Tag Archives: digital medicine

Practicing Medicine in the Digital Age: Challenges & Opportunities of the Virtual Encounter

The digital age of medicine is upon us.  This past week at the opening Plenary session at the Annual Heart Rhythm Society Meetings, we heard Dr Eric Topol and others tell us that we must embrace social networking in order to engage patients and improve care.  The Affordable Care Act has now changed the landscape of medical practice in the US–we must do more to focus on preventative care and work harder to curtail costs.  More patients are insured and a primary care shortage is upon us (according to data from the AAFP).  In fact, it is estimated that we must create an additional 65 training spots in primary care every year for the next 10 years in order to keep up with the demand–this is assuming that the AAFP estimate of a 25% growth in workforce will be needed to meet the growing pool of insured Americans.  In addition, preventative services will require frequent follow up, patient engagement and support services.

Patients are more connected than ever–most patients now go to the internet to prepare for office visits and come armed with lots of information.  Office visits are already now dominated by keyboards and EMRs–it only seems logical that the next step will be virtual access for physicians and patients.  With growing primary care shortages and an increasing pool of patients needed access to care, telemedicine is likely to play a much larger role in the future.  The concept of telemedicine is not new–remote areas and hospitals have been utilizing telemedicine consults in order to provide specialist support for primary care physicians with limited access.

This week, the Wall Street Journal’s Belinda Beck reported on the growing telemedicine business–doctors seeing patients via computer portals from nearly anywhere in the world.  Several web based companies are now regularly hosting virtual doctor visits online where physicians and patients interact via phone and internet.  Patients describe symptoms and discuss issues with their virtual doctor and are then prescribed therapy–all for a cost of only 40-50 dollars.  Most visits are completed within 15 minutes and no travel is required for either doctor or patient.  Advocates argue that for simple straightforward problems telemedicine visits are much more cost effective and also provide high quality efficient patient care.  Critics have voiced concerns over the quality of care, lack of doctor-patient relationship and the over-prescription of antibiotics.  Some argue that when a virtual visit occurs, diagnosis is made more difficult due to a lack of physical exam.  In addition, data obtained by the Wall Street Journal from Rand, indicate that virtual visits are more likely to result in the prescription of an antibiotic.

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(Graphic from JAMA Internal Medicine and Published in the WSJ)

As you may expect, guidelines from regulatory agencies and medical boards are currently in the works.  Virtual physicians will be held to the same standards as in person office visits and continuity of care is being encouraged by allowing patients to choose their virtual doctor rather than have the provider randomly assigned.  In addition, the Federation of State Medical Boards is now recommending that all virtual doctors are licensed in the state in which the patient that is treated resides.  However, this particular requirement for licensing does not really make good sense if the objective of telemedicine is to provide care to those with limited access to physicians.  Virtual medicine has the potential to meet significant primary care needs in remote, rural and underserved communities and may be an alternative to in person treatment of simple, straightforward medical problems.

As we continue to reform the US healthcare system, many challenges must be met and overcome.  Providing affordable, high quality, efficient care to a growing number of insured Americans is a significant task.  With the advent of digital medicine and advancements in mobile technologies, it is now possible to provide care to patients who may otherwise remain unserved.  Wearable sensors, mobile devices that can obtain real time electrocardiograms and other technologies in development make it possible to receive diagnostic data from remote locations.   In order to be successful, we must embrace change and utilize the digital tools that are now available to provide care to those who so badly need it.
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(Image source: Screen grab via YouTube TED talk by Dr Eric Topol)

Personalized Technology in Medicine & Building Steve Austin: Better, Stronger, Faster

As a child, I often watched science fiction movies and television shows wondering how much would become reality in my lifetime.  From space travel in Buck Rogers and Star Trek to time travel in Back to the Future, I often imagined growing up in a world where the impossible became probable.  Bionics and the repair of human tissues was captivating and the Six Million Dollar Man (and its spin-offs)  became a hit series.  (we never missed an episode on Friday nights in my house!) Now, much of what was thought to be science fiction is becoming a reality in today’s world.  No other discipline has seen science fiction become reality and produce human impact as readily as the medicine and the treatment of human disease.

Medicine is becoming increasingly “electronic” and patients of all ages are more consistently “wired” through the use of the internet, mobile devices and mobile applications for health.  Patients are able to track health status, blood pressure, blood glucose and other indicators via their smartphones.  This ability to track and transmit data is important to streamlining care and improving the efficiency of the doctor patient interaction.  Hospitalizations are prevented through early intervention when physicians and patients have access to data while the patient is still an outpatient.  For example, many implantable cardioverter defibrillators (ICDs) and pacemakers have diagnostic sensors that can transmit important information to clinicians and allow for the outpatient adjustments of medication before the patient reaches the point where hospitalization is necessary for congestive heart failure and other cardiovascular diseases.

Now, researchers are beginning to develop small, unobtrusive diagnostic tools that have the potential to not only transmit health status but also deliver therapy.  In Monday’s Wall Street Journal, author Robert Lee Holtz reports on implants that are as thin as tattoos that are able to collect, process and respond to health data.  Even more impressive is the fact that in early clinical trials, some of these sensors are able to deliver medications and therapies in response to the collected biologic information. The biophysics of personalized medicine is upon us–experiments are being conducted in laboratories all over the country in order to design miniature, accurate, responsive sensors that can easily integrate with the body and dissolve when no longer needed.  In fact, as reported in the Journal, current experiments include using digital technology sensors on eyes for glaucoma, wrapping around hearts in need of a pacemaker and implants that control pain after surgery.  These types of technologies, while potentially years away from routine human use, represent a major shift in the way in which doctors are able to care for patients.  We are becoming increasingly web savvy–at all ages and in all demographics.  As a society, we must accept more individual accountability and responsibility for our own healthcare in order to help contain costs.  New developments such as implantable sensors and drug delivery systems may help doctors treat more diseases remotely and avoid costly hospitalizations.  For patients, increased education, increased self awareness and the ability to receive real time feedback from therapies may improve their ability to make lifestyle adjustments and improve their own health status.

As I have said many times in my blogs, engaged patients enjoy improved outcomes.  New technologies such as tiny implantable sensors and drug delivery systems will allow patients to connect like never before.  I look forward to a future where devices are individualized and personalized for each patient’s particular disease process and needs.  I believe that it will not only be important for physicians to be able to interact with the biologic data BUT also for patients to receive and interpret this information via a smartphone, computer, tablet or other mobile device in order to make adjustments and prevent complications or exacerbations of disease.  Although we don’t have Steve Austin or the Six Million Dollar Man with us, we do have the technology to make all of us Better, Stronger and Healthier.  The Age of Digital Medicine is here–we must embrace these new technologies and promote their development and deployment in the marketplace in order to improve the lives of our patients TODAY.

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