Using Tecnology to advance our practice, what are the top three areas that would move away from health care bricks and mortar buildings to virtual applications or complex care at home?
I would Involve the deployment of AI (artificial intelligence) within the scope of the question.
I would suggest that action be a marriage of technology and payer enabled patient participation as step one and choice one. This I believe would be a cornerstone of additional healthcare opportunities.
- Pharmacy services- now offering home and mail delivery- Infusions are being offered in the home
- Prescriber-office visits- will be reduced
- Hospitals days stay will continue to be reduced.
Addressing with my opinion as to the movement away from brick and motor, the following
- Moving the prescriber’s office to the members residence.
- As the population increases in age and with the increasing chronic disease developments, the enhanced use telemetry, telecommunications would enable remote clinical monitoring for most chronic disease related diagnosis. Improved patient compliance with devices which indicate if a dose has been taken, Blood pressure, weight, respiratory measures, eye scans and many more elements may be developed.
- Removing the travel of the patient, removal of weather related barriers would be a benefit in better patient outcomes.
- Assimilation of patients and care givers health records in a sharable HER that is accurate, informative and reduces wasted efforts with repeats of testing done previously and the received not transferred. Pharmacist-Prescriber-Nursing- family and other care associates should be able to add information. This is being developed under the term of “Block-Chain”.
- This also removed a burden form the patient as to routine repeats of information giving.
- Actions at the home may become a derivative of Alexa, or other voice activated devices with smart AI for alerts and assistance.
- Based on patient data and demographics, the physician may desire to make home rounds for selected patients. With the preceding AI and voice activated information, the patient could precede visits with more details than the current office 8-10 minute interview now occupies.
- Hospitals will continue to shorten days stas based on technology advancements of taking the hospital to the home. Home infusion, DME, medical supplies are currently being used and deployed to minimize the hospitals days inpatient.
The three areas I would recommend to move care away from the hospital to the home include: applications that demonstrate care has been authorized by the payer, telehealth technology (scales, glucose monitoring, holter monitoring with live feedback, etc) and a shared electronic health record to allow both patient and provider the ability to see the problem list and to assure the provider has all information needed to complete the assessment and intervention.
- We will continue to have solution shops centered around doctors and hospitals. This will provide personalized care requiring a high level of education and intuition.
- There will be transactional care run by mid-level providers like physician assistants and nurse practitioners following algorithms and best practices. It will occur at retail clinics like CVS, Walmart, and various iterations
- There will be facilitated use networks like AA, The Crohns and colitis foundation where those with the problem support each other with professional supervision, providing far less costly support than a doctor could do in a 15 minute visit. This will include on line communities and apps like D-Life for diabetics. Chat bots will be utilized.
- Various disruptive innovations will be used across all domains including AI for decision support, genomics and personalized medicine, wearables, virtual reality and biofeedback, blockchain to insure the security of the internet of things, and more.
Just some general thinking. I have a useful contrarian view toward much development effort. Getting more and more productivity out of any resource eventually pushes the limits if its resiliency. That also seems to be something we appear to be running into all over, and not yet reflected in any economic plan. If you just call it "system congestion" I think that's been plaguing us for a good while already, really reducing our return on resource investment systemically. I see it in how our systems thinking seems to get increasingly devoted to fixing the problems caused by our previous solutions, forcing shortcuts that often cost more than they save.
One of the more problematic of these negative feedbacks for healthcare is that the industry's profit motive seems based on making progress in driving up the price of overcoming mortality, creating ever more costly new treatments that inevitably crowd out the delivery of basic services. I've suggested for some time that we tackle the problem by setting a fixed limit to the GDP devoted to healthcare. That would assure us of continually improving healthcare at a fixed price instead of questionable improvement at a soaring price. It does propose a rather complicated accounting task, and rather uncomfortable culture change too perhaps, but it might be better to solve it than let it break us.
Since mortality and budget limits are both rather certain, I think we need a healthcare system aimed at serving public health, not subsidizing costly care that undermines public health. It seems ultimately unavoidable too, depending on finding the math for having continually improving healthcare within our means. It might mean having lotteries for getting high priced procedures deemed worthy of research for example, instead of being available on demand, if customary procedures or respectfully assisting people with behavior change, perhaps, would serve society better. I think either something like that or a much more sharply inequitable society are not far off.
Check out Medically Home (www.medicallyhome.com) to see just how disruptive in-home healthcare can be. They get patients out of the hospital and back home faster, improving quality of care and quality of life, while eliminating much of the overhead and organizational baggage of hospitals.
More will be done through telehealth once providers can get paid adequately for their services. We also need secure platforms that support devices that are easy enough for patients to operate reliably (which is a tall order in itself). As others have mentioned, AI has an important role to play, gathering vitals and other biometrics and serving as the early warning system for when attention is required.
These changes will accelerate as large employers, insurers, and healthcare services recognize that these programs will lower their costs and result in better outcomes. We will not need to wait for government mandates; profit and loss will drive innovation.
Editor, Health Tech Insider