Remote Care, Personal Touch

Quite often these days, you will read about telemedicine and the hope for bringing improved healthcare to all parts of the worlds. The concept behind telemedicine is straightforward – deliver some form of medical care or advice via telephonic technologies. This could be as “little” as calling a nurse to ask what to do after a cut, or it could be as much as having an onsite physician who can share an entire medical record via the Internet for remote consultation. With better and better robotics, telemedicine already includes remote surgery (via a surgical robot) and ultrasound (via a robotic hand that moves the sensor over the patient’s body).

A middle of the road approach is one where a medical professional can use a set of tools that convert the medical assessment into digital data, which can be saved as part of a medical record and/or shared with the patient’s physician and/or a remote consultant.

The website, QuantifiedCare, fascinates me but seems to be a hidden jewel. This is a young company that has not even produced their full line of products, but the potential is tremendous. (I have no personal association with this company). I actually sent the company an email yesterday asking them about their advertised handheld cellphone plugin for providing onsite ultrasound (US). If the price is low enough, we will likely see such devices popping up everywhere very soon (and this will allow medical students to professors, to do bedside US and diagnose diseases faster).

In my email, I also asked the company if they have plans to create a common data store for all of their products. So if you use their ultrasound device, and then use their ophthalmoscope (eye examination tool that plugs in to a smartphone), and then use their ECG device (also works from a smartphone), all of this data should be labeled with an identifier for the patient, and then stored in a single location (perhaps in the cloud). From this location, an electronic medical record (EMR) could pull all of the information and add it to the patient’s digital record. All EMRs in all private companies and hospitals will hopefully be able to pull this data in this way. I hope to hear back from the company very soon.

This link speaks about digital health in general but reinforced an idea that I have had for some time. In the United States, mostly due to the cost of healthcare, many shopping malls have clinics that provide basic medical services for far less than an office visit with a doctor. I don’t think anyone would question the fact that a nurse, in a mall or in a remote part of a country, could use a highly customized web interface that guides her or him through standard protocols for, say, 10 common diagnoses. In this way, the nurse (or other non-physician healthcare provider – NPHP) could deal with many common illnesses on site and even save lives.

A classic example would be sore throat. A clear stepwise protocol could be presented to the NPHP and would literally guide him or her through every step of management. Using even a regular cell phone, and perhaps an external bright light source, the throat could be photographed and the image transferred to the medical record.

I have previously spoken of a company called Tyto. I have personally met with the team behind this device (I have no other association) and they are very enthusiastic (as they should be) and their team is impressive for their knowledge & engineering of the device. Using a device like Tyto, you could capture images of the throat and also of the ears. Tyto can also listen to and capture the sound of the patient’s heart and lungs. So a NPHP, equipped with such a device and with the customized website I mentioned before, could also handle suspected ear infections, asthma (which can be life threatening), bronchiolitis (a potentially life threatening viral infection in young childrens’ airways), allergies (once again, a common malady that can be life threatening) and even suspected pneumonia. Add to this a digital ECG, and the NPHP could complete a web-based form that assesses the risk of acute ischemia (i.e. insufficient blood flow to the heart that could cause a heart attack and death).

Every component of this NPHP based evaluation, including all captured data and photographs, could be visible to a remote physician consultant via another piece of software (that would need to be designed) that sends the medical information digitally to any target person and/or location. With such a system, the NPHP could even be spared sending a formal request for a consultation. The remote physician consultant could keep track of all activity and all new recorded medical data via another piece of software (also to be designed) which presents patient information from all remote sites via a unified digital dashboard. If the remote consultant sees something problematic, then he or she could contact the onsite NPHP.

I can imagine creating a package of services that would include QuantifiedCare/Tyto (or equivalent) devices and the specialized software I mentioned above and even access to remote physician consultation. This package could be made available to any remote site, including those where doctors and nurses are unavailable. Specially (but limitedly) trained medical technicians could be the primary onsite providers of care, and could be very effective due to all of the services and devices available. Actually, even a lot of the training  of such medical technicians (including important medical updates) could be done remotely.

It would take time to find the right combination of devices and develop the software I have mentioned. But the actual cost of set up of such a company would be relatively small and the potential market would be huge. I would personally be thrilled to work on such a project. I wonder if there are any takers.

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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