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A Doctor on a Stick

Capitalizing on the New Normal

Disruptive innovation is usually heralded by sudden and unforeseen events such as a crisis, war, or necessity (one may recall the famous expression that necessity is the mother of invention). The current COVID-19 pandemic is certainly proving this point as the healthcare system scrambles to adapt and pivot to enormous upheavals in patient, provider, and payor relationships. Deferred procedures, postponed elective services, new workforce protective measures, and the availability of telehealth services as an alternative to in-person care are now quite known to many. Prompted by the swirl of change in healthcare operations, entrepreneurs are developing a multitude of ways to maneuver around many of the barriers to health and wellness that have been thrown up by the pandemic, and in the face of this challenge, the best opportunities are yet to come.

Virtual and (Mostly) Instantaneous Health Results

Many leading pharmaceutical companies have commercialized rapid COVID-19 testing kits, with claims of results in under 15 minutes. This has been enormously beneficial in terms of mitigating the spread of COVID, namely: by identifying those who may be sick or asymptomatic, reducing risk of exposure to the healthcare workforce, and by fostering more timely access to treatment for the patient who may be afflicted with the virus. The re-purposing of this technology, which when combined with powerful clinical assessment services such as robotic triage and Internet of Medical Things (IoMT) is fueling many new start-up ventures beyond COVID-19 testing, whose aim is to create platforms for patient health evaluations, modernizing the quaint early attempts epitomized in drugstore blood pressure machines from yesteryear. In doing so, a key goal for these ventures is to deliver virtual and almost immediate care plans, should they be required.
The industry is bringing in to focus a virtual encounter that may be visualized as follows.

• Step 1: The patient steps inside a small booth about the size of an old-style telephone phone booth, and sits down in a comfortable chair (an enclosed booth is necessary for patient privacy given HIPAA regulations).
• Step 2: The patient is asked to pay a fixed fee (pricing transparency and competitive commoditization of healthcare services are driving value-based healthcare to a flat rate model).
• Step 3: The patient confirms their identity, answers a health questionnaire, following which the actual clinical encounter begins.
• Step 4: Clinical encounter. This may include robotic blood draws to whole body scans. Telehealth and other digital health services may be offered.
• Step 5: The session is completed, the patient is offered a personal satisfaction questionnaire, and then they exit the booth.
• Step 6: The booth is disinfected using several anti-pathogen agents or systems.

A Digital Doctor Encounter

Affordability to offer the above services in the convenience and privacy of one’s home or even in workplace settings is coming, but we are not quite there – yet. Therefore, let’s examine the clinical encounter in our example above in a greater detail, as the entire process uses what the industry calls “Intelligent Automation”. What this fancy term really means is that the process of collecting information, analyzing the results, drawing inferences, and making recommendations is completely automated, relying on Artificial Intelligence (AI) that is continuously shaped by expanding large data sets of Machine Learning (ML) over time. In plain language, the system ‘learns’ at the speed of a machine from every patient encounter. This could also include ethical and empathetic ‘rules’ that are personalized to the patient based on their preferences. The net result is that the doctor becomes completely digitized – and futurists predict tantalizing consequences.

Does this scenario seem far-fetched? Not at all, given the availability of cloud-based computing resources that offer deep machine learning coupled with sophisticated sensors. A case in point is the collection of patient vitals using non-contact technology. Vitals of interest will consist of the patient’s heart rate, their blood pressure (yes, indeed, blood pressure readings without an inflatable cuff and/or wearable sensors are truly possible), heart variability rate, respiration rate, and temperature. What is quite sensational is this information can be collected in mere seconds and made available to the digital doctor for assessment. Notwithstanding the convenience of non-contact vitals collection is the time savings (again, seconds, not minutes), and avoidance of the discomfort of having to get undressed, as in traditional encounters.

The Doctor on a Stick

Some may balk at the situation described above as being overly-simplistic. Consequently, let’s fast forward to where the industry is headed. Most of us have excitedly watched (and may be participating) in advance trials of new Consumer Digital Health technology such as proverbial ‘smart bracelets’, ‘smart rings”, and/or health-enabled ‘smart-watches’. The common denominator is that the traditional ‘smartphone’ has stepped back to become a platform aggregation point for such healthcare devices, serving to host healthcare applications, consolidate data, and act as a waypoint for data paths from the patient to a cloud service. These new Consumer Digital Health technologies are not just single purpose trinkets. They offer the consumer feature-rich capabilities to collect all sorts of relevant information that may be combined with seemingly unrelated inputs, such as one’s voice quality, to determine a relative state of health and wellness. Accordingly, gait analysis, changes in voice inflection and breathing rates, specific mannerisms, choices of words, facial expressions, environmental parameters (humidity, lumen levels, other) and vitals may be combined to deliver remarkably predictive estimates of one’s health and wellness acuity. When sampled over time, a remarkably accurate picture emerges of the patient’s true health state – one that is objective and somewhat insensitive to subjective interpretation.

What’s most intriguing is combining the latter with diagnostic sensors and digital personas (of a patient’s choosing). As an aside, the latter is particularly relevant as consistency of patient motivation for adherence to health behaviors is fundamental to ensuring optimal outcomes – clinically and financially.

With the diagnostic sensors, patient sweat, blood, urine, and other substances (one may think of a smart bathroom) are examined for signs of disease – existing or latent. In this way, the digital doctor becomes (somewhat unglamorously) a doctor on a stick – an “all in one” platform that combines subjective, objective, assessment, and planning roles for patient care, with almost immediate results.

The Future

We live in an immersive environment, surrounded by constant bombardment of digital media and services, made possible by ever-more sophisticated technologies and end-point devices. The excitement for newer, better, faster, and more experiential services pays homage to this trait. The entertainment, sports, hospitality, financial, and educational industries have longed recognized the value in embracing such capabilities. Healthcare is swiftly following suit, wrought by disruptive innovation sparked in response to the pandemic. That said, will all clinical encounters be 100% digital – likely not. Empathetic aspect of healthcare (human compassion), complexities of care (for instance, surgical procedures), and (for now) the unpredictability of human response to treatments will necessitate a hybrid model for some time to come. Nevertheless, the proverbial train has left the station, and we will see increasing convenience of care, timeliness of care, and precision of care in the coming years – not decades – thanks to the disruption that COVID-19 has caused in what was an industry that is often characterized as slow to change. With continuous focus on safety, quality, and value, the creation and mobilization of the digital healthcare workforce is well underway.

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