The term telehealth can be applied very broadly. Although many, including the Center for Medicare & Medicaid Services, define telehealth simply to encompass virtual visits, we now have a mandate to explore numerous uses for networking and remote monitoring that can improve health, creating what some observers have called a “hospital without walls” or “virtual care.”
The term “virtual care” is used at Lumeon to describe the systems they develop in this space. To find out how virtual care can help us rethink clinical treatment, I interviewed Robbie Hughes, founder and CEO of Lumeon. I’ve written before about Lumeon’s consulting practice, which can re-engineer workflows at health providers and has created a solution for COVID-19 triage. Hughes mentioned how certain important sources of diagnostic information are lost in remote visits, but how an expanded view of telehealth can provide valuable new sources.
Obviously, you don’t get to touch a patient in a virtual visit, or smell them (which often provides important clues). You usually don’t see the whole body and may miss subtleties in speech and movement. But you do see their environment, which is helpful. Now is the time, Hughes suggested, to expand telehealth with continuous remote monitoring, which proponents of connected health have pushed for years.
Hughes also suggested that we could test patients regularly for many conditions (COVID-19 and others) by setting up numerous test centers in pharmacies and community centers. It’s more convenient, probably cheaper, and perhaps safer for a patient to go down the street for a blood test than to come into a hospital. Rapid and seamless data sharing–another campaign of the connected health proponents for many years–would let us stay on top of patients’ chronic conditions or their recovery from illness. Hughes said that this distributed testing would require measures to ensure quality.
Three current uses for virtual care that Lumeon is working on with clients are:
- A “virtual emergency department”: patients can text the ED to explain a problem that just popped up. The system automatically interprets the patient’s text and takes the patient through a sequence of questions to determine whether an immediate physical visit is necessary, whether the patient should talk to a member of staff, or whether the patient’s symptoms are improving so that no action is required. See Figure 1 for an illustration.
- Surgical optimization: this involves an online survey, triage, chart review, alerts, and instructions. The system can make sure the patient arrives at the hospital in the right condition (for instance, fasting in the morning) and reduces manual interventions by staff, no-shows, and cancelations for lack of proper prep.
- Patient contacts for population health: Lumeon is currently experimenting with the use of algorithms to determine the best personalized monitoring for chronic heart failure, COPD, and diabetes. They are combining primary research with data collection in the field. Hughes expects the result to enable a 5x improvement in productivity at population health centers.
Figure 1. Using a Lumeon evaluation app
Many have pointed out that the term “telehealth” has an archaic awkwardness. We don’t label our remote data entry “telework” or our logging in to online Sunday services as “telereligion.” But since we’re focusing on the special status, of telehealth, we should treat it as frontier to explore.