It is both premature and presumptuous to talk about life in a post-COVID-19 environment, particularly now that the rate of infection is once again climbing in much of the world. But even though this novel coronavirus has only been around for a matter of several months, America’s healthcare community has already absorbed some important lessons driven home by the pandemic—lessons that are already starting to re-shape the ways in which medical services will be provided going forward, placing greater emphasis on outcomes than on processes—less on “break and fix,” and more on comprehensive patient care.
One key lesson stems from the way the healthcare industry is currently structured, where the main sources of hospital revenue derive from non-emergency procedures—skilled hands-on care like cataract removals, bariatric surgery, hernia repair, blood transfusions, and so on. At the same time, while very little income is derived from standard exam room collections of vital statistics, health systems have become the venue for those types of services as well. But with the pandemic peaking, most elective surgery procedures have been postponed, and many other patients are choosing not to come into a hospital environment for tests where people suffering from COVID-19 have been concentrated, preferring instead to go for routine health checks including eye exams, colonoscopies, and bone density scans, in their physicians’ offices.
For a growing number of clinics and group practices around the country, the answer involves making greater use of digital healthcare—a broad concept that embraces everything from video checkups and Fitbit readings, to analytical/diagnostic instruments, and sometimes even therapeutic interventions. In fact, it’s reached the point where, as coronavirus infections peaked, some practices that shut down their physical offices are now questioning whether it’s even feasible to reopen those locations once it passes; the power of remote digital tools makes at least some aspects of traditional practice seem obsolete. But it’s neither a perfect nor complete solution.
Think of today’s digital health technology as if it were a medical student, learning the trade. How far along has it come? I would place it in its second or third year of study; it shows promise, it does some things well, but it still has a lot to master. However, it is learning quickly and should graduate to becoming a medical resident sometime in the foreseeable future. Even so, I don’t see any way it will take the place of a well-trained and experienced physician. Indeed, a doctor’s high-level skills and ability to work with people will become even more important, and play a larger role in physicians’ work, than is possible under today’s protocols, where too much of a doctor’s efforts are directed toward collecting data—information that can be secured just as accurately and far more frequently using remote technology.
Beyond that, I see the inexorable growth of medical technology producing its own type of specialist—something like a cardiologist or an endocrinologist. Fifteen years ago, there were no physicians who specialized in hospital-based care—the so-called hospitalists. Today they are important members of the medical service family. By the same token, the growth of digital technology, and its distribution to individual patients in their homes and places of work, will likely lead to a different kind of specialist, what some are calling a “digitalist”—a specialist in health information management. In time, these specialists might be able to run an entire practice simply by looking at a stream of incoming data to help them guide the patient’s care. And even for physicians in a more conventional family practice, training in “techside manner,” a bearing parallel to traditional bedside manner, seems almost certain.
However, there is an important repercussion from the use of remote instruments that remain with the patient day and night. It’s this: That even though the device readings are transmitted for analysis to specialists far away, now more than ever the burden of care falls to the patients themselves. That includes adherence to prescribed frequencies for medication and other recommendations, providing accurate information about both their current conditions and health history, informing doctors about any trouble following treatment recommendations, asking questions to clarify confusion, creating and sharing advance care directives, and accepting responsibility for the consequences of refusing treatment or failing to follow healthcare instructions. Not every patient is ready to accept those changes; patients who are accustomed to looking toward their doctor, rather than to themselves, for direction, will find it disorienting. And for patients who are weak or demented and score low on the care dependency scale, it may be unrealistic.
Beyond that, for reasons of their own, many physicians are reluctant to accept the influx of digital instruments into their practices and patients’ lives. Some might even wish for a high-profile technology fiasco to vindicate their yearning for a return to the way things used to be. And misfortunes could happen; the wider their use, the more opportunities there will be for device failures.
Right now, digital medical technology is at a “show me” point where physicians are demanding to see the data proving they can deliver better care with it than without it.
Still, there’s no turning back; widely distributed digital healthcare technology is here to stay and its applications can help to re-direct a struggling medical industry while benefitting patients’ health. An important corollary of having all those metrics in hand is the recognition that patients are more than collections of vital signs and indications. They are human beings whose lives have social, cultural, and economic dimensions which strongly affect their health.
In the foreseeable future, with easy-to-use digital technology becoming so pervasive, every patient will be empowered to accept greater responsibility for their own health. At the same time, re-imagining healthcare as an instrument-enabled, proactive treatment for the whole person, will allow doctors to reestablish engagement with their patients and help to restore the uniquely human aspects of medicine.