adjust the regulation based on the success and development of tele-expertise. Several developments are on the table: in particular the generalization to all patients and the creation of a third act of telexpertise with a more attractive remuneration.

In conclusion, the medical consultation is reorganized profoundly in France, especially under the action of platforms for making appointments on the Internet dominated by the highly successful and jealous Doctolib who recently bought Mondocteur is in a situation of quasi-monopoly, it receives criticism from liberal doctors and competition (Allodoctor, Rdvmedical, Medunion …) to name only the main companies.

For the moment, these platforms have a hard time getting doctors and patients to adopt teleconsultation, which became part of the common law of social security in September 2018.

Then the telexpertise with its regulated field of action, its weak financial attractiveness will probably be difficult to find its place quickly.

As proof, the still very modest activity of the main offers: OMNIDOC, POSTELO, AVIS2SANTE, GCSNORMAND'ESANTE, GCS SARA.

But when the indicators (related to health professionals, governance, and related to patients …) will be more favorable telexpertise as the teleconsultation will have a nice card to play to simplify the course of care.

This is what we believe and hope to mitigate, albeit for a very small part, the shortage of primary care physicians.


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