The 21st-Century House Call


Remote access medicine has been a cornerstone of human space exploration since the inception of NASA. The International Space Station (ISS) permits Earth-based specialists to examine the entire habitat of the station and use a wide range of physiological systems to monitor the health details of each crewmember.

This practice extends well beyond the skin and garment triaging of pulse and blood pressures. Specialized diagnostic stations permit physicians to perform complex diagnostics while video links with each astronaut.

Remote examinations may include vascular imaging, optical coherence tomography, bone density, electrocardiography, or ultrasound imaging. About every aspect of health can be measured and linked to specialists on Earth. Naturally, weight is determined very differently; mass is measured and converted to weight.

Similarly, the isolated environment of a submarine, undersea laboratory, or a remote Antarctic station requires specialized means of remotely performing health diagnostics.

But what about the rest of us? My Fitbit is cool and helpful for my cardio health, blood pressure stations had their time, and other types of digital health applications, such as Babylon, MyChart, and iTriage, can be accessed through smartphones and watches. But could we eliminate the magazine tables of waiting rooms and establish direct links to our own health care?

My first exposure to telemedicine occurred while in Cleveland in 2014. John Nottingham reported his work with Steve Cashman to further Cashman’s Care4 concept of a personal medical pod. The effort resulted in a functioning personal health care kiosk dubbed HealthSpot. The company began deploying private enclosed booths, equipped with high-definition cameras and digital medical instruments, to provide personal medical stations in truck stops, airports, hotels, and pharmacies. The approach included live video-linked examinations conducted through integrated in-pod diagnostics, and an “attending” health professional, assisted by a local technician. This early-stage form of remote health care was trialed at Rite Aid stores in the Ohio region, as an alternative to the CVS MinuteClinic. This concept may have been ahead of its time, and it ended with bankruptcy, but its vision continues. Despite HealthSpot’s demise, virtual doctor visits survive through programs like TelaDoc, Doctor-On-Demand, or MDLive.

Here in South Carolina, Dr. Aaron Lesher has addressed the needs of rural patients using webcams, Skype, and FaceTime — to inspect children’s burns, counsel with parents to determine whether emergency treatment is indicated, or whether instead to look on while a burn is being treated and bandaged. This live consultation may be followed by another video visit to check up on the recovery progress. It is an immediate and important means of urgent care that can prevent the high cost and missed job hours associated with a long one- to three-hour round-trip to a major hospital. The MUSC Center for Telehealth in Charleston is expanding rapidly, with its video-linked pediatrician care and community hospital expert collaborations.

Also in South Carolna, Dr. Joe Krainin operates his Mount Pleasant office for patients with sleep disorders, except there is no “office.” Unlike expensive in-lab testing that may cost about $2,000, the Singular Sleep patient can buy a test kit system for $249 and receive results about two weeks later. The telemedicine software and sleep monitoring equipment permit the diagnosis of sleep disorders from the convenience and comfort of one’s own bed using a smartphone, tablet, or computer with a webcam and an internet connection. Patients can consult with a board-certified sleep medicine doctor through a secure, HIPAA-compliant web portal. Home sleep study data is reviewed and scored by registered sleep technologists, and interpreted by a board-certified sleep physician.

Krainin meets with his patients, evaluates their sleep habits, and even prescribes medications without ever stepping into an exam room with them. If more is required, medical equipment can be supplied to remotely monitor the treatment of the medical disorder. A similar home study is being explored in Greenville by SleepWorks, using its ApneaLink device.

On the grander front of telemedicine, telerobotic laparoscopic surgery is emerging. Using robots like Zeus or Da Vinci, specialists can collaborate with local physicians to remotely perform telerobotic surgeries that complement the community practice. Surgeons may be hundreds of miles away from their patient. Sure, this may confuse insurance companies, but virtual surgery is “reality.”

Clearly, telemedicine is becoming a vital part of our everyday life. With an increasing shortage of skilled nurses and physicians, as well as constant pressure to reduce health care costs, an ability to remotely access patients without adding brick-and-mortar clinics has financial and practical appeal. Tele-health care technologies improve the quality of care, reduce costs, and keep patients in their own communities.

Top: Photo by Intel Free Press [CC BY-SA 2.0], via Wikimedia Commons



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