1. PART 4 A SEVEN PART SERIES ON HOW HEALTHCARE IS TRENDING.
AND, IT’S RIGHT IN THE PALM OF YOUR HANDS.
_________________________________________________________________________
Why Telemedicine is changing the healthcare
landscape and redefining the meaning of a
Doctor’s “Office” visit.
By Steve Okhravi, MD, MBA, CPE
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PART 4
Speeding Access to a Wellness
Conversation is the Solution in the
Doctor/Patient “Office Visit.” It builds
efficient, productive relationships.
Once we realize that enabling the conversation more elegantly via mobile and robustly
technical solutions, we realize the healthcare conversation can, in fact, happen anytime,
anywhere.
And, the conversation can help grow the relationship because the old barriers:
a) Appointment setting;
b) Travel to-and-from the physician’s office; and
c) Waiting for the physician to become available, etc., etc.,
we see a whole new window of opportunity to grow the relationship, enhance the
conversation and close the service gap…to make it more universally available for
consumption. This premise puts the patient’s needs first.
In short, the interconnectivity of the patient/doctor interaction is aligned rather than on
the Doctors turf and singularly dependent on the Doctor’s calendar. There is no
separation of church and state. The relationship and power is equalized in the optimized
totally mobile Telemedicine experience. The experience is influenced heavily by the
medium through which it’s communicated. And, it’s already in your pocket!

2. The Smartphone App — the new
standard where we can turn to for
“everyday” healthcare.
This, actually, distills the matter to its essence:
On one side of the table we have a patient need. On the other side of the table we have
physician’s agenda and their practice environments. The model is untouchable. Right?
One can only wonder. We know that patients prefer not to wait for access to the Doctor.
Understandably, they want healthcare when they “feel” they need it. Also, Physicians
love to practice medicine; they enjoy helping people feel better. The General Practitioner
hangs out a shingle and encourages the patients come to them at a scheduled time. So,
therein lies the potential disconnect. The old standard is all about gaining access to the
Doctor, pending his or her availability and traveling to a practice location.
What do patients do?
Patients trust the Doctor’s instincts. They should know best. Right? The patient goes
through the paces to fit the physician’s predetermined parameters for access and they are
led through practice process. A little sheepish, wouldn’t you say?
Obviously, during the course of a “visit” or “session” the practice staff and physicians
will do what they do best: have the patient present their symptoms and respond
accordingly pending their medical knowledge, past experience, current research, an
examination, vital signs review and the patient history provided or previously recorded.
They do all the work, so they and their collaborators (medical partners, pharmacies, labs
tests suppliers, etc.) take the process as rote and continue the pattern of the when-and-
where-care determination. Physicians have the bio-medical-scientific-intellectual
credentials to make a difference in the patient’s wellness.
Separately, tech companies supply content that provides instantaneous results
(intelligence) that meet the demands of the public via their ever-present mobile/wireless
connections.
The difference between those two entities (when-and-where-care and tech suppliers and
the results they display) is simply that, a chasm. However, in cooperation the power of
both provides enormous dividends to the patient. It’s a win, win, win situation. The
traditional, inelastic-to-change bricks-and-mortar “Office Visit” model medicine works
extraordinarily well for certain indications and symptoms. No doubt. But the lion’s share
of routine symptoms presented can be vetted and (perhaps) effectively managed via the
new standard—Telemedicine conversations. The old boss meets the new boss: And, in

3. this model, the patient service quotient climbs to the top of the food chain.
Isn’t that nice for so many…at anywhere, and at anytime. Democratized medicine!
Quick recap:
Doctors practice medicine on their turf.
Tech companies provide instantaneous results via mobile technologies.
Limitations regarding one can be eliminated by harnessing the power of
the other. Amazing.
Things are quite straightforward with this new standard.
What about sharing this knowledge, enabling the adaption of the Telemedicine
technology and changing the landscape of practicing “everyday medicine”?
The Mobile Device App —
where we turn to for Knowledge
and…Healthcare?
Physicians are always learning new stuff: it’s a prerequisite to practicing
medicine…Continuing Medical Education… Now, before we safely assume that Doctors
want to change a fundamental way that they practice and “see” patients, let’s ask
questions.
The first question is:
What do patients and physicians want to learn?
But it’s difficult to draw a straight line between what we want personally and what we’ve
been conditioned to:
a) expect,
b) adapt to,
c) consume, and
d) how likely are we to change our behavior when it comes to healthcare.
A better question:
What do all stakeholders think they want to learn about?
Where is the common ground and benefit for all parties?
Is it sustainable?
Is it scalable?
Is it simplified enough to remove (rather than present) barriers to success?
The strongest reason we do things is the idea that we follow the default—
It’s the pre-existing choice!
The most interesting question to explore, then, is:
What did they have to learn about so far?
Where do they look for answer?

4. Two prominent examples that come to mind are:
a) Knowledge institutions (medical colleges) and
b) Knowledge curators (bloggers).
Medical colleges are official institutions (governmental or not) constructed to facilitate
educational activities on topics that are, practical and realistic for a physician’s career.
Their value (and relevance) lies in their ability to give you a credible medical
practitioner’s certificate.
Their main value is the credibility of the paper they hand you at the end of your studies
and their continuing commitment to learning.
Let’s not forget, medical colleges are institutions with history, brand reputation and
success rates to maintain. All this is going on while we live in a world where…
1) Quality knowledge is democratized and freely available, and
2) People care about results or quality services in addition to the assurances of one’s
medical credentials and abilities (aka-- certifications).
In reality, medical colleges teach physicians about the practical side of their career,
potentially marginalizing a vital part of today’s information age/mobile society reality.
The practical and realistic issue of practicing medicine is a time-tested tradition of
scientific evaluation, testing, observation, historical healthcare review, etc. Diagnoses’
are made, therapies are prescribed, follow-up reviews are scheduled and so goes the
process.
Practically, the majority of the physicians graduating from college have seen traditional
medicine grow in scope, technologies change and practices enabled by electronic
medical records…and so on. And, these graduates assimilate and internalize the
enhanced accessibility tools that enable the aforesaid. Certainly, the newest breed of
Doctor is a child of technology and mobility. Yes, they know how to approach, diagnosis,
practice medicine or manage symptoms. But, what’s next? Well: mobile medicine, of
course.
Let’s return to the initial question:
What have they learnt about so far?
The answer: how do we enhance their access to intelligence, manage this intelligence
remotely, efficiently and presumably grow their practice by a combination of the above.
This creates a foundational framework in medical student’s logic and likelihood for
adaption to and the technological impact on everyday medicine. So, telemedicine IS
principally a sound practice and deeply entrenched in the psyche of the new guard.
Everyday medicine can be practiced anywhere, anytime. In the next generation of
physicians this is a given practice parameter. It’s the aforementioned: Logical adaptation
of the technology immediately at hand to speed the access to the conversation between
patient and physician. Enhance the relationship. And, we can grow/serve the
“community” of the health conscious masses. It’s designed to close the physical gap

5. between the consumer of healthcare advice and the provider. It’s fast, efficient, effective
(for certain, everyday, indications and symptoms).
Even hardcore, old school, practitioners (who primarily focus on the inherent value of the
one-on-one, eye-to-eye patient interaction) are affected by the mobility context and have
realized they need to adapt to the technology they use everyday (or become irrelevant and
obsolete).
But, entities are diehards. Some are still inelastic to change. They need a pathfinder to
provide the platform, the roadmap to the new technology so they can jump on board.
And, say, they were waiting for the “right time”, the “right opportunity” to participate in
a program with “legs”. A program they can be proud to participate in because it doesn’t
interrupt the “patient experience”, is a viable way to practice, and a viable business-
responsible way to get involved in the conversation about wellness.
Meanwhile, there is another form of education for the health conscious, this time it is
related to business, promotion, communications and technological adaptation. The
knowledge curators (the bloggers) dominate in this area. They are the Sooth-Sayers.
Perhaps, so much so, that the Bloggers very existence threatens the old order of editorial
content originators.
The great thing about blogs: diversity of opinions, they’re free for everyone, you don’t
have to lock into a committed schedule to read them and you can work on your own pace.
It’s all good. Type anything in the search bar, you’ll probably find a few hundred posts
about any topic, examined from various angles. In fact grab this content you are reading
now, put in your own views and re-publish it from your point of view. References in
order, this enhances the intellectual conversation on ANY topic, and grows the dialog,
raises awareness on issues and (using social media) has the likelihood of going viral,
eliciting sea change in trends/perceptions, mass behavior and best practices. Blogs
(editorial content) can move a society.
The downsides of this blog-generated knowledge are conspicuous:
1. How credible is this knowledge and how do we filter the signal (useful
information) from all of this noise (the incremental vastness of posts)?
2. How do you stay accountable to someone, so you can put things in practice after
consumed and having processed them, and how do you get support if you have
questions?
From my experience, nothing read on the Internet should be taken for granted without
further investigation (even this article). When the entry barrier to publishing is having an
Internet connection, quality of content inevitably drops.
Just because someone can write about a topic (in an interesting way, most of the time), it
doesn’t mean its true. You should not necessarily pay attention or change your behavior
according to the precepts presented from the Blogger’s POV.

6. In a democratic society of free exchange in dialog, everyone can be an expert. And,
everyone can (and does) analyze their experiences. This creates a comfortable echo
chamber for today’s health conscious:
So, what does this mean:
1) Much is possible, and Telemedicine is not only practical, accessible, effective and
efficient according to very specific criteria;
2) Physicians can make a living as a Telemedicine Practitioners
(Without a doubt, my local health professional community colleagues have lined up to
jump on board as soon as my DocChat APP and platform is launched);
3) Healthcare knowledge/access to physicians is enhanced by this technology;
4) The Solution is easily downloaded to your Smartphone,
5) It’s freeware: entry barriers are non-existent to sign-up, and have the functional
access to the experience… the solution is virtually in the palm of your hand 24/7/365.
6) The cost of entry for a session can and will be relatively low; so calling it a
democratic healthcare solution, an alternative to an office visit; a wellness tool designed
for the masses is no hyperbolic positioning statement.
7) In fact: This premise is the REAL DEAL on Healthcare. This is one wellness solution
that can generate the “conversation” necessary to help so many, anywhere, anytime…
within 15 minutes.
a) That said, where does this effort and investment come in?
b) Who will participate to get these lofty plans for lifting DocChat off the ground?
Bloggers may “quote post” this essay, because they’re open to timely, relevant comment
on issues that effect those interested in healthcare trends. They also may reflect on the
idealistic overtones to these ideas. However, the most profound extension of this essay
would be to extemporize on the best practices necessary to implement this timely concept
in the real world as we go through:
a) Beta testing;
b) The iterations necessary to perfect the solution;
c) Rollout DocChat out in various formats; and
d) Scale: Go from local to national to global proportions.
Quick recap: Medical colleges are institutions constructed with the mindset to
graduate physicians ready to practice medicine. They offer credible knowledge.
Generationally, their graduates are less slow-to-change given their pre-
disposition to technology: a boon for the adaption of “democratized”
Telemedicine providers worldwide. They will speed access to the “conversation”.

7. The Conversation Grows
Following up on the Conversational aspect of Healthcare, wellness and closing the gap
on access to physicians--let’s study the old standard:
Bricks and Mortar Office Visits: Why do most Doctors practice medicine in an office
setting? Because that seems the best way today to converse with, inter-connect with and
practice their trade. It helps them find new patients, diagnose and treat existing patients
and earn revenue to support their practice. It is one of the few remnants of the old
standard of medical practice that has survived and still makes sense for patients and
doctors alike.
Most physicians look for practice growth in conventional ways: referrals from other
physicians, satisfied patients who refer family and friends, and physical signage at the
location of practice, and, increasingly marketing, public relations, public speaking, health
fair event participation, directories, review sites and interactive communications. They
tap into a network of venues that is known to host similar healthcare “conversations” like
corporate clients and trade organizations, senior care centers, and other places where
health conscious individuals congregate (Conversation Centers).
In short, if a physician wants to practice, they have to build the business of the practice.
Increasingly, mega practices are taking over the healthcare industry, which limits the
individual Doctor’s practice role in business of running a practice for profit. This
business building activity benefits everyone associated with the mega practice. There’s
no real exposure practicing without reaching out into the community. After all, people go
to a particular practice with a particular need given its geographical location and
specialty, if any. The “healthcare provider’s patient experience” is tied to the larger
practice; the various touch points that the patient comes into contact with as they go
through the practitioner’s operation: initial contact, answering services, administration,
appointment setting, greeting upon arrival for scheduled appointment, how long they wait
prior to seeing the physician, the experience while attended to by the physician’s assistant

8. prior to actually connecting with the physician who attends to the patient. We also need
to consider the physician interaction, treatment, follow-up correspondence and,
tests/meds dissemination, etc. And, even the billing department adds to the experience,
positively or negatively.
The real business win, the “mega-medical-practice” appears to have the upper hand in
this flow in a brick-and-mortar model.
My point of view: no matter how functional the large bricks-and-mortar
practice system is (because of the consolidation of venues in a network) there
are an increasing number of patients that simply need a medical opinion on a
common ailment. The result: there is somewhat of a void that is difficult to
satisfy for daily patient needs; to grow a patient-centric practice and build a
business that levels the playing field. This is not going away unless we look for
alternatives. Telemedicine provides those options. An App Functionality to ease
access to Doctors fills that gap, simplifies the process and lowers the overall cost
in time, money and distance between consumer (patient) and provider.
Presently, there is less emphasis on:
productive online interactions with accessible physicians /
personalized conversation in living rooms /
crowd-funded, crowd enjoyed, crowd-vetted solutions that result in healthcare sessions
on demand /
custom-made live experiences for individuals who simply need a Doctor’s opinion in
unexpected places, at unconventional times---on their terms within minutes of the need
arising.
Making a viable business of this thing called Telemedicine for “everyday illnesses.”
The notion that interactive technology can be impersonal is ingrained into the healthcare
community. It’s not a surprise why most patients hesitate to take control of their
healthcare environment, let alone make a conscious effort to dominate it by dealing with
everyday healthcare concerns via a Smartphone Application.
Patient response, hypothetically:
“Maybe that works for music downloads or a social media outlet…
but, can I manage my not feeling ‘just right’ today via an App?”
Physician response, hypothetically:
“Can I practice medicine and earn a living this way?”
To establish a credible business model to operate this way (using New Standard
Interconnections) providers in cooperation with the tech/EHR companies have created
somewhat complex, feature-rich engines, options and possibilities.
There are several models active; some have received considerable funding through
various sources.

9. We see:
• Time-for-money exchanging revenues
• Brand-related revenues (capitalizing on “name” brand’s i.e., Dr. Phil)
• Patronizing (third-party crowd funding)
• Real-time access to medical records for remote consultations
• An attempt to duplicate the “In-Office Experience,” on-line, on the phone
In practice, most physicians earn revenue through traditional medical procedures, running
tests, scans, X-Rays, Cultures, prescribing meds/devices, and so on: It’s a transactional
model that runs parallel with compassionate care. This practice has its place and is
similar to services provided by my multi-office Urgent Care practice based in NYC.
There’s nothing wrong with that, for certain indications presented by patients. This model
employs the solutions of tech companies to support the established model of practice
operation.
The DocChat point-of-view:
There absolutely are times and situations when this model shines. And, in fact, this
complex model is absolutely necessary in certain situations. This model is also
practically sustainable, scalable and patient-centric to the extent of the “conventional”
parameters in place.
Though, how will physicians build a real-time, patient consultancy for everyday illnesses
that do not require being on-site, or to have instantaneous access to myriad historical
patient records on the fly (HIPPA regulations abound for who sees what files) to be
practiced, anytime, anywhere by the “assigned physician on call, on shift, and at the
ready” business model instead?
Well, one solution is to create a Platform dedicated to unparalleled availability, for all,
with unprecedented access and delivering on the promise of a health consultation session
in 15 minutes, to boot! That is the DocChat concept in a nutshell. Pare away the
complications, simplify and provide access…all within the local regulations for practice.
Promoting Telemedicine/building a community/providing access to a consult
fast. Things are pretty straightforward in this premise. Medical marketing today is a
constant effort to raise awareness, communicate the facts is a straightforward manner,
dispel misunderstanding, and differentiate against the noise around options and
possibilities for the New Standard healthcare. At it’s most basic, this DocChat idea is
about beginning and continuing a running “conversation” about individualized wellness
advice. It provides guidance on what I keep referring to as everyday occurrences of
specific symptoms; they are the sweet spot for a DocChat session. It’s where the App and
platform works best, where we provide the most value in the shortest amount of time and

10. how we fill a gap in the current solutions: be they conventional and/or part of the New
Standard/Telemedicine. In the pursuit of promotion, for want of a better term (patient
education/market segregation?) I realize the relevance to state the DocChat intent and
mission by using social media or blogs to communicate all that’s necessary to establish
this niche and change behavior about the need for a bricks-and-mortar office visit. And,
let’s remember, it is a niche, regardless of how large I see this offering’s growth
potential. Remember, I opened this essay by saying 70% of all office visits could be
handled via Telemedicine. The number, in retrospect, is staggering when you scale the
transition from the old standard to the new standard, as an App-based solution.
Although the way to ensure this concept is heard by those tech-savvy patients who would
benefit most (as early adapters who get the long tail logic of technology assimilation to
the masses) it still comes down to human-to-human communication. It pursuit of a
passive introduction to Telemedicine it seems that most Physicians simply exhaust their
personal network and don’t go past that stage. I venture here to be that pioneer and I
have the energy and passion to follow this calling with a select team of forward-thinking
partners to help me get there.
My point of view: the noise in the digital world has increased exponentially.
Everybody wants you to pay attention to something incredible (which, when it
comes to App-based solutions and Start-ups is frequently, more sizzle than
steak). So people choose to stop paying attention whatsoever if the launch is not
carefully positioned, constructed, rolled out in phases to refine the solution and
Managed for Success.
I’d think of this effort as “Design for Manufacture.”
That is:
We will build this App to serve the audience, simply, elegantly, to the end goal of
empowering patients to get better advice for their wellness at a lower cost in
time, money while adding convenience and accessibility.
Yes, I can be called an eternal optimist: But, how do you convince the world at
large to listen to you when there is either too much information to consume or
the information is complicated and therefore inaccessible?
(Remember, the whole purpose for this solution was to ADD ACCESSIBILTY!)
Here are the Telemedicine Operational Touch Points we will employ to spread the good
word:
a) Creating an exceptional product/service worth talking about
(This includes: The App, The Patient Experience it triggers…The Healthcare Gap It
Closes | The Constructive Conversation it begins | and, The Relationship it enforces)
b) Being where attention is already
(We will ride the wave of the information era)
c) Connecting with influencers
(Bloggers, health fairs, online forums, Featured in “New and Worthy” at App Stores, etc.)

11. d) Organic Growth from within
Working with our contact list, patients, partners, colleagues, early adapters as our Brand
Champions and New Standard platform ambassadors /
Existing practice loyalty (community building) instead of constant growth /
Improved “patient experiences” instead of transactional office visits
(need a flu-shot, get a flu-shot)
e) Collaborations with other partners, brands and established networks.
f) Time Management. The notion that Patient’s time is a valued commodity has always
been a stronghold in the foundation of my multi-office NYC-based Urgent Care Practice.
So too, is the DocChat principle based. There’s nothing confusing here. Physician’s value
their time and want to practice efficiently to optimize and grow their practice, to:
“spread the wealth of their knowledge to the most patients, as practically as possible,
and to advocate wellness.” Healthcare professionals “get it”…that healthcare tactics like
telemedicine ALSO take into consideration the patient’s time to go through the “consult”
process.
The DocChat POINT OF DIFFERENCE:
There seems to be no platform where patients tap into when it comes to organizing and
prioritizing their tasks/time around their OWN healthcare conversation.
I imagine that THIS IS DocChat’s SWEET SPOT. It’s THE secret sauce.
This IS the Reason for Creating DocChat.
What comes close to an anagram for the DocChat Branded Platform is what I call:
E-M-P-A-T-H-Y
(Empowering Patients: Actively Talk Healthcare Yourself)
…that is, everything around the patient “owning” the conversational process for a
DocChat session.
Via this Unique and Proprietary App, the Patient:
a) Initiates the session
b) Has the session on THEIR terms
c) To meet THEIR needs, and
d) Does so anywhere, anytime.
Now that’s EMPATHIC, Patient Care.
This is a happy patient outcome, because spending time on your own wellness—instead
of delegating it to a process that is largely out of your hands (i.e., scheduling the bricks-
and-mortar “office visit” for a common ailment)— can lead to frustration, lack of
motivation for the “experience of the wellness consult” in light of a more advantageous
new age of instantaneous information mobility, AND crowd-sourced intelligence.
Ultimately, anything less than “instant gratification” in this context presents a lack of joy
for the healthcare process of maintaining a conversation around an everyday occurrence
of “not feeling up-to-par.”

12. My point of view: I get it… patients may feel disorganized around their
healthcare, especially when they (or the loved ones in their care) are just not
feeling particularly well. This lack of organization, time management, time
“control” can render them even less satisfied when they go through the
appointment setting process, reach out to a physician office for an appointment
to be set in days (or weeks). This results in a feeling of being “all over the place;”
and, out of control. I want control in my life. So do my patients.
The DocChat App and Platform adds these controls, establishes a commitment
and resource management (the timing and scheduling is patient or self-
actuated) are what makes patient empowerment flourish and creates a proper
balance in the healthcare conversation. It’s a sea change in attitude, process and
balance of power in the wellness dialog.
Interim Conclusions:
a) “Outsourcing” healthcare conversations to technical solutions (Apps) can have the
opposite perceived effect:
The DocChat solution can be warm, empathetic and personal (not cold).
b) Help from fans—benefactors, patrons, partners
Allocating tasks to friends of change is fully expected to help build an effective team
around a patient-centric healthcare brand, help put a practical empathetic productivity
system in place, and facilitate the patient experience of an anytime, anywhere consult.
c) Collaborations with partners outside medicine
(technologists and communication experts in new media)
…helps clarify goals, define roles and responsibilities, and provides answers to the many
questions necessary to support the launch of a healthcare start-up built around a New
Standard of Patient Care.
(Smartphone Wellness Consultation/Telemedicine for Everyday Ailments)
If the Platform (the App, its’ practical/operational ability is to speed the access and
conversation with a physician) is problematic, then the solution will never be
effective and impede progressing the remote patient healthcare experience.
Practical Goal:
Hence, my clear objective and intent is to keep this DocChat solution simple,
available to access in real time, and (always) delivered on the patient’s real terms
(I.e., The anywhere, anytime consult).
___________________________________________________________________

13.
So, the community, the need and the resources (once aligned) rise to the occasion:
The Wellness Conversation is enabled. And, the Anywhere, Anytime Consult is launched.
That’s the DocChat concept, plain and simple…(Cont’d on Part 5)
Dr. Okhravi's deep credentials have made him the perfect candidate for creating and leading Emergency Medical Care
facilities in NYC. This novel Urgent Care facility is dedicated to the NYC communities that EMC serves. In his
professional CV you'll find an uncanny blend of healthcare practice, process and work flow savvy, along with
exceptional hospital, ER and business management skills. This convergence of skills formed EMCs best practices and
stand-alone ER healthcare knowledge based on practical, progressive, efficient, and compassionate urgent care
principles.