Telehealth gaining popularity but obstacles remain

Capital News Service

LANSING – Although more health systems in the state encourage their members to use telehealth services, some patients and physicians are hesitant, experts say.

Telehealth delivers health information and services through computers. It connects patients at one site with health providers at another site, according to the state’s health policy.

The main services include real-time consultations, electronic transmission of patient’s medical records to health care providers and remote patient monitoring, according to the Senate Fiscal Agency.  

With the improvement in technologies and bandwidth capabilities, there is more recognition that telehealth services are worthwhile, said Bree Holtz, an assistant professor in the Department of Advertising and Public Relations at Michigan State University.

“The population is growing older and needs more health care while the research shows it [telehealth] provides the same level of care as in-person care,” Holtz said.

Stacey Hettiger, the director of medical and regulatory policy at the Michigan State Medical Society, said patients are encouraged to use telehealth services for minor problems, such as the early stage of a cold, flu, rashes and headaches.

“Telehealth is seen as option to more costly emergency room visits for non-emergency health conditions,” Hettiger said.

The telehealth service of Upper Peninsula Health System in Marquette had 4,293 telehealth visits in 2017, an increase from 3,547 in 2016, said Pamela Davis, the system’s analyst.

The most frequent uses were for neurology and behavioral health, Davis said.

With more knowledge of what telehealth service is, how it works and positive user experiences, an increasing number of members from rural areas are using it, she said.

The utilization rates of telehealth visits at Blue Cross Blue Shield of Michigan, a nonprofit health insurance company based in Detroit, have doubled since early 2017. Member registrations on the web and app have also doubled in the same time frame, said Meghan O’Brien, the company’s public relations manager.

The company’s telehealth service, Blue Cross Online Visits, “is especially helpful in areas of the U.S. where access to providers isn’t as robust as Southeast Michigan,” O’Brien said.

“The Online Visits app is rated 4.8 stars and 4.9 stars (out of 5) in the Apple App Store and Google Play, with members citing the convenience, low wait times and helpful doctors,” she said.

However, some rural areas face access problems, said Jennifer Morse, the medical director at the District Health Department #10. The district covers Crawford, Kalkaska, Lake, Manistee, Mason, Mecosta, Missaukee, Newaygo, Oceana and Wexford counties.

Some rural areas don’t have internet service and some people don’t have computer skills, Morse said.

There are other challenges as well. For example, U.P. Health System in Marquette is dealing with a decreasing staff size in its telehealth service.

Due to a corporate staff reduction, Davis said, “currently I’m the only one working this field. A few years ago there were four people.”

To promote its telehealth service, she said, “I would love to get out into the field to spread awareness and to go to the areas we service to see how we can do things better.”

Although telehealth services are broadly available in the state, some physicians raise additional questions.

District #10’s Morse said, “The other concerns I have, especially with urgent care needs, is over-prescribing antibiotics or misusing diagnostic tests.”

Morse also cited concerns that telehealth would negatively affect the doctor-patient relationship.

She said although technology provides doctors with advanced equipment to diagnose patients from hundreds or thousands of miles away, patients don’t always feel the same closeness or satisfaction they get from visiting a doctor in person.

As for doctors, they express concern that the use of virtual technology could affect reliability and worry that if there’s something they didn’t see, they may be sued if  something goes wrong with their patients, she added.

Another problem for physicians is “how to incorporate telehealth into their existing in-person patient workflow and how to bill for such services,” said the Medical Society’s Hettiger.

As for patients, their concern is reimbursement for services they receive, Hettiger said.

“Although there are significant concerns regarding reimbursement for telehealth services by insurers, as its application continues to grow, the states and the federal government are likely to take an active role in developing policies to address these concerns,” according to a 2017 Senate Fiscal Agency analysis.

Morse said patients need more education about telehealth services, such as “how and when it’s appropriate to utilize telehealth visits versus in-person visits.”


Michigan manufacturers explore potential of blockchain tech beyond Bitcoin

Capital News Service

LANSING — Cryptocurrency markets might remain volatile, but the technology behind the likes of Bitcoin – “blockchain” – is being looked at as a game-changer for potential uses in many fields.

Blockchain, or “distributed ledger” technology, records transactions and other data in a permanent, unchangeable “chain” that is instantly updated for everyone using the chain. That makes transactions easier to track and more secure from malicious attempts to change them.

A popular analogy, according to, is to “think Google Docs, except that all changes are encrypted in a way that they can’t be changed or deleted.”

Chuck Hadden, president of the Michigan Manufacturers Association, said he’s been talking to member food manufacturers about companies like WalMart using blockchain to ensure food safety in their supply chain.

In August, Wal-Mart joined companies such as Dole and Kroger in a partnership with IBM to improve traceability and maintain secure digital records using blockchains, according to

“If they get a bad basket of lettuce, let’s say, they’ve gotta track it all the way back to where it came from, and that takes a couple of days,” Hadden said. “If you blockchain it, it takes you like an hour. They can pull off specifically this carton of lettuce that came from this row, or they can start testing all the ones that were in that row.”

Digital security is another way blockchain can improve supply chains.

Steven Melnyk, a supply chain management professor at Michigan State University and global innovation chair in supply chain management at University of Newcastle, Australia, said blockchain can be part of the solution to a major cybersecurity problem.

According to Melnyk, cybersecurity aims to address three threats: theft of intellectual property; corruption of information technology, such as changing numbers in a company’s supply chain; and sabotaging equipment.

Blockchain, he said, is perfect for protecting the integrity of data, therefore combatting the second threat.

“If someone tries to change a schedule, there’s gonna be other copies of it,” Melnyk said.

He used a simple example: Blockchain prevents someone from changing a $500 check to a $10,000 check.

Melnyk described an American company  targeted by Chinese hackers. After penetrating the company’s computers and collecting information for two months, the hackers randomly changed order quantities and due dates in the company’s production schedule, causing it to botch several orders.

This is the kind of attack blockchain can prevent, Melnyk said.

“If you invest in blockchain, you’re investing in part of the solution,” Melnyk said.

However, blockchain cannot protect companies from intellectual property theft or the sabotage of equipment, Melnyk said.

According to Melnyk, cybersecurity is a two-part solution. One part is technology. The other is knowing how to use it, and by extension, convincing businesses that cybersecurity is necessary.

“I can have the best technology in the world, but if the person I’m trying to get to use it doesn’t understand why it should be used, guess what’s gonna happen? It’s gonna be ignored,” Melnyk said.

“The problems facing us are really far more complex than getting another solution. I think the worst thing we can do in cybersecurity is to convince people there’s a magic bullet,” he said.

That’s why Melnyk has introduced cybersecurity and blockchain into his classes at MSU.

“By the time we have a generation of managers, they’re going out there and they’re aware of the issues instead of us trying to teach them once they’re in the field,” Melnyk said.

Working to maintain blockchains is also a profitable venture.

For example, Ensource Capital LLC is a Wyoming, Michigan, company focused on Ethereum, Bitcoin’s main cryptocurrency competitor. By using a large number of computer servers, Ensource Capital verifies transactions and records for a blockchain. The verification work is then rewarded with cryptocurrency, in a process known as “mining.”

“The Ethereum network pays us to build their infrastructure — that’s how the mining works,” David Warner, its chief operating officer, said.

“We’re essentially providing their network infrastructure, so as a reward for doing that, you get the Ethereum tokens, which then get deposited to the investors’ accounts through our ‘smart contracts.'”

Ensource’s ‘smart contracts’ represent another side of its business.

The company’s main focus is expanding its Ethereum mining, for which it recently reached a $4 million private equity deal to build the largest mining facility in Michigan, Warner said.

The company also contracts out blockchain-based development projects, using the Ethereum network for applications such as automatically paying dividends to its investors.

“We’re utilizing the technology we’re building the infrastructure from,” Warner said. “If you’re a 10 percent owner, every week it will distribute (Ethereum) to your wallet automatically on a public ledger. If anything’s ever changed, everybody would know it was changed, so it creates a huge level of transparency with investors.”

Warner said blockchain has many potential applications in manufacturing, particularly to  trace supply chains.

He mentioned a test conducted by Wal-Mart in which a blockchain structure reduced its food recall process from 48 employees and two weeks to one employee in seconds.

“One guy, one second, clicked a button and knew where everything came from and where it went,” Warner said. “Traceability, on the manufacturing side, is massive.”

This could be just the beginning for blockchain technology. Warner said he recently discussed it  with U.S. Rep. Bill Huizenga, R-Zeeland, and other Michigan politicians.

“They’re all very well in the know and they’re very excited,” Warner said.

New CCC restores computer security, not trees

Capital News Service

LANSING — Michigan’s Civilian Conservation Corps. — the CCC —  helped restore the state’s forests in the 1930s.

Now, a new CCC – the Cyber Civilian Corps – has emerged to help restore the security of local governments, companies, schools and other organizations against cyber attacks.

Launched in 2014, the Michigan Cyber Civilian Corps is the first of its kind in the United States.

The team was formed by Gov. Rick Snyder and designed to assist government and industry in the event of a  massive cyber attack.

Under the Michigan Cyber Disruption Response Plan, the volunteer corps is activated only when the governor declares a state of emergency. None has been declared since 2014, and the corps never deployed.

But now lawmakers have passed a measure allowing any Michigan organization to request a corps volunteer to help itwith a cyber security problem. Snyder is expected to sign it into law this week.

It also gives volunteers immunity from lawsuits under certain circumstances.

The bill formalizes the structure of the Michigan Cyber Civilian Corps, which will work within the Department of Technology, Management and Budget.

Right now the group has 70 cyber experts who have agreed to help.

“We’re hoping to double the size of volunteers,” said bill sponsor Rep. Brandt Ident, R-Oshtemo.

Volunteers must be information security professionals who are residents of Michigan. They must have two years experience and basic security certification.

Applicants also need to pass a series of tests  to join the team, said program leader Ray Davidson. “Exams include basic tests about networking and computer security, and two tests each in digital forensics and incident response.”

The volunteers also benefit.

“We provide ongoing training that some employers don’t provide, so it’s a win-win for employers and the employee and for us,” Davidson said. “We try and offer something they can’t get anywhere else — the training, networking and the ability to give back to the community because there are still good people in the world.”

Davidson said with the new law, the corps can be activated at a lower level of alert.

Volunteers will work with municipal, educational, nonprofit or business organizations in need of expert assistance during a “cybersecurity incident.”

“Business could request us to come in, say they get all their computers like a ransomware attack,” Davidson said.

The volunteers come from throughout the state.

The government has declared 16 industries as critical infrastructure, and the corps will try to represent them all, Davidson said.  

“We try to have people that actively work in security organizations, not just in Information Technology but computer security particularly and most of these people we get, they don’t just do security at work,. It’s their hobby also,” he said.

The bills also offers immunity for volunteers during their deployment under the Government Liability for Negligence Act. That protects volunteers from getting sued if they inadvertently cause a problem but doesn’t protect them from lawsuits if they try to do damage.

“It is a pretty standard Good Samaritan legislation,” Davidson said.

Iden said organizations can request o volunteers from the Department of Technology, Management and Budget to help them fight a cyber attack for up to 10 days.