The future of health-care delivery
Remote presence technology will lower costs, writes Dr. Ivar Mendez.
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.