Virtual Care: Innovation to Impact

Featured article by Joel E. Barthelemy, founder and CEO of GlobalMed

Telemedicine is well on its way to transforming healthcare. In the coming decades, virtual care will be woven into the fabric of healthcare at every stage. For example, it will take over much of primary care, it will incorporate genomic therapy, and it will become the healthcare backbone for the Internet of Things.

As a result of machine learning, for example, AI engines will be able to perform many of the functions now provided by primary care providers. An AI engine, visualized on a screen as a human-like avatar, will guide patients through a list of questions more comprehensive than those that primary care physicians and nurses now ask them about their symptoms and health histories. The AI engine will base those questions on what it already knows about the patient and what their answers reveal. Questions that other providers have already asked will not be repeated, because they will be retained in the patient’s personal and comprehensive health record.

Videoconferencing will enable the AI engine to observe patients’ general health, including their skin condition. It will also analyze the results of vital signs monitoring on inexpensive home and mobile equipment and wearable sensors. Consumers might even be able to use a “lab on a chip” for instant blood tests and transmit the results to the AI engine.

Under the rules of the U.S. Food and Drug Administration (FDA), a device cannot be used to diagnose a patient without a physician’s input. But an AI engine could state probabilities without running afoul of the FDA. For example, it could say there’s an 84% chance that a patient’s stomach symptoms are related to the flu and only a 4% chance they’re due to indigestion. A doctor could look at this report and decide whether or not he or she agrees.

Drugs also cannot be prescribed by algorithm—a situation that is unlikely to change. But, by using data on thousands of similar patients with the same health conditions, the AI engine could advise the doctor on which drug to prescribe. As these learning machines become more and more accurate, providers will agree with them more frequently. If they know something unique about a patient, they might contact the person and ask some more questions. But in most cases, patients will no longer have to see primary care doctors in person.

Genomic therapy

Today, doctors and patients use telemedicine to consult with specialists who may be located hundreds or thousands of miles away. As genomic therapy enters the mainstream of healthcare, telemedicine will be used to provide much more personalized care to people, based on their genetic characteristics. Medical centers equipped with low-cost genomic sequencing equipment will routinely sequence each person’s genome. Based on a patient’s genetic makeup, and what is known about how patients like them respond to various therapies, AI engines will recommend how best to diagnose and treat that patient.

A physician will then decide whether and how to use that information. If that doctor wants the advice of specialists, the clinicians can use telemedicine to confer about how to use the genetic information and the AI engine’s recommendation in a treatment plan. In many cases, doctors will use the genetic data on a patient to deliver more personalized care when they diagnose and treat the patients remotely via telemedicine.

The Internet of Things

Devices like the FitBit and the Apple Smartwatch have shown the utility of wearable sensors in healthcare. Some mobile devices paired with smartphone apps are now used to monitor patients with chronic conditions such as diabetes and heart disease. But something else known as the Internet of Things (IoT) is likely to take this approach much further. If so, it will be aided by a revolution in mobile communications that is already underway.

The original cellular wireless band fell into disuse after the advent of 3G and 4G smartphones. Yet this channel is ideal for direct transmission of device data because of its low bandwidth and low energy requirements. Recently, IoT companies have revived and updated that band, renaming it Random Phase Multiple Access (RPMA). A wearable sensor in a shirt or a shoe would have a much longer battery life if it used RPMA. It also would no longer have to be paired with a smartphone or a wi-fi network to transmit data to a healthcare provider. In addition, RPMA cell towers would not have to be as numerous or as close together as current cell towers. Regardless of a user’s location, their wearable sensors and other monitoring devices will be able to transmit data continuously via RPMA.

This technological change has huge implications. Wellness monitoring, when applied to everyone throughout their lives, will help us live healthier and longer lives. The sensors will tell us about our physical condition and how to stay active and eat well. We’ll receive an alert, for example, when we’ve had enough sugar for the day.

The elderly will especially benefit from these ubiquitous health-related sensors. Patients with Alzheimer’s, for instance, will have a chip in their shoe that can track their movements and tell caregivers whether they’re upright or not, or if they have wondered outside of their home and have gotten lost. The IoT will spawn many other innovative uses in skilled-nursing facilities, assisted-living facilities and retirement communities.

About the Author

Joel E. Barthelemy is founder and CEO of GlobalMed, a telemedicine company that is honored to be the telehealth provider to the White House, Dept. of Veterans Affairs and Defense Health Agency. GlobalMed’s virtual health platform has earned the U.S. Department of Defense (DoD) Authority to Operate (ATO) on DoD networks, making their solutions available to the Military Health System. GlobalMed is a Veteran Owned Small Business (VOSB) and Barthelemy is a Marine Corps Reserve Veteran.