This is the second in a series exploring the telehealth sector and the Triangle-based companies behind its rise as a complement to traditional healthcare delivery. Check out previous articles and videos here.


Comparing North Carolina’s progress in implementing and developing telehealth technologies to other states is difficult given the nascent status of the industry.

Even so, our sources think North Carolina, and the Triangle specifically, is uniquely positioned to lead the industry.

“We have the medical and tech infrastructure combined with a very real need across the state, exactly what you would want from a state who could lead in telehealth initiatives,” says Matthew Cox, Head of Sales and Business Development at RelyMD.

Cox and other sources identified the following strengths the Triangle possesses that could set it apart: it’s strong talent pool, the existing healthcare systems and infrastructure, and the region’s growing innovation sector.

The national and state regulatory landscape and venture capital investments will also directly impact the Triangle’s leadership position in this field, but we’ll explore those issues in my next article in this series. Today, I compare the Triangle to three peer cities/regions (and their states when city-level data is unavailable), known for their healthcare and technology sectors—Boston, MA, San Francisco/Silicon Valley, CA, and Chicago, IL.

The data tell a compelling story—if talent, the existing healthcare and innovation infrastructures will lead to a competitive edge in the telehealth sector, the Triangle is poised to be a leader. But Boston, Chicago and San Francisco/Silicon Valley are stiff competitors and could outpace the Triangle if it doesn’t develop another factor by which it excels above other regions.


From surgeons to accountants, MBA’s to MD’s, a diverse range of talent and skills and training are necessary to provide quality healthcare. Perhaps that’s why in 2015 it employed nine percent of the total national labor force—more than any other sector—nationwide according to data from the Bureau of Labor Statistics (BLS).

Similarly, telehealth technologies also require a wide range of skills and expertise to design, integrate and implement into the healthcare system, notably a recombination of talents from healthcare provision and tech execution.

The wide-range of talent pouring out of the region’s three Tier 1 research universities—UNC Chapel Hill, Duke University, NC State University as well as that of the other surrounding colleges and universities creates a natural talent pool for the region’s hospitals and healthcare institutions and subsequently its telehealth industry.

Other cities have multiple Tier 1 research universities, too. Boston has Harvard, Massachusetts Institute of Technology (MIT) and Northeastern. California has Stanford and Cal Berkeley, and Chicago has Northwestern, the University of Chicago and the University of Illinois at Chicago.

In the Triangle, Duke and UNC-Chapel Hill are the only medical schools, so when totaled are graduating fewer doctors (MD’s) than Chicago which has five and Boston which has three.

Number of MD Graduates, 2015; Source: Association of American Medical Colleges

Tech talent is also an essential element for those who want to develop telehealth technologies or implement them in their health systems. Through their computer science programs, universities prepare graduates for tech-focused roles. NC’s universities rank among the top schools for computer science graduate degree programs, but trail behind MIT who topped the list in 2014 and Stanford who came in second place.

North Carolina competes well in terms of attracting new talent to the region. One report ranked the state as the third most popular destination to move to in 2015. And Forbes ranked Raleigh 9th in their annual ranking of best cities to job search, citing the regions low housing costs (relative to other cities), as a big draw to the area for job seekers.

Strong Existing Healthcare Systems and Infrastructure

Telehealth can’t happen if healthcare isn’t strong.

The Triangle’s existing healthcare institutions extend beyond Duke and UNC-Chapel Hill’s medical schools. The Triangle hosts three of the top ranked hospitals in the state, Duke, UNC-Chapel Hill and UNC Rex Hospital. Then there’s the network of specialists, clinics, and private providers.

Expertise extends beyond the Triangle. Baptist Hospital in Winston-Salem is also considered one of the state’s leading hospitals, and East Carolina University Hospital boasts one of the longest operating telemedicine centers in the country.

Boston, San Francisco and Chicago also have a plethora of top-rated hospitals though. All three house hospitals who rank above any NC hospitals on the US News list of best US hospitals.

Healthcare infrastructure isn’t confined to medical practitioners. The Triangle is dripping with biotech and pharmaceutical companies—in fact the Triangle claims either the headquarters or operations of nearly every major U.S. pharmaceutical company. In 2012, NC was home to 3.8 percent of all biotech companies, while California housed 13.9 percent, Massachusetts housed 4 percent, and Illinois housed 3.7 percent.

Growing Innovation Sector

In the Kauffman foundation’s 2016 Startup Activity Index, North Carolina ranked 8th by growth rate of new entrepreneurs, startup density, and the opportunity share of new entrepreneurs (whether they come from employment or unemployment),above both Illinois (19th) and Massachusetts (18th). California places 3rd, only outranked by Texas (1st), and Florida (2nd).

But because of the definition Kauffman uses for Metropolitan Statistical Areas (MSAs), the Triangle isn’t compared to Boston, Chicago and Silicon Valley Raleigh and Durham are counted as separate areas, though they compose part of the same community.

In terms of scale and growth, North Carolina startups are scaling faster and bigger than all peer states but Massachusetts who ranks 4th in Kauffman’s growth entrepreneurship index. NC ranks 8th while California and Illinois rank 11th and 22nd respectively.

The Triangle’s entrepreneurial support organizations, incubators, co-working spaces, and tech hubs have been integral to the region’s growth and will be necessary allies in building a telehealth industry in the region.

Possible X Factors

One of the gaps my sources identified in their work, and the big picture work of building a telehealth industry is that it takes more than talent, health and entrepreneurial institutions and infrastructure kickstart sustainable growth within an existing industry.

Brent Anthony, the Director for Strategy and Engagement at Brasco Design and Marketing believes the missing ingredient is collaboration. That belief is what motivated him to create a Health 2.0 chapter in the Triangle to bring healthcare providers, administrators, academics, and businesspeople together periodically to collaborate and problem-solve.

Similarly, Will ElLaissi of the Duke Institute for Health Innovation says, “the promise of government, academia, and industry coming together to solve all these areas [of healthcare}, is what excites me about the field.”

Whether collaboration or another X factor is what gives the Triangle an edge over other regions in leading the development and implementation of telehealth technologies is still unknown, but we’ll be watching and tracking the industry for the foreseeable future.