Telemedicine, also known as virtual care, has become an important tool for the delivery of care. Its demand from patients is increasing and the technology behind it is advancing. For instance, we’ve seen an increase in adoption of current telehealth models, SaaS Telehealth and On-Demand Telehealth, because of the convenience and accessibility that both models provide. But we do not expect telehealth trends to just stop here. The following trends are indicators that telemedicine is going to evolve far beyond what we can currently envision, and that healthcare professionals and organizations must be proactive in incorporating virtual care into their practices.
Virtual Medical Centres
Virtual medical centres refer to healthcare facilities that use telemedicine to provide diagnostic services and treatment to patients. Imagine the following scenario… You’re a patient at Mercy Health in Chesterfield, Missouri, and you notice an alarming skin deformity. You think to go to the nearest urgent care clinic or emergency room, but the roads are closed due to a snowstorm. So, you log into your Mercy Virtual portal through your computer and are connected with a healthcare professional via video. You are given a diagnosis and referral to a specialist. Sound futuristic? Well, situations like this have been going on since late 2015 when Mercy Health spent $54 million on the first “digital-only hospital with no beds.”
The ideation of virtual medical centres is rooted in digital health command centres. Health systems are equipping themselves with digital health tools, such as predictive analytics, giving them the capability to anticipate, detect, and mitigate risk in real time. These command centres are becoming standard practice when digitizing a hospital's workflow. Just recently, NewYork-Presbyterian decided to expand its virtual care services by launching the Hauser Institute for Health Innovation.
Mercy Health isn’t the only health system that recognizes the long-term benefits of telemedicine. The Cleveland Clinic launched its eHospital program, in 2014, meant as “a second layer of monitoring and a resource for bedside caregivers.” It’s important to point out that these remote monitoring programs provide a comprehensive set of services that complement and augment the traditional delivery of care. As digital health tools advance and become readily available, these services are going to become more and more complex, such as telesurgery.
Establishing a virtual medical centre or command centre requires setting up telemedicine bunkers. Bunkers are essentially work stations equipped with multiple computer screens, remote patient monitoring and video conferencing capability, and access to patient medical records. The image below offers a good visual representation of these bunkers.
A great example of telemedicine bunkers is Cleveland Clinic’s eHospital program. Their hospital network provides care to hundreds of thousands of patients, which makes it difficult to staff specialists at each location—especially during night shifts. By utilizing virtual care and remote patient monitoring, the eHospital program gathers “a team of doctors, nurses and medical technicians…to watch over 208 patients in special-care units or intensive-care beds.” As mentioned, bunkers are not exclusive to physicians, but also nurses, nurse practitioners, medical technicians, pharmacists, etc. This is an important feature as it further improves access to a healthcare professional, a commonly cited barrier to care.
Currently, setting up a telemedicine bunker is expensive due to infrastructure and staffing costs. This is changing, however, through the hub and spoke model: inter-hospital telemedicine networks are being created, “where outlying hospitals use robotic technology to connect quickly and cost-effectively with a tertiary care facility.”
In the last couple of years, the healthcare industry has gone through many mergers and acquisitions (M&A), and the lines between patient, provider, and payer have blurred. This is also the case with digital health tools, such as precision medicine or consumer-driven healthcare devices. Just in the first quarter of 2019, there have been numerous digital health M&A deals, where telemedicine is being combined with home-based care, remote patient monitoring, scheduling, and wearable medical devices.
Consolidation is not only a sign of increased investment in digital health but, ironically enough, it’s also a sign of decentralization of care. As digital health tools improve convenient access to care, delivery of care is going to be offered outside of traditional health care settings, such as hospitals and outpatient facilities. Telemedicine bunkers are a perfect representation of this. Despite bunkers usually being stationed within hospitals, they provide care to patients in and out of the hospital.
Another consideration of healthcare consolidation is the role occupied by health systems. Many digital health companies are independent of hospitals and clinics. As healthcare becomes more reliant on electronics (i.e. computers, EHR/EMR, telemedicine, blockchain, etc.), health systems are developing their own digital health and innovation departments/institutes—NewYork-Presbyterian being the latest. While many choose to create their own technology, there is something to be said about startup companies’ tailored solutions and unique expertise. In fact, certain virtual care platforms provide a full platform and domain customization, tailored to their clients’ needs.
5G is a hot topic in healthcare right now. It is the newest generation of wireless cellular networks that is promising speeds that are 10-100 times faster than current 4G. AT&T has already rolled out multiple 5G hotspots, with the goal of having it in 21 states by the end of 2019. 5G will impact everyone, but its impact on healthcare is especially interesting. With faster speed and shorter latency periods, patients and providers don’t have to worry about slow service or call failure during a video session. Currently, 4G supports about 4,000 devices per square kilometer before the network slows down or crashes. 5G can support up to a million devices.
Other than fast speeds, another potential benefit of 5G is that of customized networks, where network operators can create sub-networks that are suitable for specific interactions. For example, there could be a low-latency network for telemedicine, while creating a separate medical imagery transmission (i.e. X-rays) network with fast download speed and wide geographical coverage. By adopting these networks for services such as remote patient monitoring and robotics, healthcare professionals can reduce costs and improve patient outcomes.
As was hinted earlier, the era of wireless surgery and medical operations is near. In March of this year, Dr. Ling Zhipei, of PLA General Hospital in China, performed brain surgery on a human patient more than 1,800 miles away using the Chinese wireless 5G Internet. This is the first reported wireless human telesurgery. The reduced latency periods will allow for more accurate and quick remote surgery, without sacrificing quality of care. The future of 5G in healthcare relies heavily on infrastructure and interoperability between devices. Considering most smartphones currently aren’t optimized to function efficiently on a 5G network, we’re far from seeing robots perform surgery via an iPhone. But, we’re close.
These trends in telemedicine indicate an exciting and promising future of improved patient outcomes and access to complex care. Healthcare professionals and organizations, including small practices, should prepare themselves by setting up the infrastructure necessary to support these trends.
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