I googled knee pain and all I got was a live doctor online

I have recently done some research on the topic of remote medicine and telemedicine. This is an area of huge interest as it can bring medical advice to anywhere on the planet. With a regular video webcam, a doctor can ask questions and see the patient. This can dramatically cut down referrals to a formal medical service. If you add specialized telemedicine devices like Tyto or the suite of iPhone medical plug-ons to the interaction, the power of the tele-assessment goes up significantly.

There is no lack of telemedicine companies. I reviewed two such companies, Teladoc and Doctor on Demandwhich are being mentioned more and more in online posts, and have been pulling in funding in recent months. These systems do as advertised – give remote access to a qualified physician. But, as it turns out, there is still a need for additional services to make these companies true powerhouses.

  • As I noted above, the more information the patient can give to the remote doctor, the better will be the assessment. No one expects that every new parent will go out and buy every telemedicine-version of a thermometer, ear scope and stethoscope. Perhaps med-tech companies really will be able to shrink addons (and their price) so that it will be a no-brainer to get the “med kit addon” for iPhones (and Android phones). Also consider that low cost tablets (even those around 100$) are becoming more powerful and more available. It is easy to imagine a full home based kit of telemedicine tools being sold for 200$ in the near future. Insurance companies might join in, as there is a correlation between use of telemedicine and reduced healthcare costs.When such a low cost kit becomes available, I do imagine many if not most homes purchasing the home kit and setting it up in a dedicated part of the home, next to the computer. And when the person Googles their disease, Google could immediately detect what home devices you have and guide you through the evaluation, while at the same time, pulling together old EMR records. Finally, this whole package of data will be ready and waiting for the remote physician. THIS would be a service that would really make a difference.
  • The reach of Google is nearly worldwide. And it will not be long before access to Google reaches almost every one of the 8 billion people in this world. What will that mean to the villager in Kenya that has just noticed a rash on their child? Remember the OneLaptopPerChild program? Well, for the cost of these OLPCs, you could distribute the healthkits I descrtibed above. So, a person in a remote town in Kenya, with perhaps no running water, could still take advantage of a full teledmedicine evaluation via such health kits.
  • Remember that health information can be predictive as well. Imagine that a nearby town has an outbreak of Cholera. Using the telemedicine kit, the members of the nearest, still healthy, town could implement a list of precautions that have been laid out by the telemedicine kit. This information could be sent to those people in the village who have smartphones . When the first contact with Cholera happens, it might be possible to stop it dead in its tracks because increased hygiene and proper disposal of waste have been implemented. Also, via the telemedicine kit, you could submit daily reports on the health of everyone in the village. All of this data would feed back to the central data warehouse in the capital of Kenya and thus, the medical ministry could make informed decisions on how to manage this Cholera outbreak. The potential is outstanding.
  • You will need access to top physicians to make any telemedicine system work. Most of the telemedicine systems I have seen advertised, proudly list the specialists who are responsible for providing the remote care. If the physician group truly contains a top level group of people, this may even be a way to get an opinion on a medical condition immediately, and NOT wait the 3 months it takes for a regular appointment. But again, the success of any such system will depend on the quality of doctors staffing it.
  • One of the missing components in all of these options for telemedicine, is how to incorporate the collected data into the patient’s medical record. The EMR community MUST, repeat MUST, invest in technologies that break through any barriers between EMRs. It should be possible with a click of a button to retrieve data from any of the top EMR systems out there. And if you can get everyone to use a format like HL7 to create universal packets of historical medical data, then any EMR should be able to import this data and use it.Independent of these approaches, there are companies like “Hello Doctor” that already can extract data from 1/2 of the hospitals in the US. It seems that once they hit 100%, they could be the ultimate portal for reading medical information from all key sources.

The insertion of an “ask the doctor” button into the Google interface is brilliant.

And even though it is only a test system for now, it will soon become THE way that people access telemedical care. I just hope that the virtual waiting time does not get to be too long.

Thanks for Listening


About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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