Why We Must Go Beyond Telemedicine

As a physician, I’m all too aware that there is a crisis in access to healthcare, as people find it increasingly difficult to get the care they need, when they need it, at a price they can afford. After 40 years of costs rising at a rate significantly greater than the rate of rise in GDP, total healthcare expenditures have reached $10 trillion globally, and $3.2 trillion in the U.S. alone. Rising healthcare costs are worsening the problems of access to care, and are increasingly putting employers at a competitive disadvantage. The recent transformation of how we access information, shopping, transportation, and entertainment has highlighted the incredible opportunity to use technology to transform healthcare, improving access, convenience, and effectiveness, and at the same time reduce costs.

Today the marketplace of healthcare technology solutions is extremely fragmented, with hundreds of apps, devices, programs, and plans that don’t provide a good solution for people who simply want to understand their symptoms and get better. Doctors would like tools that help them take better care of their patients, but instead find a confusing array of ineffective technologies that only increase their frustrations.

As Dr. Atul Gawande, the renowned surgeon, author of four New York Times bestsellers about medicine, and CEO of the Amazon/Berkshire Hathaway/JPMorgan Chase healthcare venture, wrote in his recent New Yorker article, Why Doctors Hate their Computers, “... technology inevitably produces more noise and new uncertainties.” Gawande’s opinion reflects the clear need for better models of care and improved care delivery for all.

The recent rise in telemedicine offers the promise of convenient access to cost-effective virtual care. Remote virtual consultations are becoming more accepted among young, affluent, urban users — but only 17.6% of patients have communicated with their doctor by video. Telemedicine is not yet in widespread use, and is certainly not connecting underserved populations.

But telemedicine alone is not enough. Convenient, cost-effective, and efficient virtual care requires more than on-demand virtual consultations, it requires holistic integration of technologies that guide people to personalized answers, information, and the care they need, while also improving the decision making of doctors and helping people understand and follow through with their doctors’ treatment recommendations and follow up.

Crowd sourcing works when doctors are the crowd

Five percent of all Google searches are health-related, but health-search results are far from ideal. In 2017, the Western Journal of Emergency Medicine found that most patients searching the internet for their specific ailments prior to seeking emergency care did not end up being diagnosed with those ailments. A study by Microsoft Research found that search results for questions about headaches mentioned brain tumors far out of proportion to their actual incidence, and concluded search-engine results amplified unfounded health concerns, leading to “cyberchondria.”

There is a better source of answers to health queries: the collective wisdom of doctors. The internet makes it possible to crowd source and peer review the medical knowledge of doctors, and directly connect people to that knowledge. When people have access to relevant, trusted information, they ask more questions, receive better answers, and engage much more with their own healthcare. For example, one of HealthTap’s Fortune Global 500 customers discovered that when they offered easy access to this kind of information, 11.8% of their employees engaged with their healthcare each month - a rate that is 18 times the typical rate of engagement with telemedicine-only solutions.

You want your healthcare to be personal, right?

To truly deliver a transformative digital health experience, the information, care and support must be personalized, based on an accurate understanding of an individual’s personal health information. Amazon and other modern retailers personalize their customers’experiences — 87% of people say that personalization improves their purchasing decisions. Personalization of healthcare experiences helps people pay more attention to their health, interact with their doctors, follow their treatments, and achieve better outcomes. One source of personalization in healthcare is Apple Health, which aggregates users’ health records from multiple institutions onto their iPhones. This offers the promise of easy, simple applications that “consumerize” the healthcare experience—and help healthcare providers deliver better care.

Augmented intelligence: Yes, especially in healthcare

The first step in giving guidance and information to people with health concerns is to provide doctors’s peer-reviewed answers to health questions. One of the most common questions is a request for more information about symptoms — “What is the cause of my symptom, and what should I do about it?” The next step in helping people with health concerns is to give guidance about what might be causing their symptoms. An AI application can help, first by asking “smart” questions to reveal what other symptoms may be present or to confirm they are not present, and then by showing the possible explanations for the symptoms.

AI solutions are unable to make a specific diagnosis or recommend a specific treatment or test directly, because the practice of medicine requires a medical license. On the other hand, AI can help confirm if the possible or likely explanations warrant an evaluation by a doctor, or reassure if there are no more serious explanations. What’s more, when a doctor evaluation is needed, the AI-based assessment and report of possible explanations gives doctors a tremendous starting point for their evaluation, freeing up valuable time to focus on the uniquely human aspects of giving care. Moreover, the prepopulated list of possible diagnoses serves as a clinical decision support tool that reminds doctors to make sure their patient doesn’t have any of the less likely possible explanations.

The AI-based evaluation and condition report isn’t AI that could replace the doctor, it is in fact an Augmented Intelligence that helps doctors save time and give better care. This gives much needed help to the diminishing supply of primary care doctors.

The American Medical Association recently adopted policies to integrate the perspective of practicing physicians into the development, design, validation and implementation of augmented intelligence into their practices. Our own research at HealthTap has shown a 30% reduction of in-person primary care visits and a 15% increase in telemedicine visits as a direct result of patients using an augmented intelligence application. While the impact of augmented intelligence on medicine is yet to be fully realized, there already are clear benefits of an AI-based application that checks symptoms and offers triage recommendations.

In every healthcare facility in the US, virtually nothing is the same as it was 50 years ago. Doctors have a wide array of new diagnostic imaging, instant access to online medical records, surgical robots, and an ever-expanding set of new treatment options. Would you go to see a doctor who didn’t embrace the modern updates in the field?

Doctors won’t be replaced by new developments in healthcare technology, but doctors using the latest technology that goes beyond the basics of telemedicine will certainly replace doctors who don’t.

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Dr. Geoff Rutledge is a practicing emergency physician and internist who also holds a doctorate in medical information science from Stanford. He has been on faculty at Harvard, Stanford, and UCSD Medical schools, and a principal investigator on NIH-funded research in medical computing`. Geoff led the creation of the first consumer health website and patient health record at WebMD, holding multiple executive roles and undertaking several, successful, entrepreneurial projects. Geoff co-founded and is currently Chief Medical Officer at HealthTap, a pioneering digital health company focused on simplifying cost-effective access to healthcare.