CHRISTUS Health

Lynn Gibson

Telehealth and telemedicine have been in the active discussion of future trends in healthcare for many years. With the growing change in both governmental support, technology, and societal demand for convenience, we continue to see a growing increase in the utilization of telehealth. However, much of the discussions have focused on the perspective of the provider. Yet the current demand for changes are coming more from the end user’s demand and expectations. Our end users are more sophisticated on choices and options in delivery of care and their expectations are much higher today than they were just a few years ago. They are growing less tolerant of waiting rooms and long waits for the actual contact with their physician.

"With the growing intertwined Internet of Things, telemedicine will soon become our new house call"

Historically telemedicine was not a delivery method that was highly available. The reimbursement model for physicians has not being adopted, mainly to a lack of compensation for their time. It required a significant investment in technology to do anything beyond a simple face-to-face conference call. However, times have changed; the majority of the states have instituted legislation to support the payment to physicians who utilize a telemedicine approach. The technology has become more affordable and easier to use.

Technology today has changed so rapidly that many consumers now have cell phones, tablets or PCs which have video transmission ability. Many of these new devices have high-resolution cameras, which can transmit incredibility clear images on a moment’s notice. Rural communities who once had no ability to provide even basic cardiology or neurological services are now able to provide initial consults through telemedicine. When you factor in the growth of the internet and its access, user expectations are growing faster than much of the industry can maintain. Also, consider the growth and availability of internet enabled devices, which are becoming more affordable and covered by medical insurance, we are on the verge of a cultural change that has not been seen since Medicare and Medicaid became a part of our medical culture.

It was just a few years ago that a national survey was conducted to see what consumers wanted from their healthcare provider. Many in the industry had expected quality to be the number one answer. The survey yielded the expectation of quality is to pre-exist. Convenience drove the majority of need. In many urban areas around the country, several groups have appeared who have embraced this concept and now offer a simple first round online connection for a fast diagnosis or potential triage at a very nominal fee. As an example, take the first time mother who has a child with chronic colic and at 2:00 AM is at her wits end. Today she can use her smartphone to connect with a site where a live nurse, physician assistant, or physician can connect to provide the young mother with guidance. As another example, the bed-confined individual due to illness would otherwise require an ambulance followed by an emergency room visit when the issue maybe simply treated if closer monitoring was available and have the necessary care brought to them. Telemedicine is already in use to help these situations bringing a faster level of care and at a much lesser burden on the overall medical process.

The growth of new technology becoming more available for the end user is having such an impact that we may be returning to the days of house calls although virtual. More options exist today for the end user to experience home delivery services in the form of internet-enabled devices to handle basic things such as blood pressure, pulse oximetry, glucose, and heartbeat. Individuals have the ability to capture basic physiological information one would normally experience in a basic office visit and have it transmitted to their provider. Another growing development is the modular home laboratory kits where a wide variety of lab test conducted with simple blood sticks or urine samples using test strips. The reactions and results transmitted via the internet and the doctor remotely can then discuss with his patient the potential implications. At that point, the determination then made as to the best course of an office visit or even a house call as some physicians are starting to do in the larger urban areas.

With the refinement of technology, consider the potential of an individual who needs a prosthetic in a remote community. Imagine a local clinic equipped with a 3-D printer and appropriate software connected via the internet to an orthopedic surgeon hundreds of miles away. The telemedicine visit launches, the physician conducts an online exam, the sizing and other requirements are quickly determined and transmitted to the printer in the clinic. In a matter of minutes or hours, the patient leaves the clinic with the new prosthetic that just a few years ago would have required multiple trips and days of lost time before a device would have been fitted for use.

One last thought to share is more futuristic. With the development of electronic ink and nano-smart drugs, imagine being able to order through the internet a paper based body suit that you would step into in the privacy of your home. The ingestion of the smart drug and a simple connection to your smartphone or other electronic device allows an application to initiate a full scan. This scan is transmitted to your physician when completed where again a smart application has already identified potential abnormalities for the physician to review. The level of convenience and reduction in time would reduce the dreaded results wait from days to hours or even minutes. The potential cost reductions would also be significant.

With the growing intertwined Internet of Things, telemedicine will soon become our new house call. This will not be a threat to physicians but a new way of practice for those who are willing to embrace it. For the future patients, telemedicine will be a level of convenience as we live in ever-growing age of online living.