Telemedicine 2.0: the patient is becoming the point of care

April 2020

Words by Katie Puckett

Telemedicine will be an integral part of our healthcare future, and COVID-19 is accelerating the transition. But it will only reach its full potential if it is accessible to all, including society's most vulnerable

Telehealth has been one of the fastest growing parts of the healthcare sector, with a range of new apps such as Teladoc, Doctor on Demand (pictured) and Babylon serving a patient base that is increasingly tech savvy. The millennial generation and younger, in particular, are comfortable with digital interaction, and demanding that providers allow them to access services in this way.

For patients, the prospect of video consultations with clinicians is more convenient than taking time to go to the hospital, especially for routine check-ups or minor conditions. For providers, helping patients to better manage conditions at home through remote monitoring and automated reminders offers a way to reduce the burden of chronic disease and demand for medical intervention. The COVID-19 pandemic has accelerated this trend, as governments around the world urge their citizens to stay at home, and for only the most severe cases to attend hospitals.

“COVID-19 will expedite the transition to a telemedicine environment. We are piloting and clinically validating products in real time”

Michael Crawford, Howard University College of Medicine

“Telemedicine will be a critically important access point,” says Michael Crawford, associate dean for strategy, outreach and innovation at Howard University College of Medicine in Washington DC. “It’s not only how we leverage telemedicine and remote monitoring in a pandemic, it’s how we should deliver care, period.”

Data will be the key to future medicine, he believes. By integrating health, social, financial and environmental data across disparate platforms and applying artificial intelligence and machine learning, we will be able to better track infectious disease or flag patients at risk. “If people have been instructed to self-quarantine for 14 days, we could evaluate them based on historical data, and start to create personalized, real-time interventions. If an individual’s biometrics deviate from the normal pattern of recovery, we could proactively deploy resources to address the issue.”

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The only way to deliver care to people in their homes is to understand how they function within their home environment — their natural habitat, he adds. “If we are capturing a patient’s activity patterns and evaluating their heart rate, blood pressure, breathing patterns, sleeping levels from a wearable device or sensor, then we can observe if they are trending in the right direction or when a medical intervention would be appropriate.” Patients could be sent a message to check in, or in more serious cases, a medical professional could be deployed to the home.

Faster network connections between hospitals will enable experts in different places to collaborate during procedures — and even to operate on patients remotely. For example, in 2019, the CorPath GRX robot (above), developed by Corindus, was used to perform the first remote heart surgery — on a patient 20 miles away — in Ahmedabad, India. Virtual and augmented reality could also allow surgeons to view scans or anatomical data superimposed on a patient, or to control a robot that is carrying out an operation somewhere else.

The most important thing is the quality of the data, says Crawford. “If you have an integrated historical data set, collecting new information provides different insights regarding an individual’s health and enables you to personalize interventions. If we had this infrastructure in place today, we could be more efficient, strategic and prudent in our resource allocation in addressing a pandemic.”

But — and it’s a big one — telehealth’s potential will only be realized if it’s targeted at the populations that have the greatest incidence of chronic disease: “When we are referring to vulnerable patients that are susceptible to COVID-19, a disproportionate amount reside in medically underserved communities.” These are exactly the communities that find themselves on the wrong side of the digital divide, lacking the resources and technical literacy to fully participate online.

An Accenture survey of nearly 8,000 people across seven countries found that 47% would prefer a more immediate, virtual appointment over a delayed, in-person appointment

2018 Consumer Survey on Digital Health

Howard University is seeking to address this with its 1867 Health Innovations project — Crawford is inviting tech entrepreneurs, innovators and corporate partners to develop scalable models for this demographic over the coming months. Solutions are likely to be delivered over cell phones, but Crawford expects them to depart from existing products in various ways. “The clinical pilots will likely reveal that minor modifications in content, interfaces and tech will better align with individuals’ care needs. The interface might look different, the content might be worded differently, the instructions and manual might look different, the things that you have prioritized might look different for a chronically ill population.”

When super-fast 5G networks, high-definition video conferencing, and ubiquitous sensors are a reality, it will also radically reshape the healthcare landscape. Outpatient clinics are likely to become a thing of the past and only the most serious conditions will necessitate a trip to hospital: hospitals are already becoming places for only the sickest of the sick, and this trend is set to continue.

Drones to the rescue

Ultra-high-speed 5G networks will underpin another feature of healthcare’s not-so-distant future: drones. These could make a real difference to outcomes in remote areas, where they could deliver medications or defibrillators — the probability of surviving a cardiac arrest declines by 10% with each passing minute, according to the American Heart Association. A Swedish trial by Telia, Ericsson and Karolinska Institute of Medicine found that 5G-based drones could reach the scene of an emergency four times faster than an ambulance.

In Canada, about half the population live in major cities, with good access to healthcare. The other half do not. “In the interior of British Columbia, last year there were over 800 incidents where it took more than 45 minutes for a first responder to reach a life-threatening situation,” says Kevin Cassidy, head of healthcare at WSP in Toronto. “Can we use that technology so that if I have a heart attack on a mountain, a drone is dispatched right away so my friend could care for me while the paramedics are en route? Getting that reaction time down could save somebody’s life.”

In 2019, a trial using a 4G LTE cellular network provided by Ericsson allowed drones to fly 80 miles while being piloted from 3,000 miles away in Vancouver. Moving to 5G would allow an even further leap in capability, supporting many simultaneous drone flights and greater accuracy.

Main image: Doctor on Demand

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One comment on “Telemedicine 2.0: the patient is becoming the point of care

  1. Chironhealth on

    very useful information i am so glad you have provided the information

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