Dr. Kevin Most: The End Of The Doctor’s Visit

Dr. Kevin Most

Last week Steve shared with all of us that he listens to the advice of the doctor all of the time. A few in the studio shared that they found that hard to be true. Listening to the advice of your doctor is often a great idea, they have been trained to identify issues and coach us thru the illness, injury or health. The personal connection one has with their doctor has always been thought to be one of the most important portions of your health. Do you communicate well with the doctor, do you have confidence in the doctor, does the doctor have convenient office hours for you,, do they take your insurance. These are all important portions of forming and maintaining that special Physician –Patient relationship.

Well the world is changing very rapidly, and we see this history old relationship be put on its head. Healthcare is starting to see some disruption to the classic patient physician relationship. This disruption has many physicians concerned, not because of their livelihood but because of the lack of that cherished relationship. Who knows in a few years Steve may be telling us that his iPhone or a TV show, gave him his medical advice, don’t laugh it is closer than you think

TELEHEALTH

So how are we seeing this disruption form? We are seeing an increase in telehealth, in this setting the doctor is behind a computer giving advice to a patient who may be across town or across the country and soon it will be across the world. Telehealth has provided a much-needed service to many areas of rural America. We have discussed in the past that more than 50% of the counties in this country do not have a single psychiatrist. Telehealth has allowed mental health care to be delivered to those in need in a rural setting. This use of telehealth has been widely accepted as the “exam” portion of a psych visit is discussion between the patient and physician and thus telehealth allows for this.

Other specialties that can see a future in telehealth include radiology where images are digitally sent anywhere in the United States for review. Dermatology is now looking at making a big impact with telehealth as the need for dermatologist far outnumbers the demand especially in rural portions of the country. The ability to take a high definition photo of a skin condition and get an opinion and treatment will make a huge difference in the lives of many. Cardiology as well will see an impact with telemedicine as the images of tests, the digital stethoscope,( Like we had on Facebook live) and the ease of transmitting EKG and Echocardiograms show the high quality of this information in real time.

Will Telehealth spread? Absolutely, especially as the technology allows for an exam to be done remotely. You may remember when we did our Facebook live segment we showed a device that allows a lay person to do an exam and send the results of the exam to a doctor remotely. This equipment allows for a lung exam, heart exam, ear exam, throat exam and skin exam with all of the information sent to a doctor so he can review all of the information they would have collected in the routine exam.

Other areas of the changing relationship are a bit more concerning, yet interesting. Alexa is being taught what to listen for and will make a diagnosis, she is also being designed as a site for health information, health monitoring and tracking. Alexa is being used to remind patients to take their medications on time and correctly, it is also monitoring your medication use and supply and reminding or requesting a refill when the time is appropriate. Alexa is also being trained to make same day appointments for you at the local urgent care.

AMAZON- ALEXA

Amazon is partnering with many of the home health monitoring companies to make sure the equipment links with Alexa. Omron a popular home health monitoring company has partnered with Amazon to help track individuals home monitoring such as diabetes monitoring and blood pressure monitoring, it will be storing the readings, tracking the readings and potentially making recommendations based on changes in the readings, often before you would see a doctor. These home monitoring results will be able to be shared with other healthcare companies.

Cigna has partnered with Amazon to help them with their employee wellness program. Employees use Alexa to track and monitor their health-related incentives, this may be weight loss, blood pressure monitoring, diabetes monitoring, exercise tracking all focused on the health of the Cigna employee.

Alexa will be used to deliver health information as well and this will be on a personal level not just generic information. The information will be based on the health monitoring as well as any other medical conditions you may have. It will provide instructions for even things like information what to do and expect following a surgical case.

We all know that Alexa can listen to us as that is the functionality of the tool, what if it could listen to us and identify medical conditions that may be occurring or may be imminently occurring. For example, researchers at the University of Washington, taught Alexa to listen for specific breathing sounds that may be an early warning of a cardiac arrest. The devices were shown to identify the concerning breath sounds correctly 97% of the time. Research has also shown that machine learning systems like Alexa can recognize cardiac arrests during 911 calls faster than the dispatcher can. The technology also exists that the vital signs could be coupled with the 911 call.

Some hospitals are looking at this tool as a way to monitor and educate patients, so the appropriate site of care will be recommended to the patient. The patient who does not to go to the emergency room, based on vital signs and description of their symptoms, coupled with their history may be directed to a local urgent care, saving the patient the cost of the ER visit, while also keeping the ER less crowded with more appropriate patients.

Cedars Sinai in Los Angles is using this technology in the hospital. It allows the patient to control the environment in their room without needing to find the often-confusing call button. It can be a communication device between the nurse and patient, reminding them of upcoming treatments. The patients can use it to turn off lights, change the TV and also request assistance.

We talked about Amazon will change the delivery of healthcare it looks like they are starting, they also feel that close to 60% of all homes will have smart speakers in their homes by 2022.

MEDIA- CROWDSOURCING

So, we all know and agree that technology will change the way healthcare is delivered in this country. What would you say if I said Media will change this as well, and I am not referring to social media. There are now TV shows that are using the concept of Crowdsourcing to aid in treating and diagnosing patients. The concept is very simple, if you were to share your health story with millions of people, chances are someone has the same condition and can share what worked for them. This is done daily on a smaller setting in every hospital across the country. This is very common in the oncology world where hospitals hold “Tumor Board” This concept is many doctors are linked together often by video conference and a patient’s condition is presented and discussed and a treatment plan is decided on using the collective wisdom of the doctors.

There is also a medical crowdsource company SERMO, where actual cases are shared with large groups of doctors and the doctors then share their thoughts based on their knowledge as well as the experience they have seen in their practice. CrowdMed is another company that takes the same concept and exposes difficult cases to doctors, medical students and other healthcare professionals to get their opinion and thoughts on specific cases. The company charges for the service and also pays the healthcare team for the participation after the case is closed. This company certainly ,makes sense and is a unique way to get a second opinion from experts.

Mainstream media is now taking this concept to 2 new TV shows,” Diagnosis” and “Chasing the Cure”. Both of the shows are set on turning the normal process on its head, they are leveraging the perceived unproven wisdom of the viewers, the vast majority are not health professionals to help patients with a diagnosis. The shows will discuss a few cases with experts and then viewers are invited to call, text, tweet their experiences with similar problems or symptoms. Patients it appears are more willing to share their medical conditions than one would think, some may be out of frustration from bad interactions with conventional medicine and are willing to reach out to anyone for thoughts. Care is often siloed these days with restrictions on what doctor you can see based on being “in network”, the producers of the show feel this may break down those silos or allow a patient to get opinions from outside to the traditional network. The concept of the show is that if enough people watch ( the first episode had over 1 million viewers) that some of them may have had similar symptoms and can share their journeys. Chasing the Cure, has a website where viewers can log in and view the health files of the cases discussed, more than 10,000 people registered on the site after the first show. The concept of leveraging large number of individuals to look for an individual who has the same problem is interesting and may help lead some individuals to a diagnosis their personal physician may not have considered, it does however run the risk of breaking a patient-physician relationship which may be important in the future. The medical field is doing this as well and showing the accumulating big data will lead to earlier diagnosis and better treatment plans for many illnesses.

The shows also share the financial stress that these patients may be going thru and is an opportunity to show some of the costs associated with healthcare today.

APPLE HEALTH

Apple appears to be focused more on a few more personal and practical data points. They focus on Activity, Mindfulness, Nutrition and Sleep. We all probably look at our iPhone to see how many steps we took today or how many flights of stairs we climbed that day, we often set goals for steps. Apple has made retrieving that information simple and collecting it effortless in most cases.

Apple has linked to many health related apps and this allows them to put all of the information in a single place, on their health app. If you have a smart scale, it will place your weight on the site as you use the scale. If you track calories and food intake on a separate app, it will place it in their health app. If you monitor your blood pressure with a smart device that information is also pushed to the app.

Apple has figured out how to partner with the technology companies that collect data and put all of the data in a single site for use. It is essentially a single site for all of that data you collect. This is a great platform as it allows you a single snapshot without having to go to multiple apps to see your data and trends.

As this advances one would expect that Apple with all of this information will begin to suggest health related interventions as it runs algorithms on all of the individual data points it is collecting and storing. It may also get to a point where it pushes information instead of waiting for the individual to pull. Don’t be surprised to see Apple start working with health insurance companies as they start a focus on wellness instead of treating illness. This is a concern as your personal health information will be now shared and outside of what is legally protected.

It is a brave new world out there and we will see major changes very rapidly that will impact the way we think of healthcare today, Steve may be listening to Alexa or his iPhone for advice in the future.

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