Video tower from my medical office (Photo credit: Lawrence Chu, MD, FACS)
I have a friend who is a family physician, and he has made a dramatic change in his practice. He told me of the daily struggles and the extended hours he would spend every day, missing family events and even putting off vacations. He told me he was burning out. But today, he reports a renewed enthusiasm in medicine. He can attend to his wife, as she has been dealing with some serious medical issues, go to school plays and be involved daily with his family again. He became a telemedicine doctor.
At several rural hospitals nearby, there is a shortage of physicians who can work emergency room (ER) or care for acutely ill patients. Using a robot called AGNES from AMD Global Telemedicine, he is able to provide an immediate presence when needed. The robot provides a mobile platform of digital diagnostics and video communications: Littman electronic stethoscope for listening to the lungs, heart or abdomen; a dermascope (digital scope for looking at the skin lesions, rashes or whatever); an otoscope (camera to look into the ear); a vital signs monitor for the heart rate, respiratory rate, pulse oximetry and blood pressure; an Electrocardiogram (measure the electrical activity of the heart); or a multipurpose camera to look inside the mouth or more closely at a burn or cut…all are options available on the robot. The cameras can take high definition video and magnified still images of any part of the body.
He presents himself on a monitor and can speak to the patient. He does require a skilled nurse to perform some critical physical examination of a few body systems. For example, comparing pulses in different limbs or palpation of the abdomen have not quite made an electronic conversion. He told me he trained several nurses to help him with this. By his report, patient satisfaction and hospital staff satisfaction have improved. Patients appreciate a “face to face” with the doctor, and the staff is happy because the physician who is called is cheerful and ready to help. So far, a win-win. The success of this platform has been the integration of diagnostic devices and the advancement in the video codec that allows the improved video connection. (Moor Insights & Strategy has written about the technology behind telemedicine in an earlier paper.)
Suppose we consider the use of telemedicine for more common visits, other than the Emergency Room. I can see the walk-in clinic found in Wal-Mart Stores, CVS Health or even the local grocery stores begin to use this technology. These small clinics are staffed with a nurse practitioner (NP) or physician’s assistant (PA). If there is a complicated medical problem, but not serious enough to send to the emergency room, wouldn’t it be great for the patient not to incur the cost of an ER visit, but to get the help needed? There could be a network of medical specialists that could be accessed by these mid-level providers.
Lets even consider a radically different model. A merging of Amazon Prime Now and telemedicine. For example, I have a sore throat. The Amazon.com website takes a quick screening questionnaire. Based on the answers, a specialized medical kit is dispatched to my home. Arriving in two hours, the kit instructs me to attach the electronic pack to my PC. There is a link emailed to me that gives me a few doctors in my local area who have signed up to see patients. Of course, there are reviews to help me select one. The pack has a digital camera to send live video to the doctor, and I can see the doctor on my PC or tablet. Once my connection is established, the doctor can ask questions and perform an exam. Using the special camera in the pack, like the Firefly, he can examine my throat, both ears, and even up my nose, all without me leaving my home. The electronic stethoscope can listen to my chest and heart. A small diagram pops up on my PC to show me where to put the stethoscope and the doctor is watching me to make sure it is correct. The Eroscan thermometer takes my temperature. He asks me to open a special swab, and video instructions are viewed to obtain a throat culture and run a home test for strep that was included in the kit. During this visit, the physician is having a conversation with me, discusses care plans and answers my questions. Medications are electronically prescribed. My medications arrive on my doorstep from the local pharmacy. I reassemble the kit, put it back in the box and return it. If needed follow up visits can be scheduled.
The technology for many straightforward medical issues is already available. Most people do not present with a diagnosis but symptoms of a medical problem. The proper application of knowledge and experience is still needed to sift through the information to reach a diagnosis. Before the digital connection, the telephone was limited in providing useful information. Even with a smart phone that can take a few pictures, there is a problem when diagnostic examination is needed. I believe we are seeing the beginnings of a dramatic change in the physician-patient encounter. With improvements in wearable technology, smart phones and improved secure telecommunications, this will continue to evolve into a new facet of medicine.