Online Medicine – The Doctor is IN

Technology has changed our lives drastically over the past 20 years. Just about everything can be done online these days from shopping, dating and working to even consulting a doctor thousands of miles away.

One of the fastest growing online medical Internet platforms is Myca which allows doctor-patient consultation remotely, by phone, email, instant messaging or even videoconferencing. It also enables patients to schedule doctor’s appointments online. Myca is barely two years old but has gained quite a following. In the US, the Myca Platform goes under the Hello Health trademark. Welcome to today’s e-practice. The doctors call themselves “your friendly 21st doctors in the neighbourhood”.

Telemedicine / virtual medicine encompasses any digital form (e-mail, fax, telephone, videoconferencing, etc.) of bringing together patients and physicians. However, with the arrival of less expensive broad-band internet access and digital imaging, telemedicine currently refers to interactive, full motion, two-way video and audio over high-speed data networks. Patients and physicians are connected through secure web camera video that also allows rapid assessment of the patient.

What makes e-practices appealing?

(1) Cost-efficiency. E-practices need fewer personnel to run and operate, need less space to rent, thus have less overhead. This translates into cheaper bills for patients. E-practices normally charge less than the traditional doctor’s practice.

(2) Convenience. E-practices are efficient and convenient. Patients can set appointments online, and can choose the media they prefer. There are less hassles, no long waiting time in waiting rooms, no long drives or commutes to see a specialist. Refilling of prescriptions goes faster. Medical information is all stored electronically, easily available for future use.

(3) Privacy. For one reason or another, patients may prefer a more discrete way of consulting a doctor rather than just simply walking into a doctor’s practice. E-practices offer the anonymity that many patients may wish for. For the Internet generation, online medicine is hip and cool. The Facebook-like platform of Hello Health appeals to this age group.

Skeptics, however, assert that virtual practices can’t truly replace traditional face-to-face medical practice. Here are their arguments:

(1) Lack of empathy. Many people feel that medicine is becoming dehumanized by technological advancement. Bedside manners are important aspects of medicine wherein e-practices are rather lacking. A picture on the video screen or a voice over the phone is no substitute for a flesh-and-blood doctor.

(2) Data protection and privacy. E-practices have to rely on electronic health records. Due to well-publicized cases of data stealing and hacking, concerns over data protection are still a major hurdle to overcome.

(3) Regulation and accreditation. Virtual practices now exist all over the world, from Europe to India. Anybody can pretend to be health practitioner online. Scams over the Internet abound. Think about online pharmacies that offer all types of medications that may turn out to be counterfeit, much worse dangerous. Many health advocates are concerned about similar scams that can put the susceptible patient at risk. Currently, there are no real regulations governing e-practices.

Telemedicine doesn’t simply stop at consultation but extends to follow-up care of the chronically ill. How about having somebody to remind you of checking your blood pressure, taking your medicine, and refilling your prescription? Canadian researchers investigated the effect of computer-automated phone calls in the management of hypertension. Their results show that such a system helps patients manage their hypertension effectively.

A policy statement from the American Heart Association recommends “the implementation of telemedicine within stroke systems of care.” These recommendations especially apply in remote rural areas where there are no specialized stroke centers and very few neurologists to cover emergencies. Telestroke patients provide their medical history online and are examined by doctors remotely. Pictures from neuroimaging are displayed on the doctor’s local computer and quickly interpreted. If needed, treatment including thrombolysis (clot-busting) is ordered and can be monitored. In addition, with the use of the so-called crowdsourcing diagnostic data, neurologists are now able to diagnose more accurately ischemic stroke.

Cost-efficiency and acheiving a better and more accurate diagnosis utilizing crowdsourcing is the major argument in favor of telemedicine. The Canadian study on automated blood pressure monitoring system had to conduct an additional investigation on cost effectiveness. Without this additional benefit, the healthcare system wouldn’t accept it. Crowdsourcing diagnostics is a tool which can be used by doctors in an online or face-to-face practice. Using computer software, doctors enter the symptoms and test results of a patient, and the software give the most likely diagnoses and the probability for each.

An example of such a software is SimulConsult, a sophisticated online crowd-sourcing tool for identifying neurological disorders that demonstrates the potential of the Web to transform the way all kinds of diseases are diagnosed. It is like having access to the knowledge and experience of hundreds of other doctors. The result is better and quicker diagnosis, avoidance of unnecessary tests and referrals to the wrong specialists, and lower health care costs.

However researchers have identified six major barriers to the effectiveness of telemedicine, not only in stroke care but in general medical care overall; defining medical specialties suitable for telemedicine, medical licensure and liability laws, securing the health information being shared, creating simple processes for requesting and performing the consultation, developing financial models for reimbursement of telestroke services and gaining acceptance of remote consultation from patients, physicians, and payers.

Online medicine is also involved in one of the most exciting and promising areas of surgery – robotic telesurgery as opposed to the more common procedure of robotic-assisted surgery.

The da Vinci Surgical System is the most well known robotic assisted surgery system and has been around for more than a decade. It has been used in different kinds of surgical interventions from laparoscopic surgery to radical prostatectomy to heart bypass. The da Vinci is intended to assist in the control of several endoscopic instruments, including rigid endoscopes, blunt and sharp dissectors, scissors, scalpels, and forceps. The system is cleared by the FDA to manipulate tissue by grasping, cutting, dissecting and suturing.

Another system is the ZEUS Robotic Surgical System which has been cleared by the FDA “to assist in the control of blunt dissectors, retractors, graspers, and stabilizers during laparoscopic and thoracoscopic surgeries”. It, too, is used to assist surgeons and has one advantage over da Vinci – it responds to voice commands.

Unlike robotic-assisted surgery which requires the physical presence of the surgeon on location, telesurgery can be performed by the surgeon from remote- the so-called online surgeon. In telesurgery the surgeon sits in a console and guides “the movement of the robotic arms in a process known as telemanipulation”. In the UK, kidney operations have been performed by a robot remotely operated by a surgeon thousands of miles away. In Italy, a robot performed a heart surgery controlled remotely by a surgeon in Boston. These are, strictly speaking, not “unmanned” or “unassisted” surgeries but these are pioneering examples of telesurgery which allows surgeons to operate wherever they are. It is not yet as advanced or as popular as manned robotic surgery.

Robotic or telesurgery has the advantage of precision miniaturization, minimally invasive, less risk of infection, less blood loss, faster healing and shorter hospital time. Because of these advantages robotic surgery has become the favorite method of performing prostatectomy on men with suspected prostate cancer. It supposedly helps keep urinary and sexual function after the procedure.

Currently, robotic surgery is still of limited use due to the following limitations:

(1) Cost. Only big hospitals with sufficient funds and high caseloads can afford to invest in surgical robots. A da Vinci System would cost between 1 to 1.7 million US. Currently, there are only about 1,100 of these machines in the world.

(2) Acceptance. Many patients may still have the problem of accepting the fact that a machine is cutting them up or that the surgeon is thousands of miles away. For others, it can even be scary to imagine that medicine can be performed via YouTube or that medical records are exchanged over Facebook. As patients become more technology savvy, the acceptance will also increase.

(3) Training. A robot is only as good as its operator. It is estimated that a surgeon has to work on 100 cases before he can confidently and efficiently perform cardiac surgery with a robot. According to Dr. Douglas Murphy, a cardiac surgeon at St. Joseph’s Hospital in Atlanta, there’s no immediate financial incentive to do that [train in robotic surgery] since the reimbursement is the same. That means few surgeons — let alone other members of the surgical team — can afford to travel and observe an expert in action. That is why Murphy and colleagues, set up the first “robotic surgery college.” Using multimedia presentations, web chats, and live video feeds of interventions, experts in Atlanta are now training surgeons thousands of miles away in robotic surgery.

From consulting and diagnosing to performing telesurgery, online medicine is here to stay and continues to proliferate. Despite legitimate concerns, the Doctor is IN.

Insurance Companies Have a Great Opportunity in Medical Travel

With healthcare costs in the United States continuing to rise at higher rates than inflation, American health insurers are facing very tough times as there’s enormous pressure on their financials. Some allow these cost increases to impact their earnings as a means to gain share, others pass this on to customers as higher premiums, and yet others prefer to keep prices but creatively nudge deductibles, co-payments, and contract terms as to be able to survive in a fiercely competitive and controversial market. However, they must slowly acknowledge that an escape valve is found abroad.

As technology and information flows are shrinking our world, travel for healthcare is becoming universal. Americans looking for excellent but affordable medical or dental procedures find that neighboring countries have shown to have private healthcare facilities which offer very high quality care at great value. Even if US insurance companies realize this is an irreversible trend and understand that letting some of their clients choose to go overseas for surgery may offer a great opportunities to alleviate some of the strain, they are being too slow to adopt it as part of their strategy. Pushing insured clients to seek less expensive options abroad is not only looked down upon but sometimes illegal. What they don’t realize is that they are benefiting from this already and what they need is to align incentives a little better.

The story of one of our recent patients illustrates this point. Mr. Chris Moss, a Denver citizen who asked to remain anonymous, was very recently diagnosed with prostate cancer and advised by his doctor to seek immediate treatment. Having had no health problems in the past, this was his first call to Aetna Global Benefits, his employer-provided insurer. To his surprise, while the robotic prostatectomy surgery he desperately needed would only be covered 80% if performed in the U.S, leaving him with tough-to-cover medical bills of over $10,000, he could choose to have his surgery abroad and his insurer would pay 100% of it. Chris immediately began to examine overseas options, skipping consciously on everything that wouldn’t meet or exceed the quality of care he could receive in Denver and quickly found an option which: 1) offered top-notch care, technology, and surgeons’ experience, 2) is very close to home, 3) has English-speaking staff, and 4) offers the possibility of remotely consulting with the doctors beforehand.

Without knowing it, Chris quickly became a Medical Traveler, one of the hundreds of thousands of Americans that seek affordable healthcare abroad. As patients typically do not know where to start their search or what they’ll find, medical travel facilitators provide assistance in understanding which are the best options, getting price quotes, contacting doctors, booking medical trips, and making the healthcare visit run smoothly. It was through our Monterrey-focused firm called Travel For Care that Chris learned about his options in Mexico and had a seamless experience from research to bookings, and from checking in at the hospital to arriving back home. Two weeks after beginning his research, Chris’ cancer was being removed using the most advanced method the world of medicine knows today.

In this case, Chris is extremely happy to have spent about $1,000 in travel and accommodations when he would have spent easily over $10,000 in co-payments back in Denver. Likewise, his insurance company spent about $28,000 when it could have paid 80% of a $50,000 surgery, or about $40,000. The case is clear, the best healthcare outside of the US, complying with the same quality standards, is as inexpensive as to make paying 100% of it cheaper than paying 80% of the US cost. Although it is true that this type of policy and its 100% coverage abroad terms are not the typical health plan, it should be an eye opener for the industry. Let’s make it clear, that nobody was shoved to go abroad for surgery. Nothing illegal or looked-down-upon was done. All parties are happy (including the Mexicans involved). It is a simple case study for free markets and incentives. Perhaps insurers should inform holders of such policies that they have valuable options abroad. Perhaps all insurers should think of adding the “100% coverage abroad” feature to all policies and see how the market’s invisible hand actually lowers costs and therefore premiums. All in all, there are great opportunities abroad for insurers employing creativity the right way. The best part is that all are set to benefit: insurers, customers, and society as a whole.

Rowan Gibson shares his thoughts on innovating healthcare in his latest online column

Rowan Gibson is a global business strategist, a bestselling author and an expert on radical innovation. He is also one of world’s most in-demand business speakers. Rowan’s books have been translated into over 20 languages. His new book Innovation to the Core (co-authored with Peter Skarzynski) was published in March 2008 by Harvard Business School Press.

Below is Rowan’s latest online column looking at innovating our healthcare systems and rethinking and improving the way things are done.
Innovating Healthcare

The first modern hospitals were founded in Europe and America in the 18th century. About a hundred years later, both the pharmaceutical industry and the health insurance industry began to emerge. So it’s safe to say that, in much of the developed world, the healthcare business has been around for about two or three centuries. And, over time, like most other businesses, it has become bigger, better and faster. But has it actually become different in any essential ways? Not really. Yet that’s about to change. In a world of hyper-accelerating change, global competition, rapidly commoditized products and services, and unprecedented patient primacy, the industry is waking up to the need to reinvent itself from top to bottom for a whole new era.

Over the last few years, I’ve been spending a disproportionate amount of time with healthcare people. Not because I’m sick (thankfully!). But because there’s a growing recognition right across the industry that the strategies and business models of the last couple of centuries may no longer be fit for purpose. The world is simply changing so much, and so quickly, that the old ways of doing things (and they are very old) are looking increasingly archaic, perhaps even obsolete.

As regular readers of this column will know, my approach to radical rethinking and renewal is centered on a set of strategy tools called the “Four Lenses of Innovation”. Briefly, they are: challenging orthodoxies, harnessing trends, leveraging resources in new ways, and addressing unmet customer needs. And if we look at what is happening in the healthcare industry around the globe, we can see numerous and very exciting examples of these four “lenses” in action. Here are just a few.

One of the stubbornly enduring orthodoxies in hospital management is the age-old notion that we all make mistakes – “to err is human”. Everyone has heard horror stories of people having the wrong leg amputated, or getting an operation that was meant for the patient next door. Every year in the U.S., for example, millions of hospital patients suffer injuries – about 100,000 of them fatal! – from things like false medication, incorrect dosage, inefficient diagnostics, duplicated procedures, and so forth. Yet in healthcare, people have long accepted these medical errors as “part of the system”. This is clearly an orthodoxy that must be challenged. When IBM took a good look at what was going wrong – and all too often it was stupid things like illegible handwriting, misplaced decimal points, missed drug interactions and allergies – they realized they could alleviate the problem. They offered to use IT to help hospitals manage their patient data a lot more effectively, in much the same way that companies manage their supply chains. This was the birth of IBM Life Sciences, which has grown from a 2-person unit in 2000 to a multi-billion dollar, 1500-employee business today.

Consider another orthodoxy – this time in the pharmaceutical industry. The traditional pharma model is based on drug discovery – testing thousands of compounds to see if any of them makes a measurable difference. It’s a model that has essentially remained unchanged since the industry got started in the 19th century—the only difference being the scale and efficiency with which today’s pharma companies can manage the compound-testing process. Today, however, a new set of players has emerged – companies like Amgen, Genentech, and Genzyme – where the business model is focused on understanding disease mechanisms (i.e., genetic diseases, immune system disorders, heart disease, cancer) and creating targeted products that address those mechanisms. Their promise is “personalized medicine,” in which the therapy can be matched to an individual’s own unique genetic makeup, as opposed to big pharma’s “mass medicine” model. By innovating around gene-based therapy, which is based on completely different skills and assets from conventional drug-making, this new breed of pharma companies is fundamentally changing the game. Which explains why Swiss pharma giant Roche was recently so focused on swallowing up biotech pioneer Genentech.

Now think about trends. Look at what’s happening in the technology field alone – from e-health to handheld scanners, mobile information devices, telemedicine, surgical robots, remote diagnostics, “integrated digital hospitals”, 24/7 access to full medical records, and the list goes on. Or consider the parallel trend “from high tech to high-touch”, where design elements such as nature, color, lighting, noise reduction, and so forth, are being used by a few cutting-edge hospitals to promote what is known as a “healing environment” that treats both body and soul.

Then there are healthcare providers that leverage their resources in novel ways to create new value for customers. India’s Apollo Hospital Group, for example, which is the largest healthcare provider in Asia, and the third largest in the world, uses its expertise to offer medical business process outsourcing – i.e. writing of diagnosis reports, medical coding, billing etc. – to hospitals right across America. And for many of these hospitals, Apollo take cares of radiology, X-rays, ultrasound, CTs and MRIs when it’s nighttime in the U.S., taking advantage of the time difference. The company’s IT-enabled services already generate tens of billions of dollars.

And what about unmet customer needs? Again, there are great examples. Like Florida Hospital, where staff did “day in the life” profiling of patients so they could better understand and address their problems and frustrations. Or California’s Fresno Surgical Hospital, which has modeled itself on the Ritz Carlton hotel to offer a “5-star patient experience” –including luxury rooms, mini-bars, art on the walls, and food prepared by a Ritz-Carlton chef.

True, many of these examples are still about improving what has always been done. But as all this exciting innovation activity continues, I believe we’ll soon see the healthcare industry doing things it has never done before.

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Economic Consideration of the Robotics Industry During Recession

Here’s a rundown of the most expensive robots currently in use all over the industrial world.

• Sophisticated industrial robots manufactured by FUMAC costs $60, 000. They can carry a 100 pound load and can function 24 hours a day for several years doing repetitive task continuously. Take note that the programming of these robots would cost another $60,000 dollars. FUMAC robots are called six cylinder robots as it can counter gravity to pull up its springs to carry heavy loads. These robots have been used for welding, lifting and painting.

• The American manufacturing company called Adept Technology manufactures the world’s most common industrial robot called the SCARA. The robot is connected by three horizontal joints which gives it the versatility as a pick and place robot.

• Another robot called the Ivybot robot is programmed to analyze market trends and can actually do the trading for their owners using four currency at once. The Ivybot can provide monetary returns and minimal drawdown rate, what is surprising is that the entire system only costs $149

• Surgical robots are common in the health arena today and they cost over a million dollars. The robotic arms are used in complicated surgery but these are remotely controlled by the surgeon. With a camera mounted above, the surgeon can see the operation as magnified in a computer screen. Today, researchers are trying to develop an alternative machine that costs only ¼ its original price.

Industry Survival

How can the costly robotic industry thrive in recession? The Robotics Industries Association announced that members have had a good year despite conservative consumer spending last year. RIA advises continued marketing strategies to advertise their member’s product and offer support and free consultation.

In the personal services aspect, NextGen Research expects an increase of robotic units from 9 million to 25 million in the next 6 years. It is forecasted to be a $15 billion industry in the next 6 years. This however is for functional robots that can perform multiple household tasks at the same time.

Robotoys however is on the verge of wipeout and Ugobe, the makers of Pleo (the robo dinosaur) filed for bankruptcy after a low turn over of revenue during the spring holiday shopping of 2009. WowWee – the telepresence robot (a moving webcam) did well however at $300 per robot.

The next decade robots who are expected to be top sellers are those which allow people to travel at the same time keep tabs at home. Those robots in the healthcare industry that can provide assistance to the disabled and the elderly are also growing in demand.

Japan’s response to recession

In Japan however, robots are being abandoned on the side. As consumers hold off spending on gadgets and cars, the demand for robots has been declining. Take the case of Roborior, which is a house sitter robot. It has been ignored by the public despite the number of usable features such as real time imaging and sensors to detect unusual activity in the house. GP

Healthcare Robot

Welcome to Healthcare Robot. Robots will find an especially large application in healthcare. For instance, a company called Script Pro manufactures a robot designed to help pharmacies fill prescriptions.

McKesson’s Robot RX is another healthcare robotics product that helps pharmacies dispense thousands of medications daily with little or no errors. This massive robot is ten feet wide and thirty feet long and can hold hundreds of different kinds of medications and thousands of doses.

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In Japan, several healthcare robots for the home are already on the market. Japanese engineers expect robots to be available for commercial household use by 2010. The domestic market for Japanese commercial and industrial robots may be as high as $8 billion dollars by this time, and like most Japanese electronics, will be marketed to the industrialized world shortly thereafter.

NOTE: Take a look at our original website for HealthcareRobot in 2004. How the world has changed in just 5 years!

With 2010 upon us, we thank you for visiting and supporting today’s Healthcare Robot!