The health and cost benefits of delivering smarter care while the patient stays at home could be enormous

Emily SetoHave you noticed how there are no more lines to talk to live tellers in banks? Twenty years ago, I remember having to think about scheduling my time to wait in line to do my banking and trying to strategize going at non-peak hours. Today, on the rare occasions I have to go, I can be in and out in less than five minutes.

It’s not just banking. Industries such as travel and food delivery have changed dramatically over the years – all thanks to going virtual.

On the other hand, the experience of getting health-care services looks pretty much the same as it did decades ago. Patients are still travelling long distances, taking time off from work and being crammed in waiting rooms for hours, all the while potentially catching each other’s germs.

In an age when Skype, FaceTime, Zoom and other telecommunication applications are the norm, why don’t we have more virtual health-care visits? Even texts, email and plain old telephone services could be used to speed up or even replace a large portion of face-to-face appointments.

Sure, communication channels need to be secure and privacy needs to be maintained, but these aren’t technological barriers anymore.

Unless you’re going in for a health emergency, a surgical procedure or a health-care provider needs to physically examine the patient by hand, there’s no reason we couldn’t do many aspects of health care virtually. The health benefits and cost savings to both the system and patients of delivering smarter health care while the patient stays at home could be enormous.

Some advancements in virtual delivery of health care have already been made – particularly for rural and remote regions.

The Ontario Telemedicine Network is one of the largest telemedicine networks in the world. According to its 2016-2017 annual report, videoconferencing through its network has resulted in 284 million kilometres of patient travel avoided, leading to more than $77 million savings in avoided travel costs.

Beyond the advantages of virtual visits, smart systems to monitor patients at home, such as photos for applications like dermatology, and wearable technology to monitor things such as heart rate and physical activity, can be used to give clinicians information on how the patients are doing at home in real time.

A case in point is home monitoring of patients with chronic conditions. There is growing evidence from clinical trials that if implemented properly, home monitoring of heart failure patients supports self-care and clinical management, which in turn decreases hospitalizations and death.

Toronto’s University Health Network has a smartphone-based telemonitoring program called Medly that uses an app for patients to send their data such as weight, blood pressure and symptoms from home. Patients then get automated self-care instructions based on their data and their health-care providers get alerted if necessary.

The University of Ottawa Heart Institute’s Telehome Monitoring Program also has patients sending in their data with a home monitor. A cardiac nurse reviews the data daily and follows up as needed.

Unfortunately, these are the exceptions, not the norm.

Other ideas – such as replacing some in-person visits with virtual visits supported by home monitoring, and visits to determine the right dose of medications – are just now being proposed and studied. In some cases, technology can even eliminate the need for clinical visits completely – virtual or otherwise.

A recent study examined sending digital photos of skin conditions from family doctors to dermatologists within the same urban hospital; the large majority of these teledermatology cases were resolved without the patient having to see a dermatologist at all. This saved significant time and money for both the patients and the system, while providing faster service.

So how do we get to the point where going to see a health-care provider is only done as often as buying a new car?

The answer may lie largely in how health care is funded.

Expansion of bundled care, when a group of providers gets a single payment to cover all the care needs of a patient for a specific health issue, and models of funding tied to patient outcomes, could help drive innovation to achieve transformation in health care such as virtual care.

For example, successes from Ontario’s six pilots of bundled care models included reductions in readmissions, length of stay and emergency department visits, all while improving patient and provider experiences.

Importantly, we also need visionary decision-makers who will champion such disruptive innovations and embrace new models of care – to make the system work better for everyone.

Emily Seto is an assistant professor and lead for Health Informatics at the Institute of Health Policy, Management and Evaluation at the University of Toronto’s Dalla Lana School of Public Health. She’s also a Contributor with EvidenceNetwork.ca, which is based at the University of Winnipeg.


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The views, opinions and positions expressed by columnists and contributors are the author’s alone. They do not inherently or expressly reflect the views, opinions and/or positions of our publication.

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