It can’t be ignored that dramatic transformation in our healthcare system is imminent. The economy, market forces and increasing political demands will soon force physicians and healthcare professionals to change how we take care of our patients. Just as the days of housecalls are gone, so is our current system of delivering care.
The rising cost of healthcare now has the government and insurance companies placing more emphasis on controlling costs, sometimes at the expense of quality. They demand that we become more efficient and manage an even greater number of patients. Advancements in medical technology are believed to be a principal cause of the rising cost of healthcare: While they have improved patient care, they often come with a high price tag.
Does that mean we should abandon them? My answer is to play with robots.
Technology can help us deliver care that is more efficient, cost-effective and, most importantly, of high quality. As a surgeon, for example, I see one aspect of our care that needs to evolve: post-operative care. Traditionally, we have patients recover in the hospital so they can be monitored for complications and cared for until they are able to manage for themselves at home. Some patients may only need low-level care and monitoring, but cannot be discharged to their homes without significant risks.
Because hospital care is so expensive, insurance companies encourage us to discharge patients sooner, sometimes refusing to authorize care beyond a certain time period. While this reduces the immediate cost, there is a greater chance that patients will have complications and return to the hospital, negating the cost-saving effort. In addition, early discharge often leaves both patients and physicians feeling that their care was incomplete and of lesser quality.
That’s why I play with robots. Recent developments in telecommunications and remote monitoring technology can provide a bridge between the hospital and the home. Through robotic systems that include video and audio capabilities, physicians, nurses and other healthcare professionals can “go” into the patient’s home to provide follow-up care. They can monitor and assess patients and even talk families through performing minor procedures such as wound care and removal of drains and Foley catheters. Not only is the home a less costly care setting, but being at home is often medically beneficial for the patient.
There are many other applications for this method of healthcare delivery. Patients with chronic diseases, who traditionally must show up for frequent clinic visits, could have some of these visits replaced by virtual ones. Compact, mobile ultrasound devices, blood and urine analyzers and stethoscopes could provide vital information on their health remotely, minimizing the need for direct physical evaluations.
In our preliminary studies, patients and their parents have found this virtual care to be very helpful in their transition home from the hospital. They report a sense of security and confidence that their physician is watching over them – without having to surmount traffic, bad weather and physical distance to receive care. Physicians find they can be more time efficient, yet still have direct access to their patients.
One might assume that the cost of this technology would negate the cost benefits of getting patients out of the hospital sooner. This is not the case. Most of this technology is already in wide use; sometimes all that’s needed is a cell phone with video capabilities. Competition is making the technology ever more affordable, economical and effective.
In fact, with novel technology, the days of a physician having the time and capacity to do house calls may not really be over. Housecalls can be reborn with a modern twist.
Most importantly, we observed in our studies that the patients and families who utilized telemedicine technology were more engaged in their healthcare. They participated actively in their recovery, rather than having it spoon-fed to them – something many physicians have been trying to encourage for years. Their care became an active partnership with us.
Only with patient engagement can we take care of a greater number of patients without compromising on thoroughness or quality. Only with their active involvement can our healthcare system change from one that’s primarily reactive to one that’s proactive and collaborative.
Obviously, we can never eliminate the need for hospitalization or in-person visits. Some patients will always need intense care, monitoring and direct physical evaluation. We can, however, be more efficient in using these resources.
I therefore continue to play with robots, believing that technological advances can be a solution to — rather than a cause of — our current healthcare crisis.
Hiep Nguyen is a pediatric urologist, surgeon and director of Robotic Surgery Research and Training at Children’s Hospital Boston. He blogs at Vector, the Children’s Hospital Boston science and clinical innovation blog.
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