Beyond the Clinic, from Telemedicine to Remote Treatment
The Future is already here it’s just not evenly distributed — William Gibson
Telehealth has existed since the telephone & radio was invented and the first doctors began communicating over distances. But these days we can do much better than one-way communication, we can enable remote treatment.
In this age of smartphones & apps Telemedicine has become the new normal. Talking to a GP or health professional by phone or video call is nothing unusual.
This is because it’s completely normal to interact with all companies and government institutes in all other spheres of life by by website & app, so it is now abnormal to not have the possibility of interacting with your health professional on these channels too. We are a digital multichannel society and we will never go back to the way things were before.
But consultations alone which are widely available digitally are no longer enough.
At the end of the day there are 5 parts to care and for many conditions they can all be digitised.
Assessment — understanding the nature of the condition and parameters involved from patient input/ass to understand the issues.
Diagnosis — codifying the information into a succinct assessment of the nature/cause of the condition thus laying the framework for the appropriate care pathway.
Consent — outlining the options and explaining risks/benefits so that the personally most relevant / compatible solution can be selected.
Treatment — delivering the intervention — drug, device, procedure to achieve the health outcome desired.
Supervision — following and assessing the progress and improvement of the health condition as a result of the intervention until resolution of the presenting problem has occurred.
As an example our company provides technology to enable Orthodontists to remotely assess, diagnose and treat adults that want straight teeth. Let’s look at how this framework is applied.
Having the ability to assess and diagnose are important, but consent, treatment & supervision are the next logical steps and shouldn’t necessitate a physical visit in most instances if not absolutely required to gain additional information for the assessment & diagnosis. There is already remote prescribing of many medicines such as antibiotics or other drugs, but that tends to be in a singular course of treatment or for an exceptional instance.
In order to do this we need to have a digital feedback loop in place. Nowadays with smartphones, attachments and low cost sensors patients have complex tools in their pockets to enable this, and these inputs can then change or modify the treatment course recommended enabling treatment and dynamic supervision. This dynamic feedback loop from is known as Industry 4.0.
Industry 4.0 is the evolution of computers and automation into cyber physical systems. This means smart sensors, the internet of things, cloud computing, artificial intelligence and the intersection of virtual and real worlds working together creating a smart system. The end product (e.g treatment / health intervention) then communicates with the system (telemedicine platform/clinician) to tell it what exactly what is happening and the platform/clinician then understands exactly what the response is and what it needs to do next. This means that intelligent systems monitor the feedback and make decentralised decisions resulting in largely self managed processes.
There are 4 parts to be considered to be Industry 4.0
Interoperability — machines, devices, sensors and people connected, communicating and working together.
Information transparency — the machines create a digital virtual copy of the physical world through sensor data to enable a contextualised understanding of the information.
Technical assistance — both the ability of the systems to support human decision making & problem solving as well as the ability to assist humans with tasks that are too difficult or unsafe for humans to complete.
Decentralised decision making — the ability of cyber physical systems to make simple decisions on their own and become as autonomous as possible.
This is the future of care delivery. Skilled clinicians supported by A.I platforms to enable high quality scalable care for suitable conditions. Let’s look at the model further and use our Teleorthodontics platform as an example.
For a Teletreatment model for this Industry 4.0 paradigm we can summarise the process as Sense.Inform.Effect with a feedback loop from Effect to Sense.
SENSE
When we examine someone we are reliant on several inputs
Sight — we look carefully with our eyes
Sound — we listen carefully with our ears
Touch — we feel carefully with our fingertips/hands
Special Tests — we request special measures/tests to get further detailed information to enable us to fully understand the picture.
Digitally these can be translated into:
Here we use an app to collect the initial data
Then we use a self impression kit posted to the patient to capture the 3D information in a set of impressions that are then digitised and scanned.
- INFORM
When we communicate with the patient after a normal examination there is a discussion and clarification of findings. Normally we would communicate by voice digitally this can be done by:
Here we use a digital report with 3D models and videos which makes it more understandable than a monologue from a clinician. It allows more consideration and two way messaging can be used to clarify any uncertain points. All of these enable communication & clarification of information digitally in different forms making it easier to understand and process. This means that clarity & consent can be established regarding the options for course of action. This is traditionally where many telemedicine solutions finished but there is a next step enabled by different technologies:
EFFECT
Treatment can take many forms ranging from information to minor procedures and this can all be delivered digitally.
It can be information / education which is easily digitally transmitted. This can also be provided by an A.I agent automatically in addition to a human clinician.The next phase is delivery of drugs/medicines which can be done easily by prescription to a pharmacy that then post/ship the medicine direct to your door.
There is a newer option now, 3D printing / manufacture of a customised medicine on demand locally this can be done now with technology that exists and in many remote areas may become a solution of choice.
With advances in 3D scanning and digitisation custom medical appliances/orthotics can be 3D printed and manufactured and sent direct to patients. These medical devices can actually make a real difference.
This is what we use at Straight Teeth Direct — custom medical devices (orthodontic aligners) made on prescription from the orthodontist shipped direct to the door of the patient.
Overall we are now in an exciting chapter of Telehealth where Tele-Treatment is now enabled allowing more and more people to get treatment and digitally empowering clinicians to truly help more people achieve better health outcomes. The more health Specialists that adopt this mindset the more patients can benefit from increased outcomes.
If you are interested in learning more about how to design & digitise your own healthcare solution then keep an eye out for the upcoming handbook — Ex Health: The Future of Health Handbook.
Author : Aalok Yashwant Shukla — Director of Innovation, Data & Technology
