LAST MONTH two major
publications devoted significant coverage to the growing, unstoppable trend
toward telemedicine and other digital forms of measuring, recording and
responding to individuals’ healthcare needs—all for the sake of convenience,
accuracy and cost-cutting. The Economist (Feb.
3, 2018) headlined its news analysis with “Doctor You—a digital revolution in
health care is coming—welcome it.” The
Wall Street Journal (Feb. 25, 2018) published
a lengthy feature on “What the Hospitals of the Future Look Like;” the subhead
read: “The sprawling institutions we know are radically changing—becoming
smaller, more digital, or disappearing completely. The result should be cheaper
and better care.”
Optimism abounds. And,
yes, there is plenty of reason for it. The
Economist notes that the “fundamental problem with today’s system is that
patients lack knowledge and control” regarding their medical condition and
treatment options; “access to data can bestow both,” the article proclaims.
There has been a
veritable explosion of wearable devices that measure blood pressure, for
example; others can detect irregularities in heartbeat; other apps are in
development that can—with the help of Artificial Intelligence—detect skin
cancer and other potentially life-threatening conditions that, early on, do not
manifest themselves in obvious, visible or dramatic ways. A digital
early-warning system can prompt individuals to seek out medical care for
preventive measures.
Care for the elderly
is greatly improved by wearable devices that are capable, not only of measuring
vital signs, but of detecting falls and sending warning signs to centralized
monitoring stations. These, in turn, can dispatch emergency help or alert
family members to take mom or dad to a doctor. In a similar fashion, patients
of all ages, can have data pertaining to critical medical factors, such as
diabetes, automatically sent to their doctors’ computers, prompting corrective
instructions or, if needed, a visit to the doctor’s offices. Not surprisingly,
Apple has announced plans to petition health-care organizations to allow iPhone
users to download their medical records.
These innovations
certainly give patients more autonomy in making medical decisions on their own
behalf, while also serving as a safeguard to spot potential errors in medical
records that could lead to inappropriate or unnecessary treatments. Overall,
this digital revolution will save billions of dollars in unnecessary—or, no longer
necessary—visits to doctor’s offices and the administration of medical tests.
As to hospitals, the Journal writes, these institutions, too,
are developing monitoring systems that can sharply reduce the time patients
spend in hospitals or emergency rooms by keeping a remote digital eye on the
patients at home; again, the focus is on preventive care—catching conditions
before they get out of hand. By some estimates, 30 percent of care
traditionally provided in hospitals can be given at home.
More and more,
somewhat parallel to the proliferation of no-appointment-necessary medical
clinics, large hospital will make room for “microhospitals,” functioning as
extended “intensive-care units, where you go for highly specialized, highly
technical or serious critical care.” Patients with conditions that can safely
be monitored remotely can recover at home. Doctors with various levels of
specialization will operate “central hubs” to monitor both acute cases in
microhospitals, regular ERs or less severe cases in patients’ homes.
Kenneth L. Davis,
president and chief executive of Mount Sinai is quoted as saying: “We need a
new model of care that focuses on wellness and prevention and keeps people out
of hospitals.” Enormous savings and greater comfort for patients are in the
offing.
As The Economist notes, “the benefits of
new technologies”—such as wearable devices and downloadable personal health
records—“often flow disproportionately to the rich. However, government and
insurers have an incentive to provide the technology and self-care, at-home
treatment options to poorer populations as well. Alphabet, the parent company
of Google, has plans to wade through patient data in poorer parts of cities,
where many residents are covered by Medicaid.
Hi-tech innovation at the
service of the poor is also the hallmark of New York State’s revolutionary
Delivery System Reform Incentive Payment (DSRIP) Program. DSRIP, a five-year
program now its third year, provides superior medical care to Medicaid patients
at greatly reduced savings ($12B-plus!) to the state’s taxpayers. DSRIP in on
track to exceed its target of reducing unnecessary hospitalizations by 25
percent by spring 2020. The program is driven by the Value-Based Payment (VPB)
or Pay-for-Performance model: doctors are being paid, not based on the number
of hospital visits or tests, but on the longer-term health outcomes of their
patients. (It’s promising in this regard that the government has created the
Physician-Focused Payment Model Advisory Committee, with the potential of
extending VBP models to Medicare.)
Electronic Health
Records (EHRs) play a major role in DSRIP architecture; for the New York State
Department of Health to track the health of populations, EHR data are
integrated with Medicaid claims in order to paint the state of health of large
communities. Just as is necessary in the commercial, privately-insured universe
touted by The Economist and The Wall Street Journal, EHRs for each
patient served under DSRIP must be painstakingly produced, maintained and
constantly updated. This process ordinarily demands a great deal of time on the
part of physicians, who are glued to their computer screens, rather than being
focused on the patient before them.
In sum, the vital
personal relationship between physician and patient, between doctor and the
patient’s family, has little chance to be established. The personal touch, the
human encounter that forms the foundation of an authentic patient-doctor
relationship goes missing. That obviously is true for all forms of remote
monitoring of patients’ health, no matter how accurate or efficient.
At SOMOS Community
Care we have developed a solution; SOMOS is the only so-called Performing
Provider System (PPS) mandated by DSRIP that consists of a network of
independent physicians; the other 24 PPSs are hospital-based. To free our
doctors from the demands of data entry and record keeping, we have dispatched
teams of Community Health Workers (CHWs) to our practices, to record patient
data themselves or train office staff to do so.
As a result, the
doctor—often living and working in the very communities with whom he shares a
cultural and ethnic background—is free to pay full attention to patients before
him; what’s more the CHWs make home visits, as needed, ensuring that patients
keep up with their medical regimen and keeping the doctor abreast of family and
housing circumstances that may impact the health of patients and their
families.
In this fashion, our
doctors assume the role of the family doctors of old—leaders of the community
in whom patients can put their trust, in whom they can confide, and by whom
they are understood, by whom they are truly known. This new iteration of the
family doctor takes full advantage of today’s digital revolution in health
care, but without sacrificing what has always been essential for an
individual’s overall well-being—quite literally, the personal, healing touch.
Such cannot be transmitted in digital fashion, no matter how sophisticated the
technology.
