Telemedicine and Technology Infrastructure
DECEMBER 05, 2019
Simon D. Murray, MD: I went from a big practice to a small practice and one of the arguments that was made to me was, well you were seeing 30 patients a day and now you're seeing 10, what about those other 20? What's going to happen to them? Well what I found out was that I didn't need to see the other 20, they didn't need to come at all, I had 30 because I had a schedule that filled 30 people and I needed to fill it. What I found out was using my cell phone a person could send me a picture of a rash, I could just write back they didn't need to come or they didn't need to come to get a referral to see the eye doctor, I could handle it on the phone. And so I realized that with technology, even simple technology like email, a lot of money could be saved and telemed, that is another example where a lot of money could be is wasted on stuff like that, doctors seeing patients that don't need to be seen for things that don't need to be seen.
Eric Daimler, PhD, MS: Emergency rooms are classic for this they're clogged with people that don't need to be in an emergency setting, they just don't have any other medical options, so that sort of domain is a perfect application of telemedicine.
SM: But no doctor is in a hurry to discourage that kind of business though, ERs are not turning people away.
ED: And I think how we might then begin to adopt telemedicine is other underprivileged communities, you know serving remote places that don't get as much care, or serving distortions in that in the healthcare system. I was part of this this program that was evaluating the efficacy of a great new hospital that was put in in one of these developing countries, it was put there by a very well-meaning philanthropist, but the unintended consequence is it sucked the life out of all the other hospitals in the area, and there was no real way to undo that. You can't then say well I'm going to create these other Taj Mahal hospitals.
So it's very at the time a well-meaning, a great effort, to put a big hospital into which everybody could be attracted, but if it then kills off some people's local health care you might have actually done a disservice. Telemedicine could have addressed, telemedicine efforts to just bring doctor expertise out into the country and that's a way maybe to even begin to correct some of these unintended consequences.
The structures we put in place around these technologies will last a lifetime or more. Our roads define our cities, we have the same issue in AI. You know healthcare professionals I actually think represent what I think is the framework how even we'll think about our careers. You know a hundred years ago we had just a man on a horse back, maybe 150 years ago, a man on a horseback quite literally and old drug drugstores right where they were prescribing opium and we wouldn't even fathom that today. In the medical profession we don't have doctors in the same way, we don't have just the family doctor that knows everything about medicine, it would be inconceivable that one person would know everything about medicine. And it's become segmented towards multiple experts. You don't have a healthcare expert, you might have somebody that knows about the system, about insurance, about patient care, about medical records, you have people getting degrees in social medicine. You have surgeons without without a sense of ego (or maybe they do have a sense of ego) but without a sense of ego you know they can bring it a medical ethicist into the conversation and they know they're well served to have that part of the medical experience done by a professional who spends their time doing that so there's multiple different respected professional experts in their domain in the medical profession and I think that's where AI is gonna go. You're not gonna have one AI authority, you're gonna have multiple AI authorities in these multiple domains in this system of AI.
SM: I'll tell you though one of the negative things about that in hospitals, I had a guy in a hospital and I said to the man I think you should be out of bed sitting in a chair today, I go down the hall I got a call “you can't do that until the physical therapist clears him to get out of bed, okay and since you're on the phone the insulin you ordered, we can't give them that until the diabetes expert sees them as well, okay all right and since we have you on the phone, the Quality Assurance people say that he should be discharged tomorrow.” And what am I? Who am I, what am I doing here, you know what's my role? I just sign off on all this stuff? What does the physical therapist know to get this guy out of bed, I've known him for 40 years.
ED: All systems can calcify, it's really our job to make sure we continue to bring vibrancy to these systems, and we continue to adopt them to the current realities. You know no one wants to be just a cog in a wheel and no patient just wants to be on an assembly line. I think that's part of an awareness of the totality of the system and our elevating the importance of that conversation, that system-wide conversation, I think can help bring dynamism to these systems and a dynamism to these conversations that if not entirely eliminate begin to at least mitigate some of these issues.
Transcript edited for clarity.