Do you miss the days of your dear old doctor driving up to your doorstep for a checkup? While the traditional house call may be a thing of the past, something even better is on the threshold of a new revolutionary beginning. That something is Telemedicine.
Broadly defined, Telemedicine is “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status,” as per the American Telemedicine Association (ATM). More understandably, it is how doctors and clinicians are integrating themselves into the rapidly expanding web-driven world. While the ATM’s definition seems narrowed on how e-communication can help doctors and their practices relay information to other offices, I’m going to focus on a more nuanced—more radical—idea of what Telemedicine can and will be. The medical information being exchanged does not, as the ATM’s definition insinuates, have to be between doctors’ offices, it can be between patient and doctor. This is where the future lies not just for telemedicine, but the entire medical industry.
As smartphones become more and more affixed to the hands, and other smart-tech like the Apple Watch and Google Glass develop, individual persons have a much greater ability to communicate intricate data. Moore’s Law says that since hardware computing came into being in the late 1900s, computer processing power has doubled every 2 years. The ability of a single microchip, let alone the contents of a phone, will be astounding as time goes on. Forget Instagramming your dinner, MedChat that rash on your arm to a dermatologist without getting off your couch. Right now these simple, pictorial approaches to Telemedicine are already in practice. An example is the website StyeGuy , run by Dr. Dan Landmann, an eyelid doctor, wherein people can take a picture of their eye, send it in to Landmann, and for a small fee he will give a professional prognosis of what’s going on with your eye, and if you have a stye, how to treat it. No travel, no infuriatingly routine bureaucratic wait in the doctor’s office, just fill out some basic information, send a picture, and get your answer.
Pictures are just the beginning. Currently there are practices set up for taking your own blood pressure from home, and checking insulin levels for diabetics, all from your phone (with certain medical accessories). This is where we are headed not just for blood pressure, but all sorts of routine checkups. With all of the fervor surrounding digital applications, it is only a matter of time before someone develops something groundbreaking. Pulse readers will become blood monitors, or pictures of the skin turn into X-rays. Yes, I am not only suggesting but fully predicting that there will come a day, the date of which I don’t pretend to know, when you can download an app, buy (or be provided with) some kind of appendage for your phone, draw your own blood for a test, and then sync. Or take an x-ray level picture with your phone (or some attachment), sync and send it in for a professional opinion. The effects will be staggering.
As we enter this brave new age of technology, automation is a very real, very dangerous threat to workers, particularly those designated as “unskilled.” With the way that Telemedicine is heading, however, it seems that even doctors may have something to worry about. In a world where people are able to upload their ailments and send them to a hub, the doctor now works a desk job. Forgetting completely about the receptionists and nurses, the world will also need less doctors, as their work becomes more and more condensed. Orthopedics will clock in, review their uploaded x-ray pictures, and if something seems troubling perhaps then they will call the patient in for an in-person examination.
For the inordinate amount of time, difficulty, stress, and money that it takes to become a doctor, the profession may begin to lose its appeal to many when they realize all of that work is has been completed for a severely shrunken job market. In a world where the specializations of doctors can be reduced to picture interpretation, there becomes the possibility of corporatizing doctors. As many local practices currently exist as independent entities with their own staff of doctors, Telemedicine may allow for their consolidation into bigger enterprises.
These big enterprises will likely cause great damage to smaller, independent practices—think of Walmart versus a Mom & Pop Deli. As the medics become corporately owned, there will be a very interesting playout in their dealings with the already tycoon laden pharmaceutical industries.
As has long been the chicken and the egg debate in the pharmaceutical industries—what will the costs become when this new technology is developed? For the very expensive research and development costs incurred, the product must also come with a high price tag. This keeps it on reserve for the wealthy; inaccessible for the poor. Since the items will be more luxury than necessity (convenience of a doctor in your pocket vs. life-saving medicine), I cannot see much outrage being sparked, until the medical industry starts to make the above outlined changes. As it adapts to Telemedicine, and expects more and more consumers to have the technology it necessitates (as the technology will get cheaper over time), some people may get left behind. How will insurance companies play a role in this? How will company benefits play a role in this? How will the government and things like Universal Healthcare plans, and Affordable Care Acts affect this? With hubs being created for processing, a single-payer system may begin to make sense, but when it is being paid to a few select corporations that have taken over health service provisions, will we just have created another set of elites that are too big to fail? This isn’t gas, this isn’t oil, this isn’t even money—this is health and well-being.
As the independent practices are weeded out, geographical locations of doctors will lessen. Combining the closure of many independent practices with the ability of Telemedicine to transcend an actual visit to the doctor’s offices, real hubs will actually emerge to receive and process data.
This shift will spark a need for changes in how medical licensing is handled. Can a doctor with a medical license to practice in NJ review a submission from someone submitted in Wisconsin, if it is submitted to the NJ-based practice? Does the internet qualify as rooted in a single state? How will state legislation for certain healthcare laws affect cross-border submission of medical data, and how can it be regulated? Will federal laws have to emerge for a uniform method of dealing with the way that Telemedicine has affected healthcare? It seems likely that state-based medical licenses will have to be altered in some capacity to account for internet activity, if they are to stay in place for in-person procedures and operations.
As medical practices become more and more concentrated, and data is further consolidated into electronic, easily storable mediums, security will also become a major factor. Not physical security, but technical protection of information. As we have seen frequently over the past few years, hackers are out there, and they will crack into big databases, for whatever reason. As questioning the security of Target seems to have caused significant stir, imagine if a massive medical company’s information became compromised. Countless records, health histories, and conditions would be exposed to the public – confidentiality would be lost, and perhaps most scarily, files could be changed. It would be a true tragedy were someone to alter people’s health records, and if a hack is never detected, it may even go unnoticed.
There is much potential on the horizon for the industry – perhaps this entire sequence may not come to fruition, but it is only a matter of time before the enabling technology does. Whether or not the associated changes are good or bad remains to be seen, but do not be surprised when your phones are your literal lifeline in the future.