Too often, companies try to re-invent the wheel.  This is especially true in the telehealth sector where new models of care are constantly being tried and tested.  Fortunately for U.S. hospitals, health systems, and companies, however, we have great examples of telehealth models from around the world that have built successful business models in telehealth.

Take the example of Calydial, a company based in Lyon, France, that specializes in remote dialysis. Launched in 2006, Calydial started with 25 patients with renal impairment who needed remote treatment and monitoring. Today, Calydial has 230 patients, and performs 30,000 dialysis acts per year.  “When we started in 2006, there was no regulatory framework in France for telemedicine,” said Mr. Gérald Huguet, Chief Information Officer, “so we just had to learn on the job”.

What has driven the success of Calydial?

First, there is the benefit to patients who are monitored in their homes resulting in a better continuum of care, better treatment adherence, and less unnecessary readmissions.

Second, there is the return on investment. Although France has a publicly-funded healthcare system, hospitals and doctors are under pressure to better manage resources leading to more return on investment. In France, a significant portion of the dialysis treatments are completed at patients’ homes, especially for elderly patients. Calydial understood that payments made to doctors were bloated because many doctors travel to patient homes to provide consultation and dialysis treatment and are paid for the time they are commuting. Try driving in Lyon or Paris at rush hour! By eliminating this time, Calydial reduced the amount of monthly doctor hours by one week on average!

What lessons can U.S. companies learn from Calydial example?

  1. You cannot always find an off-the-shelf product that will exactly match your needs. When it started its remote dialysis project, Calydial could not find network and software solutions that fitted its needs. So the company had to work with manufacturers and suppliers to develop a product specifically tailored to its needs—while also staying within budget. In other words, if you can’t find the perfect match, work with your existing partners to create one. Manufacturers are likely to work with you because this is also an opportunity for them to expand the functionalities of their products.
  2. Telemedicine solutions might work when defined in the lab, but your success will be measured where the rubber meets the road. You have to be prepared to re-think your project and your strategies.  It is tempting for new companies launching telehealth projects to cut corners. After all, most people think that if you have a computer and an internet connection you’re in business. Calydial learned this lesson early on. They had to find solutions that guaranteed the service (videoconferencing, network reliability) and ensured patient data privacy and security.
  3. Put patients first. What if you have a blackout or a failure in the system? How do you ensure continuum of care? You need a back-up plan. And you have to prioritize the speed of intervention teams and the alternatives for care depending on the type of health care services you provide. For telesurgery you need a 24/7 back-up plan and immediate response.  For intermediate risk consultations or telemonitoring, a reasonable intervention delay is acceptable, and for low risk consultations, you need to be able to contact the patients by phone, for example, to assess the level of emergency.
  4. Look for ways to improve your product. In 2013, Calydial is launching a project with a new app that will be compatible with several platforms including smart phones, tablets, laptops, and home computers. Very often, patients suffer from several chronic diseases, and if telemonitoring came with a different device for each disease, patients’ homes would be a hub of devices, wires and connections. With this new app, patients will be able to use their phone or computer for all their needs.
  5. Talk to experienced companies. This seems like an obvious approach, but it is particularly important here. Calydial sought the expertise of several major players in the telemedicine space including network operators and health information systems.
  6. Find partners to split the work.  For the 2013 project, Calydial will work with Cluster I-care, a public-private partnership developed to promote health technologies. Another partner will be in charge of privacy and security issues, and handle electronic health records (EHR), the hosting of personal health information, confidentiality, and many other related issues. From a business perspective, bringing in partners will allow you to focus on business development. From a compliance perspective, specialized partners are usually certified by the appropriate authorities. For example, in France, companies that host personal information must be certified by the French Agency for Interoperable EHR (Agence des Systèmes d’Information Partagés de Santé) and must comply with the privacy regulations of the French National Commission for Privacy (Commission Nationale de l’Informatique et des Libertés). Choose your data hosting vendor carefully. Not all vendors have a blanket certification; some of them have limited capacity to manage personal health information. 
  7. Get proposals from several vendors. This will help give you access to several options, and you may negotiate prices among competitors.
  8. Get good counsel. If you are considering entering into an agreement or a joint venture with a network operator or a software developer, establish clear rules for liability and intellectual property. Each partner might develop one component of the final product. In the event one partner leaves the venture, it is important for the remaining parties to be able to continue the operations and market the products and services. In defining the products you buy, don’t lock in your products for only one pathology, but keep your options open for future add-ons and new functionalities.
  9. Check your local rules for physician practice. In France, physicians may not need a special authorization to offer consultations remotely if they practice within the scope of their license and certification.
  10. Check your reimbursement. In France, since October 2011, telemedicine services are reimbursed at the same levels as those for in-person visits, as long as the service appears as one of the services regularly reimbursed by French public health insurance under Article L162-1-7 of the Social Security Code. This includes teleconsultation (physicians conduct consultation remotely), teleexpertise (physicians solicit advice from peers), telemonitoring (physicians monitor remotely patient data), and teleassistance (physicians assist nurses or other medical personnel in the completion of medical acts).

The example of Calydial shows that telehealth can thrive in many environments, even when you start with a small investment.

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