Virtual care is healthcare. It is a paradigm shift in healthcare delivery. It’s not just a video conferencing tool, but it will change the way we deliver care for the next century.
Articles like “Teleneurology is Neurology” (1) are needed because people need to understand that the care we provide through Telemedicine is exactly the same care! It is just the medium of care that has changed. And that makes a huge impact on the future of healthcare, from digitization to exploring other opportunities in the healthcare ecosystem.
Virtual Care is a paradigm shift in healthcare delivery
This is part of the larger series - Digital Voice Assistant in Telehealth and it includes four major topics:
True Impact of Telehealth
Natural Language Processing in Healthcare and Overview
Ambient intelligence in Healthcare
Cloud vs Edge Computing in Healthcare
So, in this article, we will be discussing the true Impacts of Telehealth.
Virtual care is truly a paradigm shift. And the reason behind that is that, it is just the starting point, it is just the digital front door. And once you have that technologies like the Internet of Things, remote patient monitoring, even virtual hospitals can be deployed and can be managed remotely and this is truly a significant breakthrough in healthcare as we know it, and will truly lead to healthcare 4.0. So telemedicine is the key that opens the door to digital health. The key opens the virtual care door and the virtual care door opens up the complete digitization of healthcare and truly realizing, healthcare 4.0 starts with telemedicine then virtual care and digitization of healthcare. So let’s go through an example. There's a patient that comes in - a 25-year-old female from it as compared to an in-person visit. She has to pick up the phone, make an appointment, take time off from work, drive there, park, needs to find a babysitter if she has kids, and then talk to the doctor about her problems while forgetting her medications at home, maybe brought the medications but forgot how many headaches she had because she didn't have any records or logs for it. And migraine medication etc. requires constant tuning. But if the same visit was done over tele, what is easy? First of all, the doctor will be doing it on a telehealth visit and will email her all the information that is needed, including a video education platform that she can send to her sister. Doctor can recommend an app for her where she can document all her headaches, symptoms, when that happened, why it happened, etc. The data can then be accessed by the doctor and can fine-tune her visits in terms of frequency, in terms of intensity. So the minute you provide care digitally, it opens up such beautiful possibilities that were never opened before. Interestingly, once a patient shared her information with her sister and her sister was like, “Oh, by the way, you always had headaches after chocolate-covered strawberries,” She was able to identify from her family member what her triggers are. So these kinds of things when you are able to educate not just the patient, but the patient's family because that is so reproducible - the information, the documentation, is not lost. Patients actually can save it and review back as needed, send it to the family members, and can review back as well. This will change not just the patient-physician relationship, but it's going to improve patient engagement and that is the key to actually better health. So, virtual care is not just changing the way doctors do work but truly virtual care is a paradigm shift in care delivery.
Steps to Digitization:
As a matter of fact, the first step is Telemedicine which is truly the telemedicine we know of. Regarding tele-pharmacists, we'll have a separate article about telepharmacy. And telemedicine leads to telehealth, in which there is remote patient monitoring, e-sitters, cognitive behavioral therapy, all other therapies including physical therapy, occupational therapy, etc. But that level of digitization will lead to true digital health, a true e-health platform in which we can activate interoperability, artificial intelligence, real-time analytics, blockchain, cloud computing, regulations can be changed and can truly create a virtual hospital at home. So these things are interconnected and it’s really exciting to see that this telemedicine is seeing the way forward towards healthcare 4.0.
Pandemic & Contactless Care:
This is not just an opinion as you can see, pandemic created a contactless care environment. And this exponentially expanded telehealth to the farthest reaches. It expanded around 50 to 175 times the normal value (2). So telehealth is, by definition, a quarter-million dollar industry and because of the pandemic, which unfortunately is the only silver lining for the whole situation, made telehealth get the spotlight it needed, and the number of telehealth visits bloated to 50 to 175 times.
Not only that, but the key benefit of this was also the legislative expansion. There were multitudes of different bills (345) that were introduced, in fact, at the federal level and also at the state level that expanded the role of telemedicine for everyone.
And again, there are national societies, like the American Academy of Neurology, advocating the expansion of telehealth access permanently and they're fighting for it. And there are two bills that they are supporting this year to expand telehealth forever. And not only just expand telehealth but also to expand the number of services within the telehealth where there should be reimbursed. So there's a big reason that this has been pushed. And the reason, as I said, is not just telehealth but it is about virtual care and digital health 4.0.
This will directly lead to virtual hospitals. Let me give you a brief overview. Virtual hospital when you have an IoT - Internet of Things, when you can remotely monitor blood pressure, pulse oximetry, and other different physiological parameters, the same care that was required in the hospital can be provided within the house. There will be a separate series about virtual hospitals at home, and there we will discuss the evidence behind it. And we will also discuss what are the litigations, what are the benefits, and what are the limitations of it. For now, if you can see (6), there are major big healthcare systems including Ascension, Intermountain, and UPMC that have joined an alliance with Advocate Aurora to expand hospital-at-home services Now care can be provided virtually - nursing, therapist, primary physician & specialist care. While a visiting bedside nurse can take care of the patient, an e-sitter service can monitor remotely. Mobile imaging and lab services can be deployed at home.
Big Tech in Virtual Care:
And believe it or not, it is as good if not more than in-hospital care. So there's truly an expansion coming because of virtual care. And these models are not just in us, these are expanding internationally as well. In 2020, UAE’s ministry of Health started working with one of their country’s top telecom operators to set up the region’s first virtual hospital (7). And this is where the level of maturity comes in. And this is why big tech is following in the footsteps of virtual care. And you can see Amazon and Walmart are getting into it.
Cultural Shift to Remote work, learn & healthcare:
There is truly a cultural shift and even before the pandemic, the rate of change already exponential is now increasing significantly. The way we work, the way we learn, and now the way we do healthcare is getting different because of the remote culture.
Source: McKinsey & Company
It is truly a generational shift. If you look at the below picture, you will notice that this is not just how we consume media, because baby boomers were locked to TVs, then Gen X, and now millennials.
And you can see classically that at this point in time, the future of healthcare will be digital, and will be virtual no matter what it thinks. I don't believe it’s just temporary post-pandemic. It's just the patient preference, it is the changing demographics of the population itself.
Impact on Clinicians:
So one of the questions that my students asked me is, what specialties are going to be affected by virtual care? And the simplest answer is - All of them! And if you think you can’t do some things virtually, then please look at the below image.
You can see that (8) even Ophthalmoscopy can be done virtually as well. So there are ways that you can go around it to improve patient outcomes virtually, and they're innovators, we're working hard to make sure that we get all the data we need virtually. There are places where you're going to need in-person care but the tools are improving significantly and exponentially. So always remember telehealth is the gateway drug to digital health.
Telehealth is the gateway drug to digital health!
Guzik, A. K. & Switzer, J. A. Teleneurology is neurology. Neurology vol. 94 16–17 (2020)