Virtual Care Converges with the Physical

Many in healthcare are aware that the pandemic fueled the growth in "virtual" healthcare. Despite my dislike for the term "virtual" (it's still "real" healthcare, isn't it?) there's no denying a positive outcome from the "interesting times" we have lived (and are living) through have spawned. The ability to access care from a distance - and for providers to be compensated for delivering such care - stands to be the great equalizer in terms of expanding access to care for billions of people around the world. No longer is healthcare limited to being "local."

While this is spawning great disruption among the institutions that relied on healthcare being geographically proximal to patients and having virtual monopolies in specific geographies, it is also spawning great innovation in terms of how far we can push the envelop of what care can be delivered "virtually," or more accurately "at a distance." Hospital at Home, Virtual Nursing, TeleBehavioral Health, and even Remote Prescribing are becoming more and more common in our healthcare frameworks.

Hospital at Home is an interesting one because a major component in its innovation is based on the shrinking, simplification, and lower costs associated with the physical devices - monitors - the physician and nurse rely upon to render the Hospital at Home service. The evolution of the Hospital at Home model has been predominantly rate limited by the delivery and management of the physical devices necessary to provide the data back to the physician or nurse monitoring the patient. While Apple, Samsung, Garmin, and other duke it out to shrink all of that onto our wrists, companies like BestBuy and its latest acquisition Current Health are evolving a service of managing the entire supply and support chain of these devices into the home on behalf of the hospital. This convergence of the physical meeting the virtual may be the "next mile" (I dare say "last mile") in enabling an even bigger explosion in available "virtual" services.

This convergence isn't limited to monitoring devices either. While Theranos (Elizabeth Holmes) may have been a bit premature in their clinical claims, there are numerous innovations happening in terms of patients self-collecting biologic samples for lab testing which stand to again, shift the landscape. Just imagine as a physician or Physician Assistant being able to have lab results before ever seeing a patient, in office or virtually! And this needn't be just for acute episodes. In fact, its greatest potential may be in primary care and screening.

The patient suffering from frequent UTIs being able to self test to confirm the UTI may never need to visit the physician, nor will the physician need to worry they are missing something when confirming a routine prescription for an antibiotic. Or a patient on Warfarin monitoring their INR in the same way a diabetic monitors their blood sugars can have a profound effect on the cost and accessibility of care. What percentage of lab tests and office visits are related to these two tests alone, preventing other patients - perhaps more acute - from access to care?

Speaking of diabetes, continuous glucose monitoring (CGM) is now a reality, and stands to shake things up both operationally and diagnostically. If we can monitor a patient's blood glucose in real time, continuously, and remotely, will we even need a fasting A1c test?

Home DNA testing is now available not just to determine one's family tree, but for precision medicine enabling less 'trial and error' in therapeutics. This too can all be done by the patient, in their home or office, and will make the physician's job of prescribing more efficient and effective. Or better yet, Nutromics and their "lab in a patch" that monitors a multiplicity of biomarkers and drug presence in the blood-stream continuously (currently in clinical trials).

Cancer screening is another such example. Cologuard has moved colorectal cancer screening right to the home through a combination of direct-to-consumer (DTC) marketing and sales, but also sample collection and transport directly with the patient; no office or lab visit required. Everlywell and others offer STD & HPV (human papillomavirus) testing services direct to the consumer based on the patient collecting their own sample with a vaginal swab. And companies like OncoGenesis are advancing this even further to bring a self-collected cervical cell sampling device to market, all of which would allow complete cervical cancer screening without the need to see a physician.

These are only a few of the innovations and advances happening that when combined with the ability for a physician, PA, or RN to "see" a patient from a distance can have a profound effect on making healthcare more accessible. If it were as simple as being mailed or picking up a (perhaps prescribed) CGM monitor or a cervical self-sampling device from the pharmacy or grocery store rather than having to dedicate hours of fasting or visiting the MD, how much more likely are patients to engage in their own care and wellness? And how much more cost-effective might it all be, making it accessible to the billions of people who today don't have any such care? How many hours of physician office time would be freed to allow these physicians to get back to what drove them to medicine in the first place, caring for the sickest of the sick rather than doing routine, mundane things?

I'm excited for the convergence of what we can do with the physical innovations occurring when coupled with what we can now do "virtually." And I hope those that are immersed in the innovation of "virtual care" are paying attention to the developments happening around them in the physical world. These advances of devices and technologies stand to drive the next positive inflection point in "virtual care."

That said, I still think we should stop calling it "virtual care." This is real healthcare, and there's nothing "virtual" about it.