Telemedicine: Exploring the future of healthcare

Dr. Stephen Klasky talks at the Cayman Captive Forum about the potential healthcare revolution. - PHOTO: KEN SILVA

When Dr. Stephen Klasko was a medical student in 1977, he said healthcare in the United States was still not a right. Prices were rising and customer service was poor.

Some 40 years later, not much has changed, said Dr. Klasko, the president and CEO of Philadelphia-based Thomas Jefferson University and Jefferson Health.

“Why can I do all my shopping on Amazon in my pajamas while watching ‘Game of Thrones,’ but still have to use a phone and go through 11 options when I want to call my doctor?” he asked an audience at the 2017 Cayman Captive Forum.

Nevertheless, Dr. Klasko said he is optimistic that within the next 10 years, the healthcare industry will be radically transformed.

Technology will be the primary driving force behind that transformation, according to Dr. Klasko and others who spoke at the 25th annual Cayman Captive Forum.

Dr. Klasko’s Jefferson Health is one of the many hospitals throughout the world that is expanding its “telemedicine” services – the remote diagnosis and treatment of patients by means of telecommunications technology.

The potential benefits of telemedicine are many.

Larry Smith, president of the Cayman-based captive insurer Greenspring Financial Insurance Ltd., said that telemedicine drastically reduces the time it takes surgeons to conduct post-surgical visits to monitor patients’ progress. That means those surgeons can take on extra patients, he said.

“Every two post-surgical visits we can avoid means one new patient visit we can have by that same surgeon,” Smith said.

Telemedicine can also allow family members of patients to remotely be involved in patient visits, he said.

Additionally, telemedicine channels have been established between emergency hospitals and urgent care centers. That way, there can be three-way communication between a patient, an urgent care doctor, and an emergency room physician to determine how the patient should be treated, Smith said.

Benefiting both the patient and the provider is the reduction in transportation costs – and not just driving costs – Smith added.

Whereas a patient at a hospital might have to be transported to another facility via helicopter to visit a vascular neurologist to assess whether the patient had a stroke, now that determination can be made remotely. Then, the patient can be treated on the spot, Smith said.

When Jefferson Health first started its telemedical service, JeffHealth, not many people used it, Dr. Klasko said. But then, a fortuitous event happened: The Pope visited Philadelphia in 2015.

Pope Francis’s four-day visit made travel around the city nearly impossible. This caused some 300,000 patients to book appointments with JeffHealth rather than deal with gridlocked traffic, Dr. Klasko said. Since then, JeffHealth has been a staple of Jefferson Health.

Telemedicine also has a presence in Cayman. In 2013, for example, the Cayman Islands Seafarers Association donated a telemedical remote presence robot to the Health Services Authority.

The robot allows doctors on-island and overseas to monitor patients remotely. The device also enables remote access to specialists in the United States at the touch of a button.

By 2027, the majority of patient-doctor interactions will be remote and will use artificial intelligence, Dr. Klasko predicted. This is projected to make telemedicine a $36-billion-plus industry. Right now, JeffHealth is partnering with Amazon to have “Alexa” – the company’s artificially intelligent personal assistant device – help evaluate patients. Dr. Klasko showed the audience at the Captive Forum a video clip of how this would work, with Alexa asking a patient basic questions about his condition.

JeffHealth is also working on “eco fiber,” which is clothes that essentially monitor people’s health. “While you’re sleeping, your pajamas will monitor things like your heart rate, your breathing rate, and we’re working with things to monitor glucose,” Dr. Klasko said. “If anything goes wrong, you’ll have a security system like you have in your house.”

Another JeffHealth feature is a text-messaging service that sends reminders and links to easily book appointments straight to a patient’s phone. Dr. Klasko said that Jefferson Health analytics show that patients are about 40 percent more likely to book their scheduled appointments when they are sent this reminder.

All of this has ramifications not only for the patients, but the physicians too, he said. Even now, iPhones can provide the information that used to require intensive year-long courses in organic chemistry. This has rendered large portions of medical school obsolete, Dr. Klasko said.

“Technology will replace 80 percent of what doctors do,” said the Jefferson Health CEO. “Anything that can be replaced by a computer, should be.”

With technology capable of serving basic healthcare needs, doctors will have to place more emphasis on the human touch, he said.

Dr. Klasko, an obstetrician, gave the example of a doctor delivering a baby with Down syndrome. Any computer can factually explain to a mother how Down syndrome can affect a baby, but it will take human interaction to provide the mother the support system that she needs.

But while telemedicine and other technology has the potential to radically transform healthcare, legal systems and laws are still behind in many jurisdictions.

Many places in the U.S. are still establishing reciprocity rules and exemptions so that physicians from other states and countries can provide telemedical care without having to be licensed in the state where the patient is, said Angela Russell, a managing partner at Wilson Elser Moskowitz Edelman & Dicker.

“One of the big issues is licensing. Are they licensed in the state where they’re providing care? Most states want you to be licensed, but some have a common consultation exception that even if one doesn’t have a license, if he or she meets criteria, they can provide telemedical services,” she said, adding that physicians cannot use telemedicine to prescribe drugs or perform certain other services.

Additionally, there is a lack of case precedent involving the telemedicine industry. Out of some 300,000 cases analyzed by a recent study, telemedicine was only mentioned in about 50-60, Russell said. Of those cases, some involved the use of a telephone rather than modern telemedicine technology.

However, Smith viewed the lack of telemedicine malpractice cases as a positive. Because most malpractice cases still involve human error, he said, people should not be hesitant to adopt the new technology and help the industry move into the future.