The fu­ture of health-care de­liv­ery

Re­mote pres­ence tech­nol­ogy will lower costs, writes Dr. Ivar Men­dez.

Regina Leader-Post - - OPINION - Dr. Ivar Men­dez is the Fred H. Wig­more Pro­fes­sor and Pro­vin­cial Head of Surgery with the Univer­sity of Saskatchewan and Saskatchewan Health Author­ity.

In the mid­dle of win­ter, a six­month-old child is brought with acute res­pi­ra­tory dis­tress to a nurs­ing sta­tion in a re­mote com­mu­nity in the Cana­dian North. The nurse re­al­izes that the child is se­ri­ously ill and she con­tacts for sup­port a pe­di­atric in­ten­sivist in a ter­tiary care cen­tre 900 kilo­me­tres away.

The in­ten­sivist uses her tablet to ac­ti­vate a re­mote pres­ence ro­bot in­stalled in the nurs­ing sta­tion and asks the ro­bot to go to the as­sess­ment room. The ro­bot au­tonomously nav­i­gates the nurs­ing sta­tion cor­ri­dors and ar­rives at the as­sess­ment room two min­utes later.

With the help of the ro­bot’s pow­er­ful cam­eras, the doc­tor “sees” the child and talks to the nurse and the par­ents to ob­tain the med­i­cal his­tory. She uses the ro­bot’s stetho­scope to lis­ten to the child’s chest, mea­sures the child’s oxy­gen blood sat­u­ra­tion and per­forms an elec­tro­car­dio­gram. She helps the nurse to start an in­tra­venous line and com­mences ther­apy to treat the child’s life-threat­en­ing con­di­tion.

Sci­ence fic­tion? No — this re­mote pres­ence tech­nol­ogy is cur­rently in use in Saskatchewan, to pro­vide care to acutely ill chil­dren liv­ing in re­mote north­ern com­mu­ni­ties.

Ad­vances in telecom­mu­ni­ca­tions, ro­bot­ics, med­i­cal sen­sor tech­nol­ogy and ar­ti­fi­cial in­tel­li­gence (AI) have opened the door for so­lu­tions that may help ad­dress health-care de­liv­ery to un­der­ser­viced ru­ral and re­mote pop­u­la­tions. In Saskatchewan, we have es­tab­lished a re­mote medicine pro­gram that fo­cuses on the care of the most vul­ner­a­ble pop­u­la­tions such as acutely ill chil­dren, preg­nant women and the el­derly.

We have demon­strated that with this tech­nol­ogy, about 70 per cent of acutely ill chil­dren can be treated in their own com­mu­ni­ties. In sim­i­lar com­mu­ni­ties with­out this tech­nol­ogy, all acutely ill chil­dren need to be trans­ported to a ter­tiary care cen­tre. We have also shown that this tech­nol­ogy pre­vents de­lays in di­ag­no­sis and treat­ment, and re­sults in sub­stan­tial sav­ings to the health-care sys­tem.

Re­mote com­mu­ni­ties of­ten lack ac­cess to di­ag­nos­tic ul­tra­sonog­ra­phy ser­vices. This gap dis­pro­por­tion­ally af­fects Indige­nous preg­nant women and re­sults in in­creases in ma­ter­nal and new­born mor­bid­ity and mor­tal­ity. We are pi­o­neer­ing the use of an in­no­va­tive tele-ro­botic ul­tra­sound sys­tem that al­lows an ex­pert sono­g­ra­pher to per­form a di­ag­nos­tic pre­na­tal ul­tra­sound study, in real time, in a dis­tant lo­ca­tion. Re­search shows that ro­botic ul­tra­sonog­ra­phy is com­pa­ra­ble to stan­dard sonog­ra­phy and is ac­cepted by most pa­tients.

Wear­able re­mote pres­ence de­vices such as Google Glass tech­nol­ogy are the next step in re­mote pres­ence health care. For ex­am­ple, a lo­cal nurse and a spe­cial­ist in a ter­tiary care cen­tre thou­sands of kilo­me­tres away could assess to­gether an acutely ill pa­tient in an emer­gency room in a re­mote com­mu­nity, si­mul­ta­ne­ously through the nurse’s eyes.

Although re­mote pres­ence tech­nol­ogy may be ap­plied ini­tially to emer­gency sit­u­a­tions in re­mote lo­ca­tions, its ma­jor im­pact may be in the de­liv­ery of pri­mary health care. We can en­vi­sion the use of re­mote health care sen­sors and mo­bile re­mote pres­ence de­vices in a wide range of sce­nar­ios — for in­stance, the care of the el­derly, men­tal health ses­sions and the de­liv­ery of health care at home — in which ac­cess to med­i­cal ex­per­tise in real time would be just a com­puter click away.

The cur­rent model of cen­tral­ized health care where the pa­tient has to go to a hospi­tal or a clinic to re­ceive ur­gent or elec­tive med­i­cal care is in­ef­fi­cient and costly. Pa­tients wait many hours in crowded emer­gency rooms, hos­pi­tals run at over­ca­pac­ity, and de­lays in di­ag­no­sis and treat­ment re­sult in poor out­comes or even death. Un­der­ser­viced ru­ral and re­mote com­mu­ni­ties and the most vul­ner­a­ble pop­u­la­tions such as chil­dren and the el­derly are the most af­fected by this cen­tral­ized model.

Re­mote pres­ence tech­nolo­gies have the po­ten­tial to shift the cur­rent cen­tral­ized sys­tem to the de­liv­ery of med­i­cal care where the pa­tient is (point of care). In this de­cen­tral­ized model, pa­tients re­quir­ing ur­gent or elec­tive med­i­cal care will be seen, di­ag­nosed and treated in their own com­mu­ni­ties or homes, and pa­tients re­quir­ing hos­pi­tal­iza­tion will be triaged with­out de­lay.

This tech­nol­ogy could have im­por­tant ap­pli­ca­tions in low-re­source set­tings.

The avail­abil­ity of cel­lu­lar net­work sig­nals around the globe and rapidly in­creas­ing band­width will pro­vide the telecom­mu­ni­ca­tions plat­form for a wide range of mo­bile ap­pli­ca­tions. Low-cost, ded­i­cated re­mote pres­ence de­vices will in­crease ac­cess to med­i­cal ex­per­tise for any­body liv­ing in a geo­graph­i­cal area with a cell­phone sig­nal. This ac­cess will be es­pe­cially ben­e­fi­cial to peo­ple in de­vel­op­ing coun­tries where med­i­cal ex­per­tise is in­suf­fi­cient or not avail­able.

The fu­ture of health care is not in build­ing more or big­ger hos­pi­tals, but in har­ness­ing the power of tech­nol­ogy to mon­i­tor and reach pa­tients wher­ever they are.


Dr. Ivar Men­dez notes that re­mote pres­ence tech­nol­ogy is al­ready in ser­vice in some iso­lated north­ern com­mu­ni­ties.

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