Crisis ushers in the future: Telemedicine
The COVID-19 crisis is the most challenging medical crisis since the Spanish Flu pandemic of 1918. With the 24-hour news cycle, the despair of the infected and the dead is transferred to the public instantly. The concern for them is palpable. Recently, after silently saying a prayer for everyone, I was struck by a novel notion. Enough of the negatives! What good can come from this? As I dove deeper into my thought process and surveyed my past, it was like I was witnessing a tsunami of hope for the advancement of mankind.
Rosser Doctrine
COVID-19 exposed our antiquated health care system, which needs serious upgrading. In 2000, while a professor of surgery at Yale University School of Medicine, I spoke at the World Bank. The title of the speech was: “The Impact of Technology on the Future of Global Healthcare.” There, I introduced the Rosser Doctrine:
(1) Bring health care to the people using telemedicine. Telemedicine is the remote diagnosis and treatment of patients by means of telecommunications technology. Doing so would allow instant access for patients, address racial disparities, mitigate costs and increase the quality of care through early intervention. Telemedicine would also provide command/control and oversight of patients and non-traditional providers.
(2) Develop cost-effective, miniaturized diagnostic and treatment technologies.
(3) Use innovative, efficient skill and knowledge transfer techniques, including distance learning, computer simulation and even video game technology, to shorten training times. This approach enhances the capabilities of mid-level providers, develops nontraditional care supporters and empowers patients to participate in their care.
After my presentation, there was a low rumbling of voices commenting on what they’d heard. Finally, an audience member rose and made this statement: “Dr. Rosser what you have presented to us here today is nothing more than a sophisticated dream.” I really couldn’t blame him for drawing that conclusion. There were, indeed, monumental barriers to this dream, with the most significant being the acceptance of telemedicine, which is the linchpin of the
Rosser Doctrine.
Barriers removed
Nationwide stay-at-home orders activated the first pillar of the Rosser Doctrine — bringing health care to the people. That requires telemedicine. Physicians, hospitals and patients resisting telemedicine no longer have a choice. There now was a mandate to use this approach. In response, HHS eliminated the three-year doctor/patient relationship requirement for telemedicine visits and declared equal pay for telemedicine interactions.
Because of the shortage of providers, California and Florida took a big step toward universal medical licensure. Why should a physician credentialed in one state have to endure the arduous licensing process in other states?
Because of the crisis, education is now conducted using distance learning. Educators resisted the strategy but are now forced to teach online. The next step is to embrace innovative teaching techniques, including the use of simulations and video game methodologies and technologies.
The crisis also showcased the need for miniaturized technology, including smartphone medical applications for performing EKGs, blood chemistry analysis and ultrasounds. Cost-effective broadband platforms like Zoom and Skype are now embraced for telemedicine . ...
New hope for future
I still remember the rebuke of my presentation at the World Bank 20 years ago. However, Thomas Friedman gave definition and context to the Rosser Doctrine. The goal is to flatten/equalize with technology and use new approaches and processes to provide quality care to all.
As the future of health care is launched, we must not backslide. I still hear the echo of a quote from Robert Kennedy, spoken by Teddy Kennedy as he eulogized his brother in 1968. “Some men see things as they are and say why; I dream of things that never were and say why not?”
A global pandemic can birth innovation and progress. Sometimes it takes a crisis for us realize, as Franklin Delano Roosevelt said in his 1932 inaugural address, “The only thing we have to fear is fear itself — nameless unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.”