Healthcare Starts to Zoom Along

A year ago, if you'd used or even heard about Zoom, you were probably in the tech industry.  Today, if you haven't used Zoom, your friends or colleagues must not like you very much.  COVID-19 has made most of us homebound most of the time, and video services like Zoom are helping make that more bearable.

And, thankfully, healthcare is finally paying attention.

Zoom was founded in 2011, poking along under the radar for several years, overshadowed by competitors like Skype or WebEx.  For the entire month of May 2013 it only had a million meeting participants.  Even by December 2019 it could boast "only" 10 million daily users.

Then -- boom -- COVID-19 hits and people start staying at home.  Daily users skyrocketed to 200 million in March and as many as 300 million in April (well, not quite).  Daily downloads went from 56,000 in January 2020 to over 2 million in April.  Zoom is now used by businesses and families alike, drawn by it simplicity and ease of use. 

By all rights, we should be using WebEx for business video calls and Skype for personal ones.  Both had been around longer, offered credible services, and still exist.  But both were acquired along the way, WebEx by Cisco, and Skype ultimately by Microsoft.  As with its acquisition of Nokia, once acquired Microsoft didn't quite seem to know what to do with it.  Each left openings that Zoom plunged through when the pandemic hit.

Zoom's success has not gone unnoticed.  Google introduced Hangouts in 2013, Duo in 2016, Meet in 2017, with Hangouts and Meet aimed primarily at businesses using its G Suite.  Late last month Google announced it was making Meet available for free to anyone with an email account.  Google claims Meet now has 100 million daily users, up 30 times since January. 

Meanwhile, Microsoft had been pushing its business collaboration service Teams, and in COVID-19 times is now trying to broaden its reach to consumers, extending Teams to its consumer Office 365 subscription service.  While Microsoft insists Skype is booming, with over 40 million daily users, it looks like Teams is the future.  A spokesperson told VentureBeat:

For now, Skype will remain a great option for customers who love it and want to connect with basic chat and video calling capabilities.  With the new features in the Microsoft Teams mobile app, we see Teams as an all in one hub for your work and life that integrates chat, video calling, [and the] ability to assign and share tasks, store and share important data with your group, [and] share your location with family and friends, whereas Skype is predominantly a chat and a video calling app platform.  

Then there is Facebook.  Last month it launched Messenger Rooms, which allows for up to 50 people at a time on a video conference call.  It is a direct response not only to Zoom but also to life in a COVID-19 world.  CEO Mark Zuckerberg said: "Video presence isn’t just about calling someone.  It is starting to be a fundamental building block of a private social platform with lots of new use cases."  The service is free and does not include time limits.  

Credit: TechCrunch

Zoom gave competitors some openings.  Its security measures left something to be desired (although Zoom claims to have now addressed), allowing "Zoombombing" to become a thing.  Google, Microsoft, and Facebook have all stressed the security features of their video platforms; e.g., Microsoft's new Teams ad emphasizes its security.

Healthcare hadn't ignored video conferencing.  Let me rephrase that: video conferencing hadn't ignored healthcare, with companies like TelaDoc, AmWell, Doctors on Demand, and MDLIVE doing their best to make telehealth a standard part of healthcare.  With certain exceptions like Kaiser Permanente, though, telehealth seemed like healthcare's stepchild, beset by reimbursement issues, licensing restrictions, and simple inertia.   

As recently as last year, it was estimated that only 1 in 5 physicians used telehealth, and even that reflected dramatic growth.    Only one-third of hospitals had a telehealth option.  But the coronavirus pandemic changed all that.  Any kind of "elective" visits or procedures were limited; The Commonwealth Fund found that in-person ambulatory visits dropped 70% from mid-February to mid-April.  

HHS has actively promoted telehealth, along with many private health insurance companies.  Not having potentially sick people come into offices, exposing both other patients and healthcare workers, seems like a very prudent thing during a pandemic, and as both clinicians and patients get used to telehealth visits, many believe they will persist after the pandemic.

Zoom saw the potential in healthcare long before COVID-19, introducing Zoom for Telehealth (now Zoom for Healthcare) in 2017.  It offers "HIPAA/PIPEDA enabled plans" for healthcare organizations, and claims customers such as Phoenix Children's Hospital and Magellan Health, although one suspects that not all patients who are using Zoom to communicate with their physician are doing so with a Zoom for Healthcare platform. 

Similarly, Google specifically mentions "hospitals supporting patients via telehealth" as one of the uses for Meet, and Microsoft boasts that "Microsoft Teams can help healthcare providers conduct virtual visits," enabling "simple, secure collaboration and communication with chat, video, voice, and healthcare tools in a single hub."  That new Teams ad includes a healthcare customer as one of its four featured Team clients:

Not to be left out, Epic is reminding customers that its EHR can also be used to provide video visits with patients, a service it had previously rolled out with several telehealth vendors, including AmWell.  Epic is now working with Twilio to build its own telehealth solution. 

Stay-at-home restrictions are already starting to be lifted (even if it is not clear we're ready), allowing more of us to get out more often, even for healthcare services.  We'll be able to see our friends and family again, go back to work (although whether we'll give up remote work remains to be seen), and start using the healthcare system in-person again.  It's possible that Zoom has reached its zenith already, and the competition between it, Facebook, Google, Microsoft is a zero-sum game on a declining customer base,

But I don't think so.  We've now seen more of the world that broadband promised us over a decade ago, and we like it.  With healthcare, though, all too often it is about the money, not our convenience or preferences.  I just hope that healthcare learns its COVID-19 Zoom lesson.