Over the past several decades, healthcare has evolved into a discipline practiced in the home to one practiced in specialized medical facilities. According the CDC, there were 1.1 billion ambulatory care visits to physician offices, emergency rooms, and hospital outpatient facilities in 2009. However, in recent years, it seems that the pendulum has begun to swing back, with an explosion of services geared at delivering healthcare in the patient’s home. In fact, in 2009 alone, over $70 billion was spent in home healthcare.
BL Healthcare is a Massachusetts-based telehealth company that since 2006 has been developing platforms for delivery of remote care in a variety of locations. Basically, they have three setups – one television based, one kiosk based, and one touchscreen based. They have recently made headlines with announcements of partnerships with Verizon and Sprint to provide wireless connectivity to BL Healthcare’s telehealth platforms. Given recent trends in healthcare, its pretty clear that this is a company that has quite an opportunity to capitalize on an exploding market and is probably representative of things to come.
To understand better how this will impact the practice of medicine, its important to understand a bit better the technology being offered. All three platforms offer numerous peripherals to collect data – pulse oximetry, blood pressure, forced vital capacity, and so on – as well as videoconferencing. The kiosk is basically a diagnostic station complete with those features as well as optional features like a digital stethoscope, 12-lead EKG, and several connectivity options to allow integration with other devices. The television and touchscreen options are relatively simpler and designed more for home or hospital room use – they come with features like the data (labs, vitals, etc) review, educational media, and automated text message reminders that seem more oriented to improving communication and empowering patients.
Of these offerings, what I was most struck by is the kiosk. The television and touchscreen platforms seem like natural extensions of existing technology (ie as a big improvement over those awful patient education videos). The kiosk, however, is more transformational – it completely changes the way a healthcare provider interacts with and cares for a patient. In doing so, it provides some very interesting opportunities to enhance healthcare but also presents some dangers of which healthcare providers need to be conscious of.
First, the opportunities. Aside from being setup at airports, malls, or similar areas, one area where this kind of technology could really shine is in home-care. I’ve often seen patients in the hospital who ended up there largely because of lack of regular medical care – not because they didn’t want it, but because they were physically limited by medical conditions from getting it. I can easily imagine this kiosk neatly packaged into essentially a mobile care unit that could be brought to those patients, allowing them to get the regular preventative care that could keep them out of the hospital and improve their quality of life.
Hopefully we will soon see companies like this leverage the investment of consumer electronics companies and package this kind of diagnostic technology into a simple package for the iPad, Xoom, and other popular tablets. We have already written extensively about medical peripherals for the iPad. Taking the right peripherals with the iPad 2 (and its forward facing camera) could create a similar mobile diagnostic unit to the one BL Healthcare is marketing.
Another opportunity here is in delivering care in remote areas and disaster zones. When its not possible to put physicians in these areas, either because of safety or because of cost, these units could be extraordinary assets in delivering a minimal level of care to the affected community.
However, there are also important limitations to this technology. The most obvious is that this kind platform will invariably weaken the physician-patient relationship. From the introductory handshake to the physical exam, there are several elements of the clinical interaction that help build the trust between the clinician and the patient that enables the development of a therapeutic relationship. While this kind of mobile technology has an important role to fill, its important that it does not replace traditional clinical visits but rather augments them.