From remote monitoring to telemedicine to unmanned aerial delivery, all the technologies we need to deliver healthcare remotely via the Internet are available today. A variety of portable medical devices measure vital signs (temperature, heart rate, BP, BMI, oximetry and so on). Forget Skype, by next year Ostendo plans to have smartphones beam holograms just as R2-D2 did in Star Wars. Drones are being tested to deliver medical payloads to remote locations. Lab on a chip technology is more of a reality and can detect infectious diseases such as Malaria, Rotavirus, Influenza and so on. And digital stethoscopes, portable ultrasound machines, Internet-enabled otoscopes and retina cameras have been around for awhile.
All we need to do then is re-imagine healthcare delivery by connecting the dots. Let’s do so by first breaking up medicine into six discrete steps.
Six Steps of Medicine:
1. Underlying Indicators: This is when underlying indicators exist but symptoms haven’t manifested sufficiently to cause a patient to seek medical help. For example, a patient may be susceptible to heart disease (e.g. high cholesterol or high BP) but has never had symptoms such as fatigue or chest pain.
2. Visible Symptoms: Here, a patient suffers from mild to traumatic pain/discomfort owing to manifested symptoms. For example, fever is the most common symptom for a variety of diseases. At this step of the process, we do not know why a patient is suffering but we simply know that she is.
3. Preliminary Consultation: A preliminary consultation establishes objective data through vital signs (temperature, BMI, BP, SPO2 levels etc.). Vital signs broadly indicate problems that could become serious, persistent diseases.
4. Core Consultation: A core consultation is when a doctor tries to arrive at a diagnosis from a variety of possible options. Lab tests/CT-scans/radiology tests and so on are also conducted to arrive at as precise a diagnosis as possible.
5. Assessment and Plan: By this step, a doctor makes a clear assessment of the medical problem and prescribes a plan. This involves medications (e.g. antibiotics for an infection) or referring the patient to another specialist (e.g. a cardiologist for further investigation) or further examination.
6. Follow Up: Assuming that the patient follows through with the plan, a follow-up visit assesses the progress made and determines if any changes might be required.
It is these steps that need to be re-imagined and executed remotely removing the need for the doctor and patient to be co-located.
Advanced Technologies Enabling Remote Healthcare Delivery:
1. Lab-on-a-chip (LOC): An integrated microfluidics device that performs various laboratory functions. See Achira Labs, Cue, Foldscope (uses paper to detect Malaria), Eugene Chan’s Universal Blood Sensor.
2. Imaging: A pocket ultrasound device can ‘show’ the heart and working of other organs. A portable X-Ray machine extends diagnostics remotely. See GE Vscan, Mobisante, Fuji Sonosite, Siemens Acuson, Tribogenics Modis 810.
3. Digital-enabled medical devices: A digital stethoscope, otoscope, retinal camera can help doctors physically examine specific organs via the Internet. See Thinklabs One stethoscope, Rijuven Cardiosleeve, Cellscope, WelchAllyn Otoscope, Firefly Digital Otoscope, Phone-based retinal camera.
4. ECG and Vitals: Devices that can plug into a smartphone or tablet and can provide ECG and vitals such as respiratory rate, BP, BMI, temperature, oximetry. See Scanadu, AliveCor, Cardiac Designs ECG Check, Wello by Azoi, Withings.
5. EHR software: Other than storing medical records digitally, electronic health records can form a platform integrating data from doctors, patients, various medical devices and tests that make it possible to deliver healthcare remotely. This is the direction we are going with my company’s enki EHR platform.
6. Telemedicine software: Through technologies such as Skype, people are increasingly comfortable interacting over video. See Teladoc, American Well, Doctor on Demand, iKure. Ostendo develops a chip that can bring hologram technology to smartphones that would make a physician-patient virtual interaction more immersive.
7. Analytics software: Medicine is actively becoming a data science subject to analytics and therefore, protocol-driven medicine that can help curb disease at source. For example, population-scale deworming or screening for TB or vaccination protocols. Please see clinical decision support illustrations at Zynx, UpToDate, emerge, Isabel.
8. Unmanned Aerial Vehicles: Commercial drones are actively being tested to deliver payloads remotely. Watch this Amazon PrimeAir video that shows a drone deliver a package home. Why not prescriptions?
A Health Box for Remote Healthcare Delivery
Several years ago, Parashuram, an attendant in our office lost his wife (who lived back home in a village) due to a gastrointestinal complication. I tried to get her medical records to doctors in the US but the diagnosis came in simply too late. She died a futile death – like several millions of patients who lack access to a timely diagnosis. That episode changed the direction of our company – it became obvious to me that health data needs to traverse easily and globally and an early diagnosis needs to be arrived at to avoid both costs and complexity.
Given all the technologies that are today available, imagine if a patient had a Health Box, a conceptualization that integrates everything to deliver healthcare remotely via the Internet.
A Simple Visualization: When in need of medical care, the patient or her family presses a button on the Health Box that alerts a contact center, which then patches on a nurse/doctor-on-call via a hologram. Per the doctor’s request, required accessories are plugged in to the Health Box to capture vital signs (e.g. BP, temperature, oximetry) and a physical exam is conducted (e.g. asking a patient to cough and placing the digital stethoscope on a patient’s chest or back). The data is seen in real-time via the EHR. The doctor makes a preliminary medical judgment regarding the next step of care. In case of emergencies, the contact center dispatches a drone to deliver a medical payload at the precise location of the Health Box.
The World Bank estimates that India loses 6% of its GDP (that’s $110B) due to premature deaths and preventable illnesses. This statistic wouldn’t be a whole lot better for any developing country. The developed world has a more nuanced problem – the US also suffers healthcare access, premature deaths and preventable illnesses, perhaps more than the developing world. At the crux of the problem is our inability to stop disease at source. This is what remote healthcare delivery does – encourages patients and healthcare providers to deal with medical problems before they explode in complexity and cost. It’s imperative that we figure this out.
Illustration developed by Swapnil Chafale for representational purposes. Credit as due to creators of respective public images.