Telemedicine and new technologies

Conway McLean, DPM, Journal columnist

Technology has impacted modern life more so than any societal change or political movement. It has invaded every aspect of modern life, and is becoming more embedded in our lives with each passing day.

For good or bad, integrated computer systems live with us, monitor us, assist us, in a variety of ways never thought possible. We wear electronic devices, on our wrist, in our clothing. They watch us, monitor us, tireless, unceasing. This certainly has been the case in medicine as much as any part of modern life.

A perfect example is the burgeoning field of telemedicine, defined as the remote diagnosis and treatment of patients by means of telecommunications technology. Some would say this movement started in the 1950s when several university hospital systems learned how to send x-ray images electronically. But this was not a time of great growth since the equipment necessary to conduct “visits” was expensive and complicated.

Early on, health professionals developed the technology to reach patients living in remote areas. But it became apparent to those in medicine and government that the potential to share patient health records on a timely basis was a valuable and potentially important goal.

Additionally, telemedicine would allow health care providers to reach urban populations with health care shortages, and also to respond to medical emergencies. In the 1960s, significant funding was provided by the government allowing further research and innovation. It was around this time that ECG heart tests were first able to be sent to deal with cardiac emergencies.

The rise of the internet age brought great changes to the concept and practice of telemedicine. The proliferation of smart devices, capable of high-quality video transmission, opened up the possibility of delivering remote healthcare to patients in their homes or workplaces as an alternative means of delivering care, for both primary and specialty medicine.

Over-burdened medical practices, especially primary care providers, have spurred the spread of telemedicine. The public also has expectation for more convenient care and this also has led to the rise of companies looking to make use of this concept.

Many patients want to be able to monitor and track their own health without going into the doctor’s office. These demands by the consumer are also driving this movement. Simple home-use medical devices can take vitals and diagnose ear infections, monitor glucose levels, or measure blood pressure, allowing patients to gather needed medical information for a doctor’s diagnosis. All without actually going to the doctor.

Better access to healthcare is the driving force for telemedicine. Telemedicine is now used around the world, to varying degrees, whether it’s to allow residents of third-world countries to get basic healthcare, or allow a patient with mobility issues to see a doctor. Telemedicine can break down the usual barriers to care, with the potential to make the entire healthcare delivery model more convenient to patients.

Another benefit is the ease with which a medical practice or hospital can gain access to specialized care. Primary care physicians are able to consult with the appropriate specialist, no matter the location. X-rays can be sent via telemedicine, especially beneficial to smaller hospitals that often don’t have radiology specialists.

Perhaps the most critical explanation for the growth of telemedicine is the belief it will reduce healthcare costs. Currently, the U.S. spends $2.9 trillion on healthcare every year. It is estimated that approximately 200 billion of these healthcare dollars are unnecessary and avoidable. By minimizing such concerns as unnecessary emergency room visits and poor compliance with the use of prescribed medications, it is believed telemedicine can impact inefficient and inappropriate expenditures.

One of limiting factors in the spread of this concept is the requirements for equipment. Along with purchasing the technology, understandably there is going to be a need for training. How extensive and expensive the cost of the equipment will be determined by the type of interaction. A simple video chat through a secure line requires only an app and the purchase of a webcam.

Another criticism regarding telemedicine is that these interactions are impersonal and lacking in any personal touch. Additionally, many will argue that an actual exam is often necessary to determine a good diagnosis. If more and more patients resort to an “electronic” visit, what kind of effect will this have on the health and well-being of a nation’s citizens? These questions are yet to be answered definitively.

Many other new technologies will impact medicine in the years to come. Some of these portend great changes to life in the 21st century. Some examples include the ability to grow organs through gene manipulation. A new gene editing technique called CRISPR is poised to revolutionize medicine. It has the ability to remove unwanted or hazardous elements out of our DNA or even add features to the genes of animals, plants, even humans. The belief is this could lead to actual cures for previously incurable diseases like Huntington’s disease and many others. It also naturally leads to a host of concerns about the possibility of human genetic manipulation.

Wearable sensors are already allowing healthcare providers to monitor all manner of vital measures. The basic idea is to wirelessly connect the patient with care providers to monitor their health and intervene as needed – ideally preventatively. This technology relies on miniature, smart sensors that are worn on, or implanted in, the patient. Wearables are attractive, because they require no medical procedure and travel with the patient. As the size of health sensors shrink, leading to advances like digital tattoos and nanorobots in our bloodstream, we will be able to intervene in our health like never before. (This is old news to those of us who have seen various futuristic films over the years.)

Our very own national health care system, Medicare, recently proposed paying doctors for virtual visits. The agency said it would pay doctors for their time when they reach out to beneficiaries via telephone or other telecommunications devices to decide whether an office visit or other service is needed. In addition, they also proposed paying for the time it takes physicians to review a video or image sent by a patient seeking care or diagnosis for an ailment. Medicare is the standard all other health care systems follow, so this is a clear indicator telemedicine is here to stay.

How far technology goes to alter medical care is difficult to say, though many fantastic developments have already occurred. Having watched many science fiction movies and sci-fi tv shows over the years, I feel I am well versed in some of the possibilities. Will any of these far-fetched ideas come to fruition? A careful examination of medical technology news would indicate the future is here.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with an upcoming move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments at drcmclean@outlook.com.