Some experts may worry that AI will depersonalize health care, but others see its potential to deepen relationships.
- Today's rate of innovation and change has made it difficult for patients and physicians to effectively integrate technology into medical best practices.
- Experts agree that physicians need more time in their day to build bonds with patients.
- Dr. Eric Topol believes that artificial intelligence may help restore that time, creating what he calls "deep medicine."
Will AI replace doctors?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTU1Njc0Ni9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYwNTE1NDM2NX0.OxiInT3U2XKj3yj6AGXRch6m2zQQEsktKbWxLU9oFzY/img.jpg?width=980" id="803d9" class="rm-shortcode" data-rm-shortcode-id="dcc521836bd087bf6fc1545deea7d8e2" data-rm-shortcode-name="rebelmouse-image" />
With AI taking on the routine work, doctors will have more time to be actively involved with patients and referring physicians.
Photo: Tom Werner/Getty Images<p>That may sound counterintuitive. Technology like EHRs have affected doctor-patient interactions, and when we speak of AI entering a job market, it's with premonitions of the robopocalypse. Consider America's roughly 2 million truckers, who may lose their jobs to <a href="https://www.theguardian.com/technology/2017/oct/10/american-trucker-automation-jobs" target="_blank">self-driving vehicles</a>.</p><p>Yet blue-collar jobs are not the only ones subject to AI takeover. Some jobs that require the most advanced education are more likely to become obsolete, according to entrepreneur <a href="https://bigthink.com/u/andrew-yang" target="_blank">Andrew Yang</a>. "Doctors, lawyers, accountants, wealth advisers, traders, journalists, and even artists and psychologists who perform routine activities will be threatened by automation technologies," he writes in <em><a href="https://www.amazon.com/War-Normal-People-Disappearing-Universal/dp/0316414212?SubscriptionId=AKIAJGTABWIBL2VADPUA&tag=bigthink00-20&linkCode=xm2&camp=2025&creative=165953&creativeASIN=0316414212" target="_blank">The War on Normal People</a></em>.</p><p>Day-to-day workplace routines will determine whether AI can perform a job, because the technology can perform routine tasks faster and more accurately than people, without needing a break.</p><p>To pick one example from medical practice, radiologists spend much of their time analyzing patient films. It takes years of education to develop that skill. Even then, certain diagnoses can be tricky and human deficiencies, such as confirmation bias and inattentional blindness, can lead to mistakes.</p><p>Deep learning could streamline the process of analyzing medical images. One day, AI may be able to read more medical images more quickly and compare them to a catalog exponentially larger than anyone could memorize. It may also detect anomalies too fine for detection by the human eye. And you only have to develop an AI once, as opposed to the extensive costs of training and maintaining human radiologists. </p><p>AI is unlikely to eliminate the need for radiologists, but rather it may enable radiologists to be more actively involved with patients and referring physicians as part of the care team. We're years away from AI becoming commonplace in radiology departments. However, the principles are sound and <a href="https://hbr.org/2018/03/ai-will-change-radiology-but-it-wont-replace-radiologists" target="_blank">the technology is already under development</a>. Some day, when AI can manage standalone diagnosis for routine cases, radiologists will be free to focus on the most challenging cases.</p>
AI will free up radiologists' time to work on the most challenging cases. Here, neuroradiologists in Paris operate on a patient affected with an arteriovenous deformation.
Photo GERARD JULIEN/AFP/Getty Images
Deep learning, deeper empathy<p>In <em><a href="https://www.amazon.com/Deep-Medicine-Artificial-Intelligence-Healthcare/dp/1541644638?SubscriptionId=AKIAJGTABWIBL2VADPUA&tag=bigthink00-20&linkCode=xm2&camp=2025&creative=165953&creativeASIN=1541644638" target="_blank">Deep Medicine</a></em>, Topol suggests that well-implemented AI can free physicians from repetitive tasks, providing more face time to meet, inform, reassure and follow up with patients. It can also minimize burnout and improve health care quality. Topol cites one study from the National Bureau of Economic Research that found for every extra minute a home visit lasts, risk of readmission was reduced by 8 percent.</p><p>The same gains may be possible with EHRs. Integrated AI can make it easier to log entries, consolidate records, and draw data from external sources such as a patient's smartwatch or mobile device.</p><p>"Human performance is unlikely to change materially over time. But machines will progressively outperform humans for various narrow tasks," Topol writes. "To take humans to the next level, we need to up our humanist qualities, that which will always differentiate us from machines." He calls deep learning's potential to support medical empathy and outcomes "deep empathy."</p>
A humane pairing<p>Busywork and routine labor so severely cut into physician schedules that <a href="https://www.nytimes.com/2017/11/14/well/live/the-patients-vs-paperwork-problem-for-doctors.html" target="_blank">Danielle Ofri</a>, an associate professor of medicine at New York University School of Medicine, has suggested imposing fines on hospitals that detract too much from patient face-time.</p><p>As the National Bureau of Economic Research survey suggests, health care is a field where literally every minute counts. </p><p>"Most importantly ... when people are sick, they need empathy," Topol told <em>Big Think</em> in an interview. "They need the person who is their doctor to be with them, to understand what they're going through, because being in pain and being sick is the loneliest thing in the world. And if you don't have a doctor that is empathic, that is the worst-case scenario. We've got to get that back."</p><p>But Topol indicates a caveat: Implementing AI in health care just as an efficiency tool would counteract potential gains in doctor-patient relationships. </p><p>Michael Dowling agrees. As he told <em>Big Think</em> in an interview: "A lot of publicity has been given to a lot of these [big tech] players. But the core of the care being delivered to people who are very sick is still being done at hospitals and doctors' and ambulatory sites."</p><p>And that core must be building a humane — and, indeed, human — doctor-patient relationship.</p>
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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.
The future of telemedicine or virtual health care<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTQ1NjkzMC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMzI0Mzk3NH0.OgOyKVhMJ8pXaOv8KJ6_G0OISfCPnINSoNjN0bzMiC4/img.jpg?width=980" id="e526a" class="rm-shortcode" data-rm-shortcode-id="ddd077edff9cfc77fbdb101d70b7cc9e" data-rm-shortcode-name="rebelmouse-image" alt="telemedicine consultation telehealth" />
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)<p>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, <em><a href="https://www.amazon.com/Patient-Will-See-You-Now/dp/0465040020?SubscriptionId=AKIAJGTABWIBL2VADPUA&tag=bigthink00-20&linkCode=xm2&camp=2025&creative=165953&creativeASIN=0465040020" target="_blank">The Patient Will See You Now</a></em>, he emphasizes that clinicians and medical organizations need to put technological solutions at the forefront of health care strategy and delivery.<em></em></p><p>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.</p><p>Major players in the health care field are already implementing telemedicine. Dowling states in his book that:</p><p style="margin-left: 20px;"><em></em>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.<em></em></p><p>Dowling adds that health care technology falls within two primary categories: facilitating the delivery of care and consumer interactions.</p><p>Continuing technological advancements will spur non-visit health care and improve <a href="https://bigthink.com/Sponsored-by-Northwell-Health/value-based-health-care" target="_self"><u>value-based health care</u> </a>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.</p><p>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.</p>
Technological health care solutions in action<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTQ1NjkzNy9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYwOTMyMjE4NX0.4t8arm566JypaHJZ17abHPH0EWu9z7U7X63-NVKzbxo/img.jpg?width=980" id="d9aa5" class="rm-shortcode" data-rm-shortcode-id="a4282855965d4df1fe444ec522d2a4ea" data-rm-shortcode-name="rebelmouse-image" />
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)<p>Amazon made another big splash last year when it announced that it had acquired <a href="https://techcrunch.com/2018/06/28/amazon-buys-pillpack-an-online-pharmacy-that-was-rumored-to-be-talking-to-walmart/" target="_blank"><u>PillPack,</u></a> 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.</p><p>Innovations continue to unfold every day. In April 2019, Northwell Health launched an <a href="https://www.northwell.edu/lenox-health-greenwich-village/news/northwell-health-opens-emergency-telepsychiatry-hub-reducing-er-wait-times" target="_blank"><u>Emergency Telepsychiatry Hub</u> </a>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</p><p>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."</p>
Telemedicine will save billions<p>Telemedicine services are not only smart, they are also necessary. The American Association of Medical Colleges has already projected that there may be <a href="https://news.aamc.org/medical-education/article/new-aamc-research-reaffirms-looming-physician-shor/" target="_blank"><u>a shortage of some 40,000 primary care physicians</u> </a>(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.</p><p>Another consideration is the economic value of telemedicine services. <a href="https://newsroom.accenture.com/news/use-of-virtual-health-solutions-in-primary-care-could-save-10-billion-annually-accenture-finds.htm" target="_blank"><u>An Accenture analysis</u></a> found that the use of telehealth services could generate up to $10 billion annually over the next few years.</p><p>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.</p>
What health conditions can be treated via telemedicine?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTQ1Njk0NC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0MDg3ODE3N30.A10k4QWPIM5ASBNLva7ctj0dacbAdP2tEsahn3DEIfA/img.jpg?width=980" id="d1e58" class="rm-shortcode" data-rm-shortcode-id="69740317c9702c2462579bcd2376c6b2" data-rm-shortcode-name="rebelmouse-image" />
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)<p>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 <a href="https://healthpayerintelligence.com/news/payers-can-leverage-telehealth-for-chronic-disease-management" target="_blank"><u>remote patient monitoring tools.</u> </a>For example, smart phones or tablets of people with Type 2 diabetes can <a href="https://hbr.org/2018/04/virtual-health-care-could-save-the-u-s-billions-each-year" target="_blank"><u>automatically log</u> blood glucose <u>data</u> </a>from their monitoring device. Physicians can check these analytics any time and adjust treatment as needed.</p><p>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.<br></p><p>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. </p>
What can 3D printing do for medicine? The "sky is the limit," says Northwell Health researcher Dr. Todd Goldstein.
- Medical professionals are currently using 3D printers to create prosthetics and patient-specific organ models that doctors can use to prepare for surgery.
- Eventually, scientists hope to print patient-specific organs that can be transplanted safely into the human body.
- Northwell Health, New York State's largest health care provider, is pioneering 3D printing in medicine in three key ways.
Printing realistic, customized organ models<p>3D printers can take images from MRI, PET, sonography or other technologies and convert them into life-size, three-dimensional models of patients' organs. These models serve as hands-on visualization tools that help surgeons plan the best approaches for complex procedures. </p><p>They also allow doctors to customize patient-specific models prior to surgery. For example, Northwell employs 3D printing in <a href="https://www.northwell.edu/3d-design-innovation" target="_blank">several clinical applications</a>:</p><ul><li>Tumor resection models clearly highlight the tumor and surrounding tissue </li><li>Orthopedic models are useful for pre-surgery measuring and medical device adjustments</li><li>Vascular models identify malformations in organs, tumors, sliced chambers, blood flow, valves, muscle tissue, and calcifications</li><li>Dentistry oral implants and appliances can be created in just one day, significantly reducing wait periods for Northwell dentists and their patients</li></ul><p>Using realistic models not only delivers better health results but also shortens operating times. That gives patients less time under anesthesia, and hospitals potential savings of millions of dollars over just a few years. </p><p>Being able to visualize procedures before they occur also helps to comfort patients and their families. Take, for instance, the case of Barnaby Goberdhan, a man who discovered that his young son, Isaiah, had an aggressive tumor in his palate. Goberdhan met with <a href="https://www.northwell.edu/find-care/find-a-doctor/otolaryngology/dr-neha-ashwin-patel-md-11377044" target="_blank">Neha A. Patel, MD</a>, a pediatric otolaryngologist at Cohen Children's Medical Center, a Northwell Health hospital, to discuss the procedure and learn about it with help from a 3D-printed model. </p><p>"Having a 3D printed depiction of my son was really helpful when talking with the doctor about his surgery," <a href="https://www.northwell.edu/news/northwell-health-doubles-down-on-3d-printing-from-formlabs-to-provide-fast-realistic-3d-surgical-models" target="_blank">said</a> Mr. Goberdhan. "The doctor was able to do more than talk me through what they were going to do – Dr. Patel showed me. There is almost nothing more frightening and stressful than having your child go through surgery. There were several options Dr. Patel walked us through for the best way to preserve Isaiah's teeth and prevent additional cuts within his mouth. I wanted all of my questions answered so I could be less fearful and more prepared to talk my son through what he was about to face. I wanted Isaiah to feel prepared. With the 3D model, we both felt more at ease." </p><p>For years, 3D printing surgical models was prohibitively expensive. Now, more affordable systems such as <a href="https://formlabs.com/3d-printers/form-cell/" target="_blank">Formlabs' Form Cell</a> give more hospitals across the country access to the technology in order to produce realistic, patient-specific models, usually within one day. <br></p>
3D-printed prosthetics<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTM4Nzg0My9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYwODIyMzMzMH0.nbCR_5Ga21vVWDIVLlMmm4lEF1hooz6ukpxMhryGRH8/img.jpg?width=980" id="7a06e" class="rm-shortcode" data-rm-shortcode-id="a5f571636831d81a21219bba7a6d2556" data-rm-shortcode-name="rebelmouse-image" />
Credit: Northwell Health<p>While 3D-printed organs are a long way in the future, today's technology is well suited for manufacturing prosthetics. 3D-printed prosthetics are often remarkably more affordable and personalized than their traditional counterparts. That's a big deal for many families, especially those with children who outgrow prosthetics and are forced to buy new ones. </p><p>One recent breakthrough in 3D-printed prosthetics came when Dan Lasko, a former Marine who lost the lower part of his left leg in Afghanistan, wanted the ability to swim with his prosthetic leg. Wearing prosthetics in water has been possible for years, but they typically <a href="https://www.nytimes.com/2017/03/14/well/swimming-with-a-brand-new-leg.html" target="_blank">slow swimmers down</a>. No device had been able to go seamlessly from land to water or to help propel its wearer through the water. </p><p>To fix that, Northwell Health recently funded a project that developed <a href="https://thereturn.northwell.edu/" target="_blank">The Fin</a> – the world's first truly amphibious prosthetic. With The Fin, Lasko and his family can go straight into the pool from the locker room – or the diving board.<br></p>
3D bioprinting<p>For years, 3D printers have manufactured various products: phone cases, toys, and even operational guns. To produce these objects, the machines heat a raw material, typically plastic, and build the object layer-by-layer according to a particular design. </p><p>3D bioprinting, a young field developed by researchers with Northwell Health, may someday perform the same process but instead with living cells in a raw material called bioink. </p><p>Daniel A. Grande, director at the Orthopedic Research Laboratory in the Feinstein Institute for Medical Research, an arm of Northwell Health, said he and his team first pursued 3D bioprinting by modifying 3D printers so they'd accept living cells. </p><p>"My initial concept of 3D printing was early studies that looked at modifying ink-jet printers, where we incorporate a bioink that includes cells within a delivery vehicle," Grande <a href="https://youtu.be/oWnbUuJXtFc" target="_blank">says</a>. "That hydrogel can then be polymerized, or hardened, upon heat or UV-light stimulation, so that we can actually make a complex structure, three-dimensionally, that incorporates living cells. The hardened hydro-gel is then able to keep the cells alive and viable. It's also biocompatible, so it can be safely implanted in humans." </p><p>It's a promising enterprise, and it can radically change how we experience medical care.</p><p>"3D bioprinting's potential is almost limitless and has the potential to replace many different parts of the human body," <a href="https://theislandnow.com/news-98/3d-bioprinting-wins-northwell-health-medical-breakthrough-contest/" target="_blank">says</a> Michael Dowling, president and CEO at Northwell Health, and author of <em></em><a href="https://healthcare-reboot.com/" target="_blank"><em>Health Care Reboot</em></a>. "Researchers envision a future with 3D printers in every emergency room, where doctors are able to print emergency implants of organs and bones on demand and revolutionize the way medicine is practiced."</p><p>Dr. Todd Goldstein explains more about 3D bioprinting below: </p>
Taking care of our minds is an often neglected aspect of aging. What are we going to do about it?
- Studies have shown that depression can worsen in our old age.
- Other mental health concerns, too, are not only debilitating on their own but they can often make it more difficult to treat other health conditions.
- However, recent advances in how we treat mental health in the elderly are making a big difference. Here's how.
Percentage of older adults who claim they don't receive the social and emotional support they need by state, which can put individuals at risk for developing mental health conditions.
Centers for Disease Control and Prevention and National Association of Chronic Disease Directors. The State of Mental Health and Aging in America Issue Brief 1: What Do the Data Tell Us? Atlanta, GA: National Association of Chronic Disease Directors; 2008.
Bringing psychiatry to primary care<p>How can we better meet the mental health needs of elderly patients? In his book, <em><a href="https://www.amazon.com/Health-Care-Reboot-Megatrends-Energizing-ebook/dp/B07KQFMQY5/ref=sr_1_1?keywords=healthcare+reboot&qid=1554919842&s=gateway&sr=8-1" target="_blank">Healthcare Reboot</a></em>, Michael J. Dowling points to the divide between psychiatry and primary care as a major issue. "While it was true that psychiatrics went to medical school," he writes, "their subsequent clinical training was so far removed from other doctors that they tended to live in a psychiatric silo. In many ways, psychiatrists had walled themselves off from the rest of the medical profession."</p><p>A <a href="https://news.gallup.com/poll/159035/congress-retains-low-honesty-rating.aspx" target="_blank">Gallup poll</a> on the perceived honesty of various professions shows another way in which psychiatry has been pushed aside. 85%, 75%, and 70% of respondents reported that nurses, pharmacists, and medical doctors had very high ethical standards, respectively. Only 41% of respondents reported that psychiatrists had very high ethical standards.</p><p>One way to bring psychiatry back into the domain of primary care is to do just that; tighten the connections between psychiatrists and general practitioners through the <em><a href="http://aims.uw.edu/" target="_blank">collaborative care model</a></em>. In this system, a behavioral health care manager and a psychiatrist are incorporated into the primary care setting. The psychiatrist serves as a consultant for the primary care physician and the behavioral health care manager, who could be a psychologist or a nurse trained in managing mental health. The primary care provider has some training in screening patients for mental health issues. Rather than refer them to a psychiatrist, they can instead point them to the behavioral health care manager. This helps normalize the relationship between mental health and primary care and can reduce the stigma associated with seeking help for mental health conditions.</p><p>A study on the use of this model for older adults suffering from depression showed resounding success — using the collaborative care model doubled the efficacy of depression treatment. Over twelve months, <a href="https://www.ncbi.nlm.nih.gov/pubmed/12472325" target="_blank">half of the patients</a> reported an at least 50% reduction in their depression symptoms compared with a 19% reduction in the control group. What's more, the system saves money. For every $1 spent on implementing the collaborative care model, hospitals get $7 back over the course of four years. Today, Northwell Health and other health care organizations have incorporated psychologists and other mental health professionals in their primary care clinics to help deliver the mental health care that elderly patients need.</p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTM4MTA0Ny9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY2NDQ4MjUyMX0.LHlDFQpvCUU4mQfZDBQyl1Q6wJfPseYYkD2tgMSt8_g/img.jpg?width=980" id="516af" class="rm-shortcode" data-rm-shortcode-id="ba6e80bddf54e33b3f58ff0b285c9bc9" data-rm-shortcode-name="rebelmouse-image" />
Virtual reality: Not just for gaming<p>Addressing mental health issues in the elderly doesn't just have to take place in hospitals and clinics, however. Advances in technology are blurring the lines of where treatment can happen. <a href="https://rendever.com/" target="_blank">Rendever</a>, for instance, is a new project by MIT graduates that uses VR to help provide the elderly with mental health treatment. VR has the potential to serve as a powerful therapeutic tool for older adults, especially those in assisted living. Often, older adults in assisted living can feel isolated and trapped in their conditions; VR offers an avenue out of those conditions. In an interview with <a href="https://www.aarp.org/home-family/personal-technology/info-2018/vr-explained.html" target="_blank">AARP</a>, a co-founder of Rendever related a story about an isolated former pilot flying a simulated aircraft: "All of a sudden he was sitting in a pilot seat again, and all these stories started bubbling out of him." VR technology like Rendever have been used to treat PTSD, chronic pain, phobias, depression, and drug addiction. There's even some preliminary evidence that VR could be used to keep cognitive function sharp in old age.</p>
From the clinic to the home<p>One major challenge for the elderly is mobility. It's not always practical for them to travel to a clinic, psychiatrist, or psychologist. The use of "virtual visits" has become increasingly more common for health organizations. Companies like Apple and Samsung are increasingly leveraging their smartphone technologies to provide easier access to healthcare records and tackle chronic conditions. For its part, Northwell researchers have helped pioneer the use of remote intensive care units, or eICUs, to watch over multiple patients at once from a central location.</p><p>It may seem as though technology like this wouldn't be useful for psychiatric issues; in fact, the opposite is true. For the elderly, easy access to a psychiatrist may make them more likely to reach out. For patients in assisted-living facilities or unable to travel, "<a href="https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/geriatric-telepsychiatry" target="_blank">telepsychiatry</a>" is sometimes the only way they can gain access to a psychiatrist.</p><p>When it comes to the health of the elderly, a broken hip or a pneumonia diagnosis can overshadow the importance of maintaining a healthy mind in one's older years. Taking care of one's physical health will always be important, especially in geriatric patients, but it doesn't make sense to focus solely on treating a physical health issue while ignoring ongoing mental health concerns. Fortunately, advances in our institutions, systems, and technology are bringing mental health issues back into the spotlight.</p>
Upstreamism advocate Rishi Manchanda calls us to understand health not as a "personal responsibility" but a "common good."
- Upstreamism tasks health care professionals to combat unhealthy social and cultural influences that exist outside — or upstream — of medical facilities.
- Patients from low-income neighborhoods are most at risk of negative health impacts.
- Thankfully, health care professionals are not alone. Upstreamism is increasingly part of our cultural consciousness.
What is upstreamism?<p>Upstreamism is a call for health care professionals to recognize that many of the determinants affecting a patient's health exist outside the medical facility — that is, upstream of it.</p><p>A clinician can prescribe medicine or offer advice when the patient is in their practice, but consider how much time the average person spends in a hospital and the like. Very little. Instead, the vast majority of a patient's life is spent upstream, in their environment, where many mental and physical health issues can manifest and potentially worsen.</p><p>If a health care professional is to be an upstreamist, they must equip themselves to assess and address these social and cultural determinants together with a patient's symptoms.</p><p>Rishi Manchanda, founder of <a href="https://www.healthbegins.org/" target="_blank">HealthBegins</a> and upstreamism advocate, says that "one's zip code matters more than your genetic code." In fact, he points out, epigenetics shows us that our zip codes can shape our genetic codes.</p><p>In <a href="https://www.ted.com/talks/rishi_manchanda_what_makes_us_get_sick_look_upstream/transcript?language=en" target="_blank">his TED talk</a>, Manchanda illustrates upstreamism with an anecdote about a patient named Veronica. Veronica suffered chronic, debilitating headaches. She had visited emergency rooms three times before trying Manchanda's clinic. The previous doctors looked at Veronica's symptoms in isolation, saw nothing wrong, and prescribed standard pain medication. </p><p>He measured the same vital signs, got the same results, but asked an additional question: what were her living conditions like? Turns out, her living conditions weren't ideal. Her housing had mold, water leaks, and cockroaches. Manchanda theorized that her condition may be the result of an allergic reaction to the mold, a diagnosis the others missed because they only considered Veronica's symptoms in isolation. They forgot to look upstream.</p>
Swimming against the social current?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTM3MjQxNC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMDIxMjU3OH0.hXiAIgpOk0vOWDNVol2RTS8cMylTxphJ2PyY-hX03OM/img.jpg?width=1245&coordinates=0%2C629%2C0%2C2&height=700" id="92e2e" class="rm-shortcode" data-rm-shortcode-id="ebe1f0c66196f4aca1a0980bdeec9eb0" data-rm-shortcode-name="rebelmouse-image" />
Volunteers beautify a park in Bowie, MD, as part of a three-year project to repair low-income neighborhoods in the county. (Photo: Staff Sgt. Alexandre Montes/U.S. Air Force)<p>Like an actual river, a patient's upstream environment doesn't flow in a straight line. In lieu of springs, streams, headwaters, and tributaries, a patient's constitutional watershed contains their social environment, their physical environment, their economic status, their individual lifestyle, and their access to care.</p><p>As a result, people living in low-income neighborhoods face far more negative social and cultural health influences than those living in wealthier areas. Patients from such environments are less likely to have access to <a href="https://www.washingtonpost.com/news/energy-environment/wp/2016/01/27/its-not-just-flint-poor-communities-across-the-country-live-with-extreme-polluters/?utm_term=.7dbde0676d39" target="_blank">pollutant-free water</a>, <a href="http://frac.org/obesity-health/low-income-food-insecure-people-vulnerable-poor-nutrition-obesity" target="_blank">full-service grocery stores and farmers markets</a>, and parks and playgrounds. The stress of such environments leads to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2186297/" target="_blank">higher rates of depression</a>, <a href="https://inequality.stanford.edu/sites/default/files/PathwaysWinter11_Evans.pdf" target="_blank">unresponsive parenting practices</a>, and even increased rates of mortality.</p><p>"If you're living in a very, very good neighborhood, […] you will live years longer than the person who lives in a very, very poor area, in general," Dowling said in an interview. "So if I want to improve your health, I've got to make sure that I have doctors, and nurses, etc., to provide medical care to you. But I've also got to figure out how to work on all of these other things."</p><p>That's a lot for health care professionals to be responsible for, especially when one factors in the exorbitant rates of burnout facing <a href="https://www.medicaldaily.com/many-american-doctors-overworked-likely-make-medical-errors-due-burnout-425644" target="_blank">doctors</a> and <a href="https://thehospitalleader.org/americas-physicians-overworked-and-burning-out/" target="_blank">physicians</a>. </p>
Mapping the upstream<div class="rm-shortcode" data-media_id="P6SaTbeg" data-player_id="FvQKszTI" data-rm-shortcode-id="b6acaef7833ade2ec77ac58dbea0db16"> <div id="botr_P6SaTbeg_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/P6SaTbeg-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/P6SaTbeg-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/P6SaTbeg-FvQKszTI.js"></script> </div> <p>The challenges of upstreamism would be daunting to health care professionals if they had to face them alone. However, we are in the midst of social changes that will make upstreamism viable. One of those changes is an always connected world where new information is available quickly.</p><p>Going back to Veronica's story, Manchanda didn't solve the problem alone. He connected her with a community health worker, and the partnership paid off. The community worker found mold, a strain Veronica was allergic to. Once her home conditions improved, Veronica's quality of life did as well. Manchanda inadvertently helped one of her sons, too, as his asthma was exacerbated by the same mold.</p><p>"If we're all able to do this work, doctors and healthcare systems, payers and all of us together, we'll realize something about health. Health is not just a personal responsibility or phenomenon. Health is a common good," Manchanda said in his TED talk.</p>
The health care payment system is due for a major overhaul.
- Value-based health care focuses on tangible improvements in patient care outcomes.
- The goal is to reduce the per capita cost while improving treatment.
- Current fee-for-service payment models focus too much on quantity and not quality of care.
Time to shift to a value-based payment system<div class="rm-shortcode" data-media_id="4vbb5hTR" data-player_id="FvQKszTI" data-rm-shortcode-id="a1f2f58d51ae2e69d43406d44903c6bb"> <div id="botr_4vbb5hTR_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/4vbb5hTR-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/4vbb5hTR-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/4vbb5hTR-FvQKszTI.js"></script> </div> <p>The current state of payment systems in health care takes the form of disjointed and disparate bill of costs that don't take into account whether or not the treatment was valuable. Let's look at a simple example on why this is so. </p><ul><li><strong>Fee-for-service care - </strong>A patient undergoes surgery. They end up getting an infection. On their next visit back to the medical center <em>the patient </em>now bears the cost to treat it.</li><li><strong>Value-based care -</strong> A patient undergoes surgery. They end up getting an infection. On their next visit back to the medical center <em>the hospital </em>bears the cost to treat it.</li></ul><p>While this is an overly simplified example, it cuts to the heart of the issue. Health care services and payments need to be held accountable for what value they bring and not what laundry list of treatments they doll out. </p><p>Fee-for-service models lower quality of care and are a disservice to patients and employers alike. Michael J. Dowling, president and CEO of Northwell Health, argues that the rising costs are intrinsically tied to lower quality of care. "Value-based care ties reimbursement to quality, not quantity of care. The goal is to incentivize better care and lower costs," he writes in <a href="http://healthcare-reboot.com" target="_blank">"Health Care Reboot".</a><strong></strong><em><strong></strong></em></p><p><a href="https://bigthink.com/Sponsored-by-Northwell-Health/the-unexpected-cost-of-living-for-a-very-long-time" target="_self">Dowling imagines</a> a world where the quality of care is the standard rather than the volume of care.</p><p>A lot is at stake here. Business as usual is going to be unsustainable for both hospitals, employers and individuals. For institutions like Northwell Health, clinical outcomes are paramount; health care improvement and high-quality care need to become the norm. </p><p>And patients agree. In a quest to figure out just what value-based health care means to patients and physicians, The University of Utah <a href="https://uofuhealth.utah.edu/value/" target="_blank">conducted a far-reaching survey.</a> The results showed that patients identified a few key characteristics of high-value health care: </p><ul><li>Around 62% considered the quality and effectiveness of their care to be the most important factor of high-quality health care.</li><li>26% were most concerned with their out-of-pocket costs.</li></ul><p>Major companies are <a href="https://hbr.org/cover-story/2019/03/how-employers-are-fixing-health-care" target="_blank">already taking note</a> and are springing into action with new plans.</p>
Employer initiatives with value-based health care plans<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTM0NzQxMi9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTY0MzMyNDI5MH0.hc0ABfXkqfqq4ydS9hjddvyj_ZZPbzcHrmHPO4oxV-0/img.png?width=980" id="0fcb2" class="rm-shortcode" data-rm-shortcode-id="741ff71613e9b8637d10f7b8bd91180b" data-rm-shortcode-name="rebelmouse-image" />
Are employers doing enough for their employees?