It’s 2 In The Morning, Where’s Your Doctor?

It’s 2 a.m. You wake up to discover your 3-year-old daughter has a high fever. What do you do?

Today, your options are limited. You can call the pediatrician only to reach the answering service, which instructs you to dial 911 in case of an emergency. You can drive 20 minutes to the emergency department where you and your daughter could wait several hours. Or you can endure a sleepless night until you can reach a doctor the next morning.

But what if a pediatrician could come to your house and advise you what to do? It could happen today. But it wouldn’t be a traditional house call.

If you’ve ever used Skype to talk face-to-face with a loved one across the country, you understand how technology can eliminate distance and time.

As a parent, how much would you pay for the ability to reach your doctor instantly? How would you feel if such a service reduced – rather than increased – what you’re paying now for your health care? It could happen.

What about when a man’s back pain flares up during a trip abroad? He could go to the local emergency room and hope there is a translator who speaks English. Or he could obtain advice from his physician back home through a video consultation. A writer for the Harvard Business Review called these “virtual visits“ a top 10 innovation that will transform medicine. However, the author points out many challenges still must be overcome before such visits with transform health care.

Medical technology can do more than just provide convenience. It also supports higher quality.

For example, the typical patient in an ICU is monitored continuously but is seen by the responsible physicians only once or twice each day. Imagine if a team of centrally located specialists could support this care and follow the patient’s progress hourly through vital-signs monitoring, the patient’s electronic medical record (EMR) and video technology. Today, there are expensive ICU robots that can assist with this function. However, with the increasing quality of cameras and the ease of transmitting video through computers and mobile devices, all ICU beds could have individual, inexpensive systems installed to help patients achieve a more rapid recovery.

The same combination of approaches could be used to provide immediate consultation for patients in the ER. For example, a small number of neurologists could evaluate patients in dozens of ERs whenever they’re presented with symptoms of a stroke. Compare this approach to waiting for the local neurologist to drive from his home or medical office. With technology, life-saving care with better quality outcomes at a lower cost is within reach.

When I talk with CEOs about their own care, they say they would be willing to pay more for these high-quality, convenient services than they do for the medical care they receive today. They just don’t believe it’s possible. That perception would change rapidly if executives knew such services were available at a reasonable cost – both to them and their employees. In fact, it would disrupt the entire health care world.

Why these technologies don’t yet apply to health care

In the past, video connections were unreliable, phones weren’t “smart” and EMR use was limited to just a few organizations. But all of that has changed. While doctors would need to be licensed in all of the states in which they provide “virtual care,” that’s not what’s holding up progress.

What’s stifling these medical innovations is the reimbursement system. If you are paid to see patients in your office, then that is what you do – even if virtual care could be provided twice as conveniently at half the price.

What the future might look like

Overcoming technological and regulatory issues is challenging but doable.

Translating potential into practice will require three shifts in health care: First, payment to doctors and hospitals has to be prepaid to reward increased efficiency. Second, physicians need to work together within and across specialties to aggregate the volume required to achieve economies of scale. Finally, doctors need to agree on how high-quality medical care should be provided for particular medical problems. This way, patients can receive the same level of excellence seven days a week, regardless of which physician is providing the video consultation at the time.

In last week’s article, I noted that some of the least cost-sensitive patients (the ones with the best health insurance who, in their day-to-day lives, expect the convenience that technology affords) will likely be the ones who first demand this virtual concierge service. But once this process starts – and once people recognize that the cost to provide this service is less than the current model – it has the potential to produce industrywide disruption.

Once mass adoption begins, the increasing volume will lower costs further and accelerate the process of adoption.

The 2 a.m. house call may be available before we know it.