74. Flipping the Clinic

Dr. Brad Younggren, Brad Younggren, MD, Chief Medical Officer 98point6, medical director EvergreenHealth, and emergency physician.

This is part of a series of essays on the Health Rosetta’s Principles.

Inefficiencies abound everywhere you examine our current, traditional model of health care. That unassailable fact has led us to no less than a humanitarian crisis, one in which vast numbers of people get little or no care while countless others receive unnecessary, wasteful and even harmful amounts.

To appropriately treat our global population, we need health care that scales effectively, delivering just the right amount of care at just the right time. And that means we must turn to technological solutions if we are to fix our most vexing problems and structural issues.

Leveraging technology and non-traditional thinking will move the needle of population health in the right direction. It can’t come soon enough. As highlighted by Keehan’s recent analysis in the journal Health Affairs, health care is growing at an astronomical rate of more than 5 percent annually, with no signs of slowing. That rate fast outpaces our GDP, and makes it clear we need a huge shift in the delivery of health care if we are to both serve those who desperately need it and if we’re going avoid a collapse of the system.

We can start with the inefficiencies inherent in traditional brick-and-mortar medicine, which is costly to both deliver and maintain. The facilities are expensive, there are millions of dollars of associated transportation costs, and layers of bureaucracy abound in these establishments which neither add value nor improve outcomes.

The Internet of Things (IOT), sometimes known as the Internet of Medical Things (IOMT) as it relates to health care, will play a pivotal role in breaking down the walls of the traditional medical clinic. The Internet of Medical Things refers here to the medical devices and applications that connect to health care information technology systems through computer networks. This technology presents us with a multitude of opportunities to improve outcomes through non-traditional settings. In the last decade, there has been enormous growth in medical devices and software solutions to solve long-standing and numerous problems. That includes technologies related to patient monitoring, patient tracking, lab work and diagnostics, medication management and telehealth tools, to name just a few.

It’s important to note a byproduct of the Internet of Medical Things explosion is that we have more personal data collection than ever before, and these large data sets will have a direct impact on health and wellness. The IOMT revolution frees up the data, allowing for its remote and flexible interpretation, and also allows for the acquisition of data in non-traditional venues. All of this allows us to continue imagining flipping the traditional clinic upside down.

Consider the congestive heart failure (CHF) patient, who typically requires hospital admission if he or she gains 10 lbs of water weight. Traditionally, physicians have relied on weights collected in the clinic, or self-reporting by patients to follow all trends. The weakness of this approach is it often relies on patients remembering to weigh themselves, interpret the data and report it correctly and in a timely fashion. But now, patients can weigh themselves at home with connected scales and share weights directly with doctors via mobile integrations. That mobile integration, in turn, can notify a care coordinator when a person has gained an amount deemed unsafe by the managing physician.

Technology allows even more sophisticated monitoring. Patients can also place a connected stethoscope to their chest and have that information processed remotely or even through machine learning algorithms, notifying a care coordinator when that patient develops changes in heart sounds concerning for acute CHF. On top of that, digital platforms can cheaply coach and educate CHF patients in their own daily treatment, including medication and physical activity, on a virtually unlimited basis, something critical to their health status and medical expenses. IOMT essentially allows you to have a much more prescriptive than passive system for collecting data and managing patients - and this is just one example that layers technologies on a specific medical problem.

Such digital care directly connects patients to their health care teams, allowing for deeper, richer conversations between all parties, lower costs and better health outcomes. And, I might add, less burnout for physicians who can work at the peak of their skills, rather than be bogged down in the EMR and other administrative tasks.

Pick a disease, find the shortcomings of the current management system, and insert digital technology in every gap you can find. This is one of the most hopeful and promising ways we can actually start to lower the cost of health care delivery around the world. It also empowers people everywhere to monitor and take charge of their own health.

The added benefit of building technologies that leverage the IOMT is that it puts patient care into a lower-cost settings than hospitals and clinics. According to Keehan and colleagues, more than $1.67 trillion is spent in the federal budget for costs associated with hospital, doctor and clinical services. The average cost of a telemedicine visit today is roughly a third of a traditional visit, and as more technologies and data points can be leveraged through telehealth, the cost will likely drop even lower while the value continues to rise. I see partnerships developing between medical hardware companies and telemedicine companies to increase the amount of data that can be a part of a virtual visit. You can expect this kind of synergy to increase exponentially in the coming years.

So what will the virtual clinic look like in other instances? It will start in your pocket or purse, as mobile devices will clearly serve many functions to support health care. A smartphone, for instance, is a gateway to store data from a variety of devices, as a telehealth platform and as a way to capture and transmit that data and any pictures for analysis. If we could reduce the number of unnecessary primary care visits by 50 percent through the thoughtful use of such mobile devices to deliver health care, as an example, we could theoretically reduce the wait time to schedule a visit that does need to be in person from an average of 3.4 weeks to 1.7 weeks, or perhaps even close that gap further.

Furthermore, when you do go visit your doctor in the future medical smart home, deep analysis will have already been performed on a variety of platforms. No need for your physician to ask “How are you sleeping?” because a sleep tracker has already provided that data prior to the visit. No need to ask “How has your blood pressure been?” as the physician has already analyzed the aggregate readings from the past few months and knows what medication changes are needed, even before you sign in for your the visit. This revolutionary change in procedure will allow the patient more of an opportunity to get through all of the issues he or she wants to talk about, with no more need to schedule a follow-up visit to continue the discussion because the physician ran out of time and needed to get to another patient.

In short, imagine walking into your doctor and being told this: “I have reviewed your records and data and we need to double your blood pressure medication. Also, your resting heart rate is trending in the wrong direction, so I would recommend increasing your walks. I’ve already sent a few recommendations to your secure account which you can review at your leisure, so log in when you get home.” This kind of seamless interaction embodies the clinic of the future.

These solutions help scale health care in new and exciting ways, and allow non-traditional approaches to care delivery. It’s time to break through the walls of the hospital, and through the virtual walls of our electronic medical records that fail to support deep interoperability. We need health care solutions that work outside our traditional constraints, that are available outside our clinics walls and that meet our patients wherever they are. Digital health care solutions offer the best way, the most affordable way, to improve population health outcomes. I can’t wait to experience this revolution.

Brad Younggren, MD, Chief Medical Officer 98point6, medical director EvergreenHealth, and emergency physician.

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