The term ‘doctor in a box’ – once used as a derisive term for physicians that provide primary health care at an hourly rate in unaffiliated ambulatory care clinics – has taken on a very different meaning. There, for the past seven years, it has been used to describe several formats of telemedicine where, instead of flying patients from remote settlements into medical centers for examination and treatment, it involves using either a robot stationed at a nearby local clinic, or a cell phone link from the patient’s home, to connect doctors in medical centers many miles away with that patient’s vital signs, test results, and diagnostic instruments. Continuity of their doctor-patient relationship over time is generally assumed.
In the United States, however, that pejorative term has largely been eclipsed by the concept of an “e-doctor.” It is used to characterize an integrated, mobile, electronic health platform that not only enables physicians to monitor patients remotely, but one which also uses algorithms and artificial intelligence to analyze that data, much as a human doctor would, and then goes on to provide appropriate interventions. In other words, this e-doctor would collect, assess, and act — embodying the knowledge of a doctor, as well as the authority of one, yet remaining at the patient’s side 24/7.
But does such an e-doctor actually exist? And if it does, is it really legal? Not quite yet.
While most electronically-generated prescriptions and procedures are still not ready for FDA approval, they are moving inexorably in that direction. That means fully-credentialled e-doctors still don’t exist, at least not in their entirety. But major elements of the concept have already been deployed in the field, and progress toward a more comprehensive e-doc is well underway. Software to interpret patient readings and recommend appropriate actions is developing quickly. And their final fruition is already within sight. Their legal approval, however, is still a work in progress.
Even so, there are compelling medical and business reasons for continuing to advance that movement. Consider, for example, the condition that healthcare professionals call “walking diagnosis.” When someone goes into a doctor’s exam room, they present a set of symptoms. Yet when they walk out, leaving their doctor behind, they still have those same symptoms. But an e-doctor can remain fully engaged with the patient, both during and after the exam, and then guide them on their journey to wellness or treatment as appropriate. A combination of intermittent in-person doctor visits with continuous electronic monitoring can be especially valuable for conditions like chronic care management, post-acute care, and other situations where patients simply can’t walk away from their responsibilities.
But what about the healthcare system itself? Isn’t this a recipe for an industry, already under serious stress, to lose even more essential revenue? The answer is no, at least not over the long haul. That’s because a great deal of the capital infrastructure and staff effort of traditional hospitals is currently geared toward collecting routine patient data. That investment is largely a holdover from the time when only well-equipped hospitals were able to gather the types of patient health data that are now reliably available from doctors’ offices, freestanding clinics, and even with home-based instruments. A realignment of facility assets would provide a better fit for acute-care hospitals’ most important strengths.
What the e-doctor concept offers is a way to collect patient information – not every six months, but every six minutes – and to provide a stream of continuous data that’s been missing in traditional medical service models. As a result, human doctors receiving that data can go from simply reacting to the way a patient presents, to instead projecting forward and highlighting trends – seeing where patients may be moving toward a different diagnosis.
An e-doctor can be a kit of instruments provided to the patient. Alternatively, a patient can attach their own devices and report their outcomes using surveys. Surveys, by the way, can have tremendous value because they typically involve a mix of behavior, social health determinants, and other factors affecting the patient’s well-being. Medication management is key to successful patient management. Helping patients adhere to their medications – particularly those with chronic conditions – is huge, and e-doctors are able to collect and present that data to human physicians, even at distant locations, in near-real-time.
Right now, if I were to compare the current state of e-doctors to their human counterparts, I would place them in their second or third-year of medical school. But in the foreseeable future, I see their status being upgraded to that of medical residents. However, I don’t see e-doctors ever becoming expert physicians. What I see instead is e-docs becoming inseparable companions to experienced doctors as well as a source of improved revenue to medical systems everywhere – and sooner than most people imagine.
Photo: mrspopman, Getty Images