Telemedicine: The future of health care is already here
Technology that enables telemedicine is set to change the medical field for patients, doctors, and investors.
- Digital technologies that disrupted industries like communication and transportation are steadily changing health care, too.
- Virtual health care will save consumers money while growing the industry by billions of dollars.
- Non-visit care combined with smartphone apps will give patients more power over their health care.
Progress in health care over the last 200 years has typically resulted from technological development, as new devices and medicines became available. Today, as technological innovation disrupts entire sectors of the economy, doctors and health care professionals are more than willing to adopt, and even promote, new approaches to health care.
Yet there is still much more room for growth. Telemedicine or "virtual check-ups" is one such area. Mobile devices and other computing advances have already drastically changed how we do business, communicate, and live our lives. The ways we receive medical care have started to follow suit.
Michael Dowling has a birds-eye view of the evolution of patient care. The president and CEO of Northwell Health, New York State's largest health system, Dowling reflects on the availability of thousands of health-care-related apps in his recent book, Health Care Reboot: Megatrends Energizing American Medicine. He notes that some apps connect to wearables that calibrate blood pressure, heartbeat and medical implants that can monitor breathing, glucose levels or other health indicators. Many of these apps alert doctors when a patient needs a check-up, blood work or prescription changes.
All of this is resulting in a new shift toward technologically driven health care that will improve how patients are cared for. In his book, Dowling writes:
.. the in-person visit in health care—what is now the first step in many medical encounters—might be someday thought of as a last resort, after first exploring options to safely and effectively resolve a patient's needs remotely.
The future of telemedicine or virtual health care
Telemedicine allows A&E doctors at Dole Hospital – which doesn't have a neurology department – to obtain an immediate diagnosis for their patient by a neurologist in Besancon hospital, seen over the doctor's shoulder. This system allows doctors to exchange medical imagery and the patient's file.
(Photo by: BSIP/UIG via Getty Images)
Dr. Eric Topol of the Scripps Research Institute is an ardent proponent of increasing the role of technology, especially smartphones, in the way that health professionals conduct business. In his book, The Patient Will See You Now, he emphasizes that clinicians and medical organizations need to put technological solutions at the forefront of health care strategy and delivery.
Noting that "the culture of medical practice is famously conservative," Topol concedes that it will be a challenge, but the opportunities are too great to pass up.
Major players in the health care field are already implementing telemedicine. Dowling states in his book that:
At Kaiser Permanente, 52 percent of 'the more than 100 million patient encounters each year are now 'virtual visits,'' via text messages, calls, email, or video conferencing.
Dowling adds that health care technology falls within two primary categories: facilitating the delivery of care and consumer interactions.
Continuing technological advancements will spur non-visit health care and improve value-based health care solutions. Companies such as Apple, Amazon, Facebook, Google, and Microsoft have already publicly expressed interest in continuing to grow their health care presence. For years, Apple has been consolidating medical records on iOS through extensive partnerships with major medical centers – including Johns Hopkins, Cedars-Sinai, and Geisinger Health System.
One of the more noteworthy entrants is Haven, a nonprofit collaboration between JP Morgan, Berkshire Hathaway, and Amazon. Haven's goal is to improve health care services and lower costs for the three companies while making primary care easier to access.
Technological health care solutions in action
Erica Jensen, with her 5-month-old daughter, Charlee Jaques, by her side, video conferences with her doctor, Dr. Marie McDonnell, from her mother's home.
(Photo by Dina Rudick/The Boston Globe via Getty Images)
Amazon made another big splash last year when it announced that it had acquired PillPack, an online pharmacy. PillPack is a high-profile example of a telemedicine solution that brings the Silicon Valley spirit into the medical arena. PillPack's digital pharmacy platform manages patient data and controls logistics for delivering and managing customers' medical needs.
Innovations continue to unfold every day. In April 2019, Northwell Health launched an Emergency Telepsychiatry Hub that provides around-the-clock mental health care. People in crisis no longer have to wait long hours during crucial times of need. Patients have benefited from drastically reduced waiting times to speak to someone who can help them – members of an expansive team that includes 23 psychiatrists and 9 behavioral health practitioners with master's level training
Already, the new telemedicine service has brought the wait time down 90 percent to an average of 45 minutes. Northwell is increasingly integrating these services to many of its hospitals and centers. Jonathan Merson, MD, medical director of Northwell Emergency Telepsychiatry Hub Program, stated, "It's a technology that has no boundaries and the goal is simple: No patient experiencing a behavioral health emergency should have to wait to be seen."
Telemedicine will save billions
Telemedicine services are not only smart, they are also necessary. The American Association of Medical Colleges has already projected that there may be a shortage of some 40,000 primary care physicians (PCPs) in the coming decade. Increased virtual services will alleviate this shortage and allow already-overworked clinicians to focus on giving advanced care to patients in more critical situations.
Another consideration is the economic value of telemedicine services. An Accenture analysis found that the use of telehealth services could generate up to $10 billion annually over the next few years.
Without needing to expand the workforce, telemedicine can assist and augment medical professionals' activities. Personalization and efficiency will benefit the individual patient as the tools for controlling their own medical records and care plans allow them to become more engaged.
What health conditions can be treated via telemedicine?
Telemedicine is being used by rescue services in Hesse, Germany, to better treat patients in urgent conditions.
(Photo by Arne Dedert/picture alliance via Getty Images)
Telehealth is also useful for people whose frailty or chronic condition make it difficult to visit a doctor's office. There have been significant developments in what some medical providers are calling remote patient monitoring tools. For example, smart phones or tablets of people with Type 2 diabetes can automatically log blood glucose data from their monitoring device. Physicians can check these analytics any time and adjust treatment as needed.
Telemedicine is also more efficient than office visits or house calls for non-chronic health issues. A quick follow-up by video conference can ensure a patient is following their physician's directions. Medication management – confirming compliance with prescription doses and schedules, ensuring there are no troublesome side effects – is another helpful application of telehealth.
The technology that drives telemedicine is only in its infancy, but it will gain increasing prominence in the medical field and public sphere as innovations skyrocket and new startups enter the arena. As people grow accustomed to the ability to chat to their doctors without passing through a waiting room, to receive instant attention based on data from their medical devices, and to control their health from the palm of their hand, the life-saving convenience of telemedicine will be realized. That future is already under way.
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They came from different places and with different ideas, which still resonate today
- Early British settlement of the American colonies came in four distinct waves, from different places.
- Puritans, Cavaliers, Quakers and Borderers had their own ideas of what America should be.
- Some of the cultural fault lines in today's America can be traced back to those differences.
Four 'folkways'<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ0MDY2NC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzOTAzNzk0OX0.YfBxVdS46dX1eUZhGA_4remlW4YYMIxlZ65wjQ2pyMs/img.jpg?width=980" id="d2108" class="rm-shortcode" data-rm-shortcode-id="2efd697c8c1a31a446da2d4f34168094" data-rm-shortcode-name="rebelmouse-image" alt="\u200bQuaker pioneer William Penn (center) treating with the Delaware Indians for the purchase of what was to become Pennsylvania." />
Quaker pioneer William Penn (center) treating with the Delaware Indians for the purchase of what was to become Pennsylvania.
Image: frieze by Constantino Brumidi (1865) in the Rotunda of the US Capitol; via Architect of the Capitol - public domain.<p>How many Americans are of British descent? It's a surprisingly difficult question to answer. Is that because, in an age of hyphenated identities, the founding one still is the default? Or has that identity become so amalgamated that it is now irrelevant? Perhaps the correct answer is: a bit of both. </p><p><span></span>In the 1980 Census, 61.3 million Americans (32%) self-reported British ancestry; most claimed English descent (26%), followed by Scottish (4%), and tiny amounts of Welsh (<1%) and Northern Irish. In the 2010 Census, that figure had dropped to 37.6 million (14%), with just 8% reporting English heritage, 3% Scottish and 2% Scotch-Irish. </p><p>The precipitous drop in self-reported British antecedents corresponds in part with the rise of those who identify as (unhyphenated) 'American', up from 12.4 million (5%) in the 1990 Census to 20.2 million in 2000 (7%) – the largest growth of any ethnic group in the 1990s.</p><p>However, back around the year 1700, about 80% of the population of what was to become the United States were of English (or Welsh) descent, with about 11% of African origin, and the rest being Dutch (4%), Scottish (3%) and other European. The imprint of the British on early American society was overwhelming, diverse and long-lasting: the regional and cultural differences between the settler groups created distinct regional and cultural identities in America.</p><p>That's the argument made by David Fischer, a history professor who in 1989 published a 900-page treatise on early migration to North America called <em><a href="https://global.oup.com/ushe/product/albions-seed-9780195069051" target="_blank">Albion's Seed</a></em>. He identified four British 'folkways' that came over to the other side of the Atlantic in the 17th and 18th centuries (<em>see map</em>), each with their own ideas about the liberty they wanted to find there.<br></p>
From exodus to flight<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ0MDY2NS9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTY0NDg1MzczOX0.-LwTLCpuIub9QhTVWL9vhnd8Jlz9j8aRyt9bePqQPuo/img.png?width=980" id="65f97" class="rm-shortcode" data-rm-shortcode-id="4457df0ca7f66fe87026322bad771da6" data-rm-shortcode-name="rebelmouse-image" alt="\u200bMap showing the origin and destination of four British 'folkways' that influenced American society." />
Map showing the origin and destination of four British 'folkways' that influenced American society.
Image: Geni.com<p><strong></strong><strong>1. The Exodus (1629-41)</strong></p><ul> <li>About 21,000 Puritans, migrating from East Anglia to New England.</li><li>These religious fundamentalists believed in 'ordered liberty': everybody had the right to live by their own rules, and the duty to live according to God's law.</li><li>The Puritans were a major influence on the culture of the Northeastern US, especially in terms of business and education.</li></ul><p>These religious fundamentalists are the ones who came over on the Mayflower and gave America Thanksgiving and the self-image of being a 'City on a Hill'. Puritan society was gloomy and repressive: 'exceeding the bounds of moderation' was a punishable offense, and even just 'wasting time' got you into trouble.</p>The other side of the coin: life was very well-ordered. There was little income inequality and crime rates were low. Not only was charity towards poor the rule, being uncharitable was, yes, a punishable offense. Domestic abuse was punished severely. Women had a relatively high degree of equality. And government operated via town assemblies in which all could have a say.<br><br><strong>2. Cavaliers and their Servants (1642-75)</strong><ul><li>Some 45,000 Cavaliers drawn from English nobility and their indentured servants, migrating from the South of England to Virginia and the Lowland South.</li><li>These aristocrats believed in 'hegemonic liberty': dominion over self, and others. In other words: keeping slaves was okay, but domination by others was not.</li><li>The Cavaliers were the foundation of plantation culture in the South. </li></ul><p>The Cavaliers came from the losing side of the Civil War in England, which was now led by the Puritan-inspired Oliver Cromwell. Royalist, Anglican and aristocratic, they brought along with them their indentured servants – more than 75% of the total migration – hoping to recreate in Virginia and environs the socially stratified agrarian society they had left behind.</p><p><span></span>When their servants began dying en masse, they started importing African slaves, laying the groundwork for the race-based slavery system that underpinned the economy of the South until the end of the Civil War.</p><strong>3. The Friends' Migration (1675-1725)</strong><ul><li><strong></strong>Around 23,000 Quakers, migrating from Northern England to the Delaware Valley in Pennsylvania, and later to the Midwest.</li><li>These religious liberals believed in 'reciprocal liberty': granting others the freedoms they wanted for themselves, including the right to vote, to own, to be free, to worship and to a fair trial.</li><li>Quakers had an important impact on the industrial culture of the Mid-Atlantic and Midwestern regions of the US.</li></ul><span></span>Halfway between the fun-hating Puritans and the pleb-hating Cavaliers, the Quakers seem modern and likeable. Believing everybody intrinsically good, they practiced tolerance, pacifism, gender equality and racial harmony. They opposed slavery, the death penalty, and cruelty to animals and children.<p>Quakers replaced a wide range of social acknowledgements according to rank (bows, nods, grovels) by a single, neutral equivalent: the handshake. Quakerism was perhaps one of the first Christian denominations to become indistinguishable from liberal, secular modernity. On the other hand, they were more prudish even than the Puritans. Doctors had a hard time treating Quakers because they described everything from their necks to their waists as their 'stomachs', and everything below as their 'ankles'. </p><p><strong>4. The Flight from Northern Britain (1717-75)</strong></p><ul><li>Some 250,000 'Borderers', migrating from the Anglo-Scottish borderlands and Ulster to the Backcountry of Appalachia.</li><li>These individualists believed in 'natural liberty': freedom to do as one pleases, without interference from society or government.</li><li>Borderers contributed to the rural culture of America's South and the ranch culture of its West. </li></ul><p><span></span>Inhabiting the border regions between Scotland and England, and between protestant settlers and catholic natives in Ireland, the Borderers were used to violence and lawlessness, and to lives that were nasty, brutish and short. </p>It is no coincidence that they ended up in Appalachia, at that time itself a violent border region. It was the kind of world they knew. Borderers were wary of government, prone to violent family feuds and not bothered by traditional morality. By one estimate, in the year 1767, 94% of all 'backcountry' brides were pregnant on their wedding day.<p><span></span>These Borderers were not much beloved by other settler groups in America. One Pennsylvanian writer called them "the scum of two nations". But the Borderers also contributed vigorously to the success of both the American Revolution and America's westward expansion. </p>
'Blue' vs. 'Red'?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ0MDczNy9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1MzE5MTc4NH0.EtbfEc9BlGG8R4VlyHr2W7kQ0LzvRdAHRRRlsEI01Pg/img.jpg?width=980" id="ce2a3" class="rm-shortcode" data-rm-shortcode-id="ba2cd744238f9a08ce63e85be2860528" data-rm-shortcode-name="rebelmouse-image" alt="Representative Preston Brooks (SC) caning Senator Charles Sumner (MA) on the Senate floor. The attack, on 22 May 1856, symbolised the breakdown of civil discourse between North and South, prefiguring the Civil War." />
Representative Preston Brooks (SC) caning Senator Charles Sumner (MA) on the Senate floor. The attack, on 22 May 1856, symbolised the breakdown of civil discourse between North and South, prefiguring the Civil War.
Image: lithograph by John L. Magee (1856); public domain.<p>It's tempting, and perhaps not entirely unjustified, to see in these four strains of British 'folkways' the antecedents of some of America's current cultural divides. One might for example see Puritans and Quakers as constituting elements of the 'blue' tribe, while Borderers and Cavaliers could be considered the ancestors of the 'red' tribe.</p><p><span></span>But thinking of America as a "death match between Puritan-Quaker culture and Cavalier-Borderer culture", as one commentator put it, is perhaps a bit too easy. There may be plenty of overlap within either pair, there is also much to distinguish each from the other. And then there are other and subsequent migrations contributing to and complicating the picture.</p><p>Nevertheless, a bit of cultural archeology can be illuminating, if only to see where the bodies are buried.<br></p><p><strong><br></strong></p><p><strong>Strange Maps #1049</strong></p><p><em>Got a strange map? Let me know at </em><a href="mailto:email@example.com">firstname.lastname@example.org</a><em>.</em></p>
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