Digital medicine allows patients in rural and remote locations to receive much higher levels of medical attention
There is something of a diaspora going on in the world of medical monitoring. Instruments that used to be clustered into hospitals, clinics and doctors’ offices are starting to spread throughout the consumer world, and medical professionals are beginning to take notice. Some, like blood pressure monitors, thermometers, and bathroom scales have been around American homes for years. But now they’re being joined by more sophisticated devices – including units connected wirelessly to one another and to cloud-based medical records. Together, they hold the potential to upend the practice of medicine as we know it.
Consumer wearables, for example, have been advancing rapidly. Starting with the relatively simple activity trackers introduced a few years ago, systems offered today by a number of familiar vendors including Apple, Samsung, and Amazon can now monitor heart rate, calories burned, blood pressure, seizures, physical strain, stress, and the release of certain biochemicals, as well as suggesting which workout routines would be most effective for you. Other health-related indicators, including mood changes, blood alcohol, ECGs, and health risk assessments, are currently under development for wearables. In addition, work is underway to integrate information from their sensors into the wearer’s electronic medical records so that, at least in principle, a patient with a heart condition could regularly share electrocardiogram readings with their doctor, no matter how far apart they may be.
Other technology companies are also enthusiastic about the opportunity to participate in the multi-trillion-dollar healthcare industry, and many have already done so – particularly in areas that involve healthcare data. At the same time, though, Covid-19 has changed the game for everyone.
For example, one of its most likely legacies will be the relocation of America’s workforce from central office concentrations into widely dispersed private homes. But that decentralization echoes another important reality: that despite more than a century of urbanization, there is still a significant rural population, and that population needs medical attention as much as their urban counterparts. But for them, a full-service hospital or clinic may be many hours away. Their choices for care are rather limited. Health professionals are reluctant to set up shop in rural areas. It would be both personally and professionally challenging for them to do so. Yet a rural diabetes patient will need the same forms of care as an urban patient. But for rural patients, surrounding themselves with specialists in a remote location is simply unrealistic.
From time to time, isolated communities have tried different strategies to secure healthcare. In one rural Scottish rural community, residents decided to use local volunteers who would be led by a paid health professional. But they couldn’t decide what sort of practitioner needed to lead the effort. They wanted parts of the skill-sets associated with nurses, doctors and health advisers. But the closest they could find were physician assistants, nurse practitioners and paramedics and, they concluded, none of those were satisfactory. So, their healthcare model never got off the ground.
It’s a complicated issue. What might work well in one rural area might not work at all in others. For example, not everyone has access to the internet or the equipment required to connect with it. A digital divide, mirroring the country’s social and economic divisions, is still very much in place, and urban areas are just as likely as those in isolated rural ones to be on the wrong side of that divide. But where connectivity is available, the same disruptive technologies that are starting to penetrate the consumer world offer a promising way to meet the need for tracking patients’ vital signs, even from a distance. Virtual visits of the type brought on by the coronavirus, combined with electronic monitoring devices wirelessly connected to a physician’s office, can provide remarkable visibility into a patient’s health. It can even be better in some ways than an office visit because the connections can be set to transmit frequently enough that worrisome developments won’t be able to sneak up and catch the doctor by surprise.
A companion technology – cloud-based software platforms to receive, combine, and interpret that data – is also becoming available to support patients and their healthcare teams, most of which have capabilities well beyond those of consumer apps. They come from multiple suppliers and each works a little differently. For example, among the professional remote care capabilities are the capacity to issue prescriptions, provide patient education, help with scheduling, issue reminders, complete surveys, and participate in video visits with the virtual care team. One company has configured a 30-day protocol to remotely evaluate potential exposure to Covid-19 as well as underlying conditions. Others update doctors by tracking patients between visits for blood pressure, weigh, and blood glucose. A third operates a capture platform that integrates patient data with support information and automatically updates their medical records.
What all of it means for residents of isolated communities is that digital medicine, enabled by remote patient monitoring, can offer them a level of healthcare never before available. The combination of closely following patients’ health even though separated by hundreds of miles, is a disruptive change to the world of medicine, but it’s one that physicians are starting to feel increasingly comfortable with.