Update on remote healthcare delivery from Michigan to Sri Lanka
I wrote earlier about an experiment in remote healthcare delivery – in which medical students from University of Michigan (under the guidance of an Ann Arbor-based physician Naresh Gunaratnam, MD) are working with an eldercare facility in Sri Lanka (Grace Care Center) to manage health of 40 patients via a virtual, group consult every other week. Here’s what we have learnt so far.
1) A group consult is very effective, even emotionally. Unlike the private nature of healthcare delivery we are used to in the developed world, a group consult can actually be highly effective – even emotionally. It helps patients realize that others are sick too and they are not alone. This somehow converts the group consult into a more supportive environment that can possibly increase patient compliance.
To describe a group consult, a patient in Trincomalee, Sri Lanka sits in front of a Skype camera and interacts with doctor(s) in Ann Arbor, Michigan while other patients wait in the background and observe. The doctor(s) go over key vitals, past history, medication list, dosages and examine latest data available and note what’s changed from the last time. They ‘look’ at the patient via Skype, ask questions (some general) with the help of a translator/ medical assistant on the Sri Lanka side. Naresh and the medical students arrive at a consensus on what to do and then they move on to the next patient.
2) One hour together is a lot of time. When a group of doctors go over each case methodically for a group of patients, a lot is actually accomplished. Time is saved. There’s a unique sense of transparency – everyone knows what is being done. Unlike in private practice medicine, there’s a different sense of teamwork among the doctors and among patients. Learning occurs both ways.
3) The mind can’t really tell the difference. Video-conferencing even via a blurry medium (in this case Skype over a moderately paced Internet connection) is very effective. Patients (and doctors) forget after a point that no one is physically in front of each other. The doctors aren’t located in a formal office – in fact, some are on their bed, some in their studies, some in their kitchen. This provides a different sense of camaraderie and in a completely different way they are welcoming the patient into a personal space. After the initial minutes, the mind actually forgets what’s virtual and what’s real. The patient-doctor interaction can get as immersive and real as a video game.
4) Using evidence-based guidelines. Given the age of patients, the focus of care has been hypertension, followed by diabetes. Readings are captured by the assistant every other day and entered into the system. We are now programming enki EHR using JNC 8 guidelines for hypertension to automatically assist during care based on age and medical background of the patient. During the group consult, the guidelines keep care-givers in check based on evidence-based protocols. The evidence-based methodology provides great balance to the human interaction enabled through a virtual consult.
4) Medical devices that aid remote healthcare delivery. From blood pressure monitors to glucometers to stethoscopes, there are now several Internet-enabled devices that can “show” you the data via the Internet.Quantified Care demonstrated via the Smartphone Physical a variety of devices that could be used to conduct a physical exam remotely. The most interesting device out there is Scanadu Scout that captures a variety of physiological readings (several times a day if needed) through a tiny sensor-filled machine. We are exploring the use of remote monitoring devices to further our experiment.
5) Sometimes, virtual is better than the real thing. This past week, Naresh shared the outcome of a short survey done amongst patients. They feel well taken care of and actually prefer ‘virtual care’ over a real one. While this may be early, it’s startling and very telling. But when you think about it, it’s actually not surprising. For some patients, the alternative to ‘virtual care’ is usually bad care or even no care.
Why this is the future and could change how healthcare is delivered
Every few decades, medicine undergoes a big shift – increasing access, life expectancy and so on. We are in the middle of another one – where medicine is becoming a more precise data science. There’s increasingly more data available about the human body – from a gross level (# of steps taken in a day to # of hours slept) to a deeper level (DNA testing to microbiome testing). Doctors are increasingly reliant on data (usually via lab tests) before making a medical judgment. Most data is always available via a patient’s electronic medical record. The ‘Internet of things’ is a very real trend (think, the Nest thermostat) and is becoming the ‘Internet of medical things’ where medical devices are Internet-enabled. Patients continue to live longer through the aid of medications and fixes at the hospital. Fewer and fewer doctors are getting into primary care where the basic flow chart of a patient’s diagnosis begins. Cost of care will continue to explode (even in the developing world) as science advances further within specialties and the influences of regulation, administration, insurance companies and law continue to rise.
The trends point to a world where access to quality and reliable healthcare will not just continue to be difficult but may also increase. The trends also point to a possible future where healthcare is accessible from anywhere through a mobile Internet connection with the aid of virtual consults and medical data through an EHR.
By Praveen Suthrum, President & Co-Founder, NextServices.