Virtual Doctors… a Good Question.

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Hi Gang, I was at the Medical Devices Summit in Boston this week, and one of the attendees asked a...

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Posted by Tom KraMer (Discussions: 1, Comments: 4)
Replied on March 29, 2018 12:00 am
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Interesting question. The term "virtual doctor" sounds like a marketing term aimed at investors, rather than at physicians, who are probably not wild about the idea of being replaced by one, or at patients, who strike me as unlikely to want to consult a virtual doctor. On the other hand, videoconferencing makes it sound as technologically old school as it actually is....which I think is likely to appeal to physicians and patients, but maybe not so much to those who are looking to lure investors. But of course patients rarely have a say in the use of technology in their healthcare, and it would seem physicians have less and less say in the matter as well, so my first guess is that is more about reimbursement than cost, but I'm really in no position to know.
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Posted by Julie O. (Discussions: 8, Comments: 316)
Replied on March 28, 2018 8:00 pm
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Video conference-like sessions with the physician is what the question was revolving around. Using artificial intelligence (ie: Watson) to do something similar is another concept, but much further out.
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Posted by Tom KraMer (Discussions: 1, Comments: 4)
Replied on March 28, 2018 8:00 pm
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Tom KraMer - I would guess that reimbursement comes in, but I think it would also be worth distinguishing between video conferencing with a doctor you ready also see in person and having a telemedicine app.
Post-surgery, my doctor had me email her pictures of the site when there were concerns about it healing properly. I could see that virtual follow-up on an existing patient improve adoption rates if the revenue could be addressed and if one app became the gold standard. I don't want to have to download and learn to navigate a different app for each medical professional I see.

We are also seeing progress in the development of diagnostic tools that can be plugged into a smartphone. As this advances, I would expect patients, providers and payers to all become more confident that virtual medicine would actually be sufficient in some cases and not just still require a F2F visit to complete.
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Posted by Caitlin Morse, PMP (Discussions: 0, Comments: 11)
Replied on March 29, 2018 8:00 pm
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I agree wholeheartedly with Caitlin Morse. Reimbursement hasn’t yet caught up with the technology. And most patients want to start with in-person interactions that could be supplemented by video and app interactions.
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Posted by Jill Stanley (Discussions: 0, Comments: 1)
Replied on March 30, 2018 8:00 pm
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Virtual medical care (physicians and nurses) is just one arm of digital health. Digital health is about speed and prevention. I can get banking information and conduct a stock trade in seconds by touching my brokerage App. But I can’t get my own digital health records quickly and easily? Repeat MY OWN digital health record...meaning it’s my information. Technology such as sensors and home monitoring will improve the speed and efficiency of healthcare. These tools help prevent health issues from escalating into more serious matters. Such as Heart Failure events that an implantable ICD can detect before it happens. Virtual doctor visits add to this tool set by screening patients from unnecessary ER visits or by catching a problem before it arises. If local doctors and nurses don’t offer this service patients will get the help and support from India or another country. Whether you are based in downtown Toronto or India doesn’t matter to me as the patient. Digital health is about speed, efficiency and effectiveness gains. If you as a physician don’t have time to offer virtual care someone else will do it.
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Posted by Peter Aikins (Discussions: 0, Comments: 1)
Replied on March 30, 2018 8:00 pm
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Marc Slabbert an interesting debate
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Posted by Dr Variza Roopa (Discussions: 0, Comments: 1)
Replied on March 30, 2018 8:00 pm
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I feel it’s all about costs . I need a real doctor present if It was for me
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Posted by Janet Turansky (Discussions: 0, Comments: 1)
Replied on March 30, 2018 8:00 pm
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Posted by ZAIN Shah (Discussions: 0, Comments: 1)
Replied on March 31, 2018 8:00 pm
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Absolutely. There are several points to consider.

Time is the biggest factor. Will there be enough time to assess these patients as web consultation takes more time in average compare to face to face consultation.

How will you elicit the relevant clinical signs is there a reliable physician assistant available at the patients end?

How will you fit this patient if they need office based assessments, is insurance or patients are happy to pay for second face to face consultation

Governance around this needs to be sorted to ensure patient safety and safeguarding of the clinicians.

It would only work if this is a team work with proper framework
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Posted by Alakendu Sekhar (Discussions: 0, Comments: 1)
Replied on March 31, 2018 8:00 pm
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For three years I’ve been offering house calls and telemedicine when feasible between my ER shifts. Love it and feel a virtual tsunami is approaching. Bricks and mortar should be getting worried. I get an awful lot done with that 10% verbal.:)
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Posted by Samuel Slishman (Discussions: 0, Comments: 1)
Replied on March 31, 2018 8:00 pm
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The driver of this transformation will be runaway costs. We're outliving our useful economic lives. Society can't afford to keep a growing percentage of us tethered to machines, pills, doctor/hospital visits, and so forth for an ever greater portion of our time on earth. Let's face it--overall, medical technology enables better than cures. Diseases and conditions that kill may shrink; however, the dark side of such life extension poses a troubling future dilemma for the hive.

Ultimately, who will pay for it all? For example, will citizens who make better lifelong choices continue to passively support a system that enables--encourages, even--a large subset of the population to eat itself into a disabling state?

This thread is looking to the next year or so. My thoughts are more like decades out. In the meantime, Happy Easter to all!
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Posted by John Gillespy (Discussions: 0, Comments: 8)
Replied on April 1, 2018 8:00 pm
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John, It isn't costs that have run away; it is expenditures. Not the same thing.

I don't see how telemedicine saves much on costs in the foreseeable future. A physician's time is a physician's time, whether spent in person or via the internet. Seems like it would save patients time, which the system has never considered a cost. Over the very long haul, maybe reduced costs for bricks and mortar infrastructure. Whether that really proves to be a cost savings, time will tell.

It will be paid for with other people's money, and we are running out of other people to tap. I tend to think of the driver as form of market saturation. The market of users willing and able to pay for healthcare services and products was tapped out a long time ago. Now, if "other people" won't pay for it, you probably can't sell it.

I'm inclined to think that "decades out" may be a bit optimistic.
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Posted by Julie O. (Discussions: 8, Comments: 316)
Replied on April 1, 2018 8:00 pm
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Maybe if your patients are 1,000 ++ kms away, then you think differently about remote consultations eg in Australia?
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Posted by Raghav verma (Discussions: 0, Comments: 1)
Replied on April 1, 2018 8:00 pm
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PART I of Response: I'm old enough to remember health care before managed care and other forces disrupted the relationship between provider and patient--at times for the better, at others for the worse. And yet the revolution of the past 50 years, from creation of what in the short run turned out to be the medical "dream act" (Medicare, with its cost-based reimbursement scheme), is nothing compared to what's coming in the next 50 (or 40... or 30...). What is still lacking is a true expert between medical condition and treatment. That will require (very) big data, real time monitoring (from inside the body), (real) smart algorithms, and a virtual personal advocate to guide each of us. Eventually that information may be linked to personal lifestyle choices (food, exercise, and so forth) to create rewards and punishments that steer the populace toward better physical and mental health. A bit Orwellian, yes--something akin to the new social monitoring system being implemented in China.
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Posted by John Gillespy (Discussions: 0, Comments: 8)
Replied on April 1, 2018 8:00 pm
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John, that is a huge step, but I am sure elements of it are realistic in the coming years.

Samuel, I think it starts with what you are doing. You can use it where it fits best, and still go face to face when needed.

Hopefully as the world John described becomes more attainable, we will add those upgrades to Samuel's world bit by bit until we get there.
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Posted by Tom KraMer (Discussions: 1, Comments: 4)
Replied on April 1, 2018 8:00 pm
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Julie, a cost is an expenditure (whereas an expense is the usage of the thing purchased, but that's getting into the accounting weeds).

Information technology will devalue the health care provider's time, much as technology has for classes of workers since the industrial revolution. When big data + smart AI + the internet of things (the things being each of us) merge, of what value is the doctor or nurse? Some, yes; but far less than today. To a great degree they become technologists.

Radiology offers a case in point. An explosion of imaging devices since the 1960s elevated the value of a radiologist's time, leading to higher incomes. Today, however, machines are proving to be just as good as humans at reading x-rays, MRIs, CT scans, and so forth. The switch from Homo Sapiens (expensively trained and unscalable) to Watsons (massively expensive but eventually self-learning and remarkably scalable) is underway, and can only accelerate.
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Posted by John Gillespy (Discussions: 0, Comments: 8)
Replied on April 1, 2018 8:00 pm
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If it isn't reimbursed, there is no ROI and it goes nowhere. The technology is highly capable and ripe for treatment of common illnesses and for collaboration.
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Posted by Rick W Hogan (Discussions: 0, Comments: 4)
Replied on April 1, 2018 8:00 pm
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John, if we ever reach that point 50 years out, eating choices and lifestyle may no longer be an issue. There may be a tsunami coming from the DNA crowd, too.

Whatever you call them, my point is that it isn't the "cost" of an x-ray or a shot of penicillin that has skyrocketed since the 50s, but the amount that is being spent on diagnostic imaging and antibiotics, due in part to the use of more expensive imaging technologies and drugs, but I think more due to the number of images and antibiotics prescribed.

If first you buy a KIA to get from point A to B and then later buy a BMW to make the same trip, did the "cost" of transportation increase, or did you just spend more on it? Same question if you buy 364 BMWs, so you can make the trip in a different one every day of the year.


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Posted by Julie O. (Discussions: 8, Comments: 316)
Replied on April 2, 2018 8:00 pm
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But my own far-sighted question is what happens 50 years out, when healthcare (and many other) workers have been replaced by machines, and only a small percentage of people have jobs. This would seem to mean that most people won't have health insurance, and they won't be paying taxes to fund government-paid healthcare. Isn't that the end game here?
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Posted by Julie O. (Discussions: 8, Comments: 316)
Replied on April 2, 2018 8:00 pm
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There is no way it can be anything but incremental, even if the technology allows for more rapid advancement in other sectors. Healthcare is too important, and liability is a huge issue.

Plus, Rick keeps mentioning reimbursement, and he is right. It won't get adopted in a clinical world until it is reimbursed, and that will be incremental.

Direct to consumer would be a lot faster, and that 50 year prediction could be a lot less. I think technology will help people put their healthcare in their own hands, and will take some burden off the healthcare system. I think that is the short term end game.
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Posted by Tom KraMer (Discussions: 1, Comments: 4)
Replied on April 2, 2018 8:00 pm
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I think it will be sooner! Trying to get out of the house when you are sick is a real pain! Or a sick child for that matter! It would be hard to check your heartbeat, ears and throat, unless those are incorporated with products with capabilities to televise, for the doctor to see. The possibilities are actually exciting to think about in my opinion!
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Posted by Merrie East (Discussions: 0, Comments: 1)
Replied on April 2, 2018 8:00 pm
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I think Telehealth is a great start to make a convenient connection with healthcare professionals for a quick turnaround when a full visit isn't warranted. Virtual doctors is still some time away before being accepted the same way.
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Posted by Ihab Rashad, MBA PMP (Discussions: 0, Comments: 1)
Replied on April 2, 2018 8:00 pm
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Growing use of smartphones, increased numbers of internet users globally, are the major driving factors for OMC market. Get More Infornation @ https://bit.ly/2Ee7fN1 Penetration of internet and smartphones allowed people residing in rural and remote areas have access to online healthcare and doctor consultation apps.
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Posted by Mukund Salgar (Discussions: 0, Comments: 1)
Replied on April 2, 2018 8:00 pm
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As mentioned by previous commenters, all the technologies exist to make it happen. There are some insurance systems and other providers that are using telemedicine in limited regions (usually within state boundaries). Some of the current obstacles are state licensing restrictions, medical politics and turf battles. Those may be the most time consuming and difficult obstacles to overcome.
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Posted by Ted Newill (Discussions: 0, Comments: 2)
Replied on April 2, 2018 8:00 pm
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I think that is also depends on the medical specialty. As an example there are not many psychiatrists practicing in rural areas yet 40% of ER visits involve mental health issues. Tele-health psychiatric consults can be very beneficial to the both the patient and the facility.
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Posted by Dick Davis (Discussions: 0, Comments: 4)
Replied on April 2, 2018 8:00 pm
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See https://kry.se/en/ for reference. Used in Sweden as a substitute for your local outpatient clinic.
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Posted by Sara Sundström (Discussions: 0, Comments: 2)
Replied on April 3, 2018 8:00 pm
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The problem tele health solves is of access. To really capture value ,the pool of doctors catering to these patients should be increased. As of now they are just providing cures or prescriptions for common illnesses. Doctors present locally can utilize their time much efficiently treating in house visits on much complex problems or incidents of care then going online. This prescription piece can be handled by remote doctor operating in any part of the world. Thats when we will be able to solve access. That would not just need technology piece to change but also the regulations .
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Posted by Sahil Khullar (Discussions: 0, Comments: 1)
Replied on April 4, 2018 8:00 pm
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See https://kry.se/en/ for reference. Used in Sweden as a substitute for your local outpatient clinic.
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Posted by Sara Sundström (Discussions: 0, Comments: 2)
Replied on April 4, 2018 8:00 pm
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IoT in Healthcare is Growing used of smartphones, increased numbers of internet users globally, are the major driving factors for the healthcare market. Get More Information @ http://bit.ly/2qmjzXk Penetration of The growth of big data analytics, cloud services and artificial intelligence for healthcare applications is gaining significant traction. Several leading technology firms are investing huge resources to tap the potential of the IoT in the healthcare market.
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Posted by Erica Durance (Discussions: 0, Comments: 1)
Replied on April 11, 2018 8:00 pm
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