The Shape of Care to Come

In recent months, the vague outline of a new Telemedicine system, that will allow doctors to diagnose and treat patients online, has come into sharper focus. This is just one of many advances that are in the pipeline of the medical entrepreneurial community. Let’s consider the future landscape, the shape of care to come, if you will.

Right now some of the most revolutionary innovations in healthcare involve technology that will tend to move care “centrifugally” away from large centers such as hospitals and clinics and toward the home and the internet, with the latter encompassing both desktop and mobile platforms.

Imagine in a few short years having many of your less serious healthcare needs met over the web through a secure connection with your doctor and the use of home health devices that will electronically transmit your vital signs, cardiac rhythm and even echocardiographic (heart) images. They will routinely include pulse oximeter (oxygen) readings and galvanic skin response (to detect swelling) and will use high definition video to show a close-up of a rash or a cut (if it’s a full thickness laceration it would require a visit to the urgent care or ER. If not, the care could be completed at home and an unnecessary visit avoided). Diabetics can already send their blood sugar readings and a patient will soon place a device in his ear that will transmit data enabling his doctor to diagnose an infection remotely.

Telemedicine technology is already available now, although only a fraction of “early adopter” patients are using it with any regularity. Village Health is in the process of designing a software solution that will enable us to bring the above care to our patients, increasing convenience and reducing the cost of care. We are also planning for the eventual use of remote monitors for those patients who are not so sick that they require continual inpatient cardiac and vital sign monitoring but who would benefit from a remote system. Such pro-active systems will detect clinical worsening before advanced hospital care becomes necessary.

The system will rely on small transducers taped to the skin, which will send out signals wirelessly to a 24-hr monitoring facility. Any vital sign, pulse oximeter reading or cardiac monitor event which was outside the stable range would result in an immediate alert to the patient’s doctor via text or other signal. The patient could then be contacted by phone, text or video conferencing, “examined” virtually by the doctor, who could escalate the level of care, including possible remote activation of the EMS system – within minutes of the alert.

This is all part of an accelerating “devolution” of care away from costly hospital admissions where patients are exposed to ever more dangerous superbugs and sometimes risky procedural interventions. The often wasteful and superfluous layers of mandated care, which doctors frequently criticize as treating the checkbox – not the patient – is a legacy of the old healthcare model. It should be remembered too that when you’re sick, there really is no place like home.

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