Imagine, you are a 50 year old male experiencing difficulty breathing, distorted vision, sweats and peripheral numbness. Merely seconds after beginning to experience these symptoms, you receive an electronic alert message. “Robo-Doc will see you now!”
You direct your device to open a line of communication and a slew of data is virtually and seamlessly transmitted to your treating physician including your temperature, pulse and heart rate. Next, you are prompted to answer a series of questions and provided with specific instructions. Within minutes you are greeted by the paramedics ready to transport you to the nearest specialized stroke treatment center.
At arrival, the nurse does not ask questions wheeling you to your pre-checked room. There awaits a stroke specialist who has already reviewed your virtual-chart (“v-chart) and is ready to conduct additional diagnostics and provide you with appropriate medical care. This scenario is not the future. Indeed, it is the healthcare system achievable today.
With the Department of Health and Human Services shifting its focus to quality of services rather than quantity of care rendered to patients, providers’ pay is now commensurate with the results obtained.2 The next generation Accountable Care Organizations (ACOs) launched in 2016, promise not only care coordinated services but also increased availability of telehealth services.3 While in some instances, quality may be measured via objective tests; in others a patient’s rating will be the most meaningful factor in determining provider’s pay.
Providers are scurrying to develop patient rating models to measure subjective system satisfaction. This data will not only contribute to higher pay rates, but also be utilized to attract new generation of care services shoppers. To build a foundation for delivery of care excellence, providers must evaluate their facilities and substantially invest in next generation healthcare systems, such as telehealth, virtual care and remote treatment centers.
One of the early pioneers of telehealth are Teladoc and MDLive offering video and phone physician consults.4 In 2014, Google introduced a San Francisco based Doctor on Demand Application offering access to over 1,400 board-certified physicians to consult with you via video chat.5 Heal is an application similar to Uber with a doctor arriving at your doorstep instead of a car service. This service is currently available in California, Los Angeles, Columbia and Stanford. 6 Go2Nurse brings a nurse to your home in Milwaukee. 7 Curbside Care brings a nurse practitioner or a physician to your home in Philadelphia. 8
The nature and extent of virtual consults are as diverse as healthcare itself. Spruce offers dermatological video consults; HealthTap offers web-based chats and video conferencing type consults; and Maven focusing on women’s health exclusively. 9 Opternative offers a home equivalent refraction test.10
Healthcare providers and insurance companies are also competing to capture shares in the virtual treatment market. Jefferson University in Philadelphia offers convenient internist, urologist, ENT follow-up visits.11 Mount Sinai Health System in New York offers patients PCP video visit.12 Mercy Health System in ST. Louis recently opened a $54 million virtual care center to house urgent care as well as high risk and chronic illness PCP follow up consults.13 Hamilton County Hospital successfully launched telestroke, tele-ICU as well as remote pediatrics, dermatology and PCP programs.14 Perhaps more interesting is Hamilton County Hospital’s purchase of a telemedicine robot which is currently utilized in its emergency department to connect patients in this rural town with specialists in metropolitan hospitals. The robot is equipped to remotely run EKG or sonogram for the physician in real time.15
Elite hospitals are already equipped with or are in the process of integrating cutting-edge technologies into their reception areas, examination rooms and treatment facilities. The abundance of technological advancement allow for a wide array of options to equip healthcare centers of any size to meet the particular demands of todays discerning patients. The options for an advanced healthcare center include remote-controlled cameras, ceiling mounted microphone, high resolution television screens, specialized computer equipment, wiring systems, self-operated diagnostic tools as well as countless programs and software all supported by an uninterrupted power supply.
In addition to the advanced facility upgrades, the next generation hospitals of today are equipped with telemedicine robots, telemedicine carts and even portable examination stations. At check-in, you are greeted with a nurse escorted by a portable examination station; the cart contains all the necessary tools for the nurse to perform full patient diagnostics. A specialized cart is automatically deployed based on the gathered data and information. At your bedside is a button you simply press to summon your telemedicine cart carrying tools to self-check blood pressure, heart rate, temperature among other diagnostic tools. A friendly telemedicine robot makes the rounds from room to room visiting with and comforting patients while simultaneously uploading data and transmitting updates to the patient’s v-chart.
For hospitals and healthcare centers to attract savvy patients and compete with advanced healthcare centers, they must prepare their facilities for the influx of technology headed their way. Capital investments will determine not only the nature but the extent of technology integration within a healthcare system. A diligent investigation of available tools and products that meet and even exceed the standards of medical care for the treatment of desired condition. Implementation of advanced technology means not only investing in computer equipment and software but also preparing for routine calibrations and maintenance. It also means investing in next generation nurses and physicians requiring the development of appropriate standard operating procedures and training personnel.
Most importantly, healthcare facilities must ensure that all equipment and technologies adopted are compliant with state and federal laws and regulations related to practice of medicine as well as health information privacy and security laws such as HIPAA and HITECH. Of particular consideration, facilities should be aware of new regulations being promulgated to meet the utilization of advanced technologies in the healthcare system including the Medicare Telehealth Parity Act (H.R. 2948, 2015), a bipartisan bill currently pending before Congress, which addresses coverage for virtual doctor’s visits.
New Jersey has yet to take a position in support of or against virtual healthcare. If the lessons learned from business outsourcing were applied here, the remote healthcare delivery systems would not only impact recipients but also the way New Jersey medical practices operate. The New Jersey Medical Board and legislators should be actively investigating (1) whether remote services will improve access to underserved areas in this State; (2) whether tele-health will affect the standards of care currently practices in this State; (3) the impact on the medical services industry including independent physicians, small healthcare centers and large institutions; (4) the overall financial effect on the State, and (5) what legislation is necessary to accommodate the inevitable advancement of healthcare while protecting New Jersey and its residents and businesses alike. In the meantime, providers should consult with their legal counsel to determine the appropriateness of virtual care in their facilities.
With unclenching thirst, patients are demanding more from the healthcare system and are holding their providers accountable. Technically astute patients are also investigating provider’s ratings prior to seeking service. With this trend on the rise, hospitals and healthcare providers are formulating a rating based on “patient experience” rather than the deficient “patient satisfaction” score which fails to take into account the full experience of the patient.16 The patient experience rating measures every facet of care provided in every setting, by every person, every day. Such rating will factor technological preparedness of a facility.
The changing landscape of healthcare also includes value-based payment to providers. As such, both government payors and insurers will be evaluating services and looking at patients ratings closely. It’s easy to speculate that investing in advanced healthcare centers will earn providers higher patient experience ratings, and therefore, better value based pay for their services. Advanced facilities soon thereafter will be rewarded by high return patient rates and attraction of new generation of patients looking for efficient healthcare systems.
With more and more hospitals and medical centers merging, facilities are readily sharing services, resources and medical records. Seamless access to highly skilled providers and specialized services are also available on electronic devices and can be delivered to your doorstep a la carte. So if your smart watch is ringing, it could be alerting you that Robo-Doc is ready to see you now.
1 Abeer Abu Judeh is a healthcare attorney representing medical providers and small healthcare organizations. She is the owner of the law firm Abu Judeh Health Law LLC. For additional information regarding her services,
2 Medicare ACOs, First Generation ACOs Launch, Healthcare Financial Management, News Watch, Feb. 2016.
3 Telehealth is defined as “ the use of electronic information and telecommunications technologies to support long distance clinical health care, patient and professional health-related education, public health, and health administration.” 42 U.S.C. 254C-16(4).
4 Jennifer Jolly, Wired Well, The New York Times, An Uber for Doctor House calls, May 5, 2015.
10 The American Optometrist Association does not recommend the use of online eye exams. Jennifer Jolly, Wired Well, Take an Eye Exam on Your Laptop, The New York Times, Sept. 29, 2015.
11 Abby Goodnough, The New York Times, Modern Doctors’ House Calls: Skype Chat and Fact Diagnosis, Jul. 11, 2015.
14 Bryan Coffey, Telemedicine in Small-Town America, A Game Changer for Rural Hospitals, Health Management Technology, Nov 2014.
16 Christy Dempsey, The Evolution of the Patient Experience, Future Scan 2016-2021, Healthcare Trends and Implications, Mar 262-106, pg. 6.