Doctor’s Offices of the Future

Forward in Silicon Valley

The way medical care is delivered is constantly evolving, yet the experience you have with your general practitioner really has not changed that much over the past 50 years. Consider this: The stethoscope still commonly used today was invented in 1816. The blood pressure cuff was invented in 1881. Even electronic medical records (EMRs), invented in 1972, are over four decades old.

There are plenty of good reasons that technological advancements and new digital health inventions are slow to be adopted by most modern medical professionals. However, the speed at which innovation happens today means high-tech solutions reach the mainstream market faster than ever before, sometimes bypassing traditional gatekeepers. There is new hope that advances in health technology might soon replace some of the inefficient parts of health care. It is not just technology that causes disruption—our interactions with healthcare professionals are changing as well, and as such, health-care practitioners are having to adapt their treatment approaches.

So although it is true most general practitioners’ offices contain relics from the past, health technology, and digital health are beginning to augment the primary care experience, as well as in other areas of medicine. In the quest to make health care more accessible, personalized, and economical, new models of care are being proposed that might challenge the traditional ways health care is practiced.

Technology-Based Model of Care for a New World

In 1973, Dr. Lewis Thomas, president of the Memorial Sloan-Kettering Cancer Center in New York, gave a speech. He contrasted the “old world of trial-and-error empiricism and hunch” with the new world of access to data and the use of health technology. Dr. Thomas thought the latter was the future of medicine. He strongly believed that a better technology assessment was needed so that the field of health care could benefit from a more systematic approach. He also observed that the general public was often concerned about the hideous technology they imagined hidden away in some underground medical lab.

Almost 45 years ago, Thomas discussed the impact of technology on medicine and suggested bigger investments in science to solve some of the medical mysteries of his time. These days, technology can indeed offer many new and novel solutions to problems that previously seemed insurmountable. However, there are some who still doubt digital health’s role in everyday medicine. Although few would argue that modern medicine uses technology as a tool to deliver care, a model of care that is fundamentally grounded in technology has not yet been fully realized.

There are signs that this might change in the near future. There are several medical startups that have the ambition to shake up the relationship that used to exist between patients and their general practitioners. These new pioneers of health aim to bring the “new world” of technology to every patient at an affordable price.

How Is Technology Being Used Right Now?

One such example is Forward, a Silicon Valley startup founded by an ex-Google engineer. To bring each patient a personalized plan, Forward combines artificial intelligence with a human doctor’s in-person assessment. Their doctor’s office includes a body scanner that offers instant information on basic body functions, DNA testing from saliva, and real-time blood testing that provides clients with medical information in less than 15 minutes.

Instead of a client paying for each visit, Forward has a flat-fee membership model, which includes 24/7 access to health professionals via their mobile app. The membership also includes ongoing health management through the use of their integrated technology offerings. Companies like Forward are changing the way we are used to interacting with our general practitioners and could expand the way we currently look at the continuum of health-care. 

Connecticut Institute for Primary Care Innovation (CIPCI) is another enterprise that aims to create the Primary Care Office of the Future. A collaboration between Saint Francis Hospital and Medical Center and the University of Connecticut School of Medicine, the institute has been running since 2010. They are interested in how to advance the patient experience by providing better health technology and improved office design. Some of their key concepts include a focus on improving patient engagement, the use of telemedicine, better adoption of wearable devices and developing efficient online communication tools.

For many patients, it can be economical and more efficacious to manage their conditions through self-care and remote monitoring. To demonstrate how care can be managed from afar, CIPCI is providing examples of patients using wireless devices that transmit directly to their electronic health records. Secure text messaging and video chats are also being utilized to improve outreach and quality of care. CIPCI is trying to provide a primary care experience that transcends the office visit. Their hope is to be anywhere the patient is in need. They are also focusing on how to improve collaboration and communication between different team members by creating clinical team hubs for better integration of services. CIPCI is also using technology to automate certain time-consuming tasks, such as prescription refills.

Changes We Can Expect by 2022

The high-tech doctor’s office presented by Forward and CIPCI might sound like visionary ideas. However, health systems across the globe are bracing themselves for wireless and technology-facilitated models of care. The UK’s National Health Service (NHS) published a document that lists some of the changes patients can expect from medical practitioners over the next few years. Technology and remote care are big components of the NHS plan.

Telemedicine and online consultations will likely soon become the norm, eliminating the frustrations of waiting rooms. Another potential change might be the amount of time we spend with our doctor. Short time slots offered to patients these days are being increasingly recognized as inefficient, especially for patients with complex conditions and multiple morbidities. According to some predictions, the general practitioner of the future will be able to offer more flexible times and potentially increase appointments to aptly address our need without haste.

By 2022, patients can expect to have virtual appointments with their physician and be able to access their medical records, referral systems, and prescriptions anywhere they are able to get online. As information technology continues to better inform patients and improve their ability to manage their own conditions, the emphasis on shared decision-making will become promoted even more than it is now. Also, the value of online discussion boards and online peer support groups is likely to increase over time. In the future, basic primary care will likely move out of the doctor’s office and into our homes (or another setting of our choosing) via different online tools and digital options.

Clinical genetics is another area of science that is progressing rapidly. Different genetic risk tests are becoming more readily available, with primary care settings no longer acting as gatekeepers. Screening tests can use a sample of saliva or blood to detect a patient’s genetic predispositions for a certain disease. This is already considered an important preventative method for some forms of cancer, including breast, ovarian, colorectal, and prostate cancer. 

Since genetic testing raises a number of new questions, the doctor’s future role will need to expand to include correct interpretations of results, as well as provide patient guidance. Patients will need to understand the implications of results. For example, when a hereditary condition is discovered, a doctor may advise if offspring/relatives should be tested as well. This suggests that primary care practitioners will likely need to improve their knowledge of clinical genetics.

Modern Technology in the Hands of the Patients

Technologies and digital tools that patients can use themselves are now a big focus in digital health and health technology conferences. Mobile apps and wearables are often mentioned in relation to future care. At present, unfortunately, many of the available health apps have not been properly evaluated to ensure they meet standards of quality care. Brenda K. Wiederhold, editor-in-chief of Cyberpsychology, Behavior & Social Networking, notes that a broader review of medical apps is required to ensure their efficacy. Randomized controlled trials are still often missing.

For instance, a 2016 study showed that only about 10 percent of apps meant to serve people with depression have been supported by empirical evidence. To address this gap, app evaluation programs have now been started in many places. For example, in the UK, NHS Digital and NICE are working on future app regulation to improve the quality of these offerings. When this technology has been properly assessed, doctors will likely to be able to prescribe evidence-based apps to their patients. This will increase the safety and quality of such treatment options, as well as contribute to their clinical value and patient adoption.

Wearable technology is becoming an integral part of our health care system, too. We can expect that in the future, general practitioners will be able to rely on real-time information from wearables. This might play an important role in health management, especially when treating vulnerable patients. Data collected by condition-specific wearable devices will be able to alert the care provider if any warning signs of a particular health condition appear.

However, some experts believe that the use of wearables is facing many challenges, including patients losing interest in different devices and apps. Also, some people still do not trust progressive health technology, which suggests that some patterns described by Lewis Thomas in 1973 are persevering. More time and better regulations are likely required to build consumer trust and develop new, technology-related health habits among a broad base of users.

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