The Dartmouth Hitchcock Medical Center based in several US cities is implementing a new system that introduces telemedicine. A medical kit is distributed to users, which includes a watch that measures heart rate, a scale and also a blood pressure monitor - all smart devices. The data obtained by these instruments is then cross-referenced with the patient's digital medical record.
In parallel, a kind of call centre staffed by doctors provides remote care. Based on the evolution of heart rate, weight and pressure variables, an automatic alert is triggered if something out of the ordinary happens to the patient, and the institution proactively contacts the patient and attends to him or her virtually through a video call.
It's like having a doctor following you 24 hours a day. This case was brought to light by the general manager of Microsoft Uruguay, Rodrigo Astiazaran, as this and other projects linked to medicine that are being implemented in institutions in the United States and even in the region in Brazil, are developed jointly by this technology company.
According to Astiazaran, in the case of Dartmouth Hitchcock, it means cost savings for the institution, not only in the type of care that is not face-to-face if the patient does not require it, but it can avoid hospitalisations and intervene proactively before the person is more serious. "Currently, access to artificial intelligence has become very democratised. The investment may start at US$3,000 per year, but for a company that wants to enhance its services, it ends up being a benefit, as well as for its users," he explained.
In Uruguay, the Electronic Health Record (EHR) project began to be implemented in 2012, and it is expected that by 2020 all institutions will have this input. "Today the digitisation of medical records is the most common thing in Uruguay, but through this it is possible to understand all the metadata in those records and transform them into something useful," said the manager of Microsoft Uruguay. One of those uses could be to determine what diseases a patient is going to have, by cross-referencing data.
For the consulting manager of EY Uruguay, Ernesto Scayola, traditionally, when talking about the incorporation of technology in medical institutions, the focus was "behind closed doors", on the equipment and systems used by the institution. However, that has changed in recent years. "Institutions are looking to rely on technology to improve the relationship and experience with their members, so we have seen the birth of platforms that allow you to schedule an appointment, review clinical studies or even consult a doctor by video conference," he said.
He also predicted what the use of the internet of things could bring in the future. "Health can be monitored and this will allow professionals to make timely decisions based on a wider range of data, but these developments will not be without regulatory challenges and integration with institutional platforms," he said.
Video consultations: more approach
The interaction between engineers and doctors made it possible to implement electronic medical records at MP Medicina Personalizada. According to MP's commercial manager, Juan Manuel Zorrilla, although video consultation and even WhatsApp communication between doctor and patient is used, face-to-face consultation cannot be replaced. "Our doctors always prioritise personalised care. That means face-to-face clinical consultation, where a lot of information about the patient can be shared," he said. He added that this does not preclude "that in some circumstances a consultation can be done using technology, even if it has certain restrictions".
MP App
According to Zorrilla, the world is talking about the "4 Ps" concept in medicine: preventive, predictive, precision and personalised. "Precision is, for example, making a specific medicine for a person according to their DNA. Personalised medicine goes in this direction in the doctor-patient relationship, in which empathy and collaboration are fundamental," he summarised.
In the case of Seguro Americano, in addition to the application that allows patients to interact with the institution, schedule appointments, view their medical history, among other things, changes have been implemented over the years on the care side, said director Carlos Tarabochia. "With the introduction of video surgery, with minimally invasive procedures, technology has taken the doctor out of the patient's body, and the patient is watched from a monitor," he said.
For the doctor in charge of the insurance company, when the patents for robots become free, production will become cheaper and their use will become more popular. "In a short time, there will probably be a greater number of robots in surgical blocks, which is the same thing that happened with imaging," he explained.
Meanwhile, BlueCross & BlueShield's commercial, marketing and development manager, Pablo Fernandez, commented that it is becoming increasingly common for the most advanced institutions to implement devices that collect information, monitor a patient from a distance and can assist them. "All the information collected by the devices is accessible through the internet, generating alerts so that the doctor has the most agile information," said Fernandez. In the case of this health insurance company, which belongs to the Swiss Medical group, access to this type of technology makes it easier for the Uruguayan branch to use them.
According to the members of the institutions, the issue is that even if changes are generated in business and this implies an improvement in user service, the security of sensitive information must be taken into account. "Sufficient precautions must be taken to ensure that it is not breached," said Fernández.
More data usage
New technologies have also made it possible for medical centres to find out what the client (user) has to say to the institution. In the case of the British Hospital, online post-care satisfaction surveys are carried out to find out what the experience has been like in each of the services. Sandra Bogado, manager of the institution's services, said that "satisfaction monitors" are installed in the hospital itself to permanently monitor customer feedback on site. "While the British Hospital has always had a lot of feedback from its users, with different methodologies to know the levels of satisfaction, today technology is aligned with this perspective and gives us much richer and immediate possibilities. Multi-channeling is essential and we understand that more channels and back and forth contact channels are needed. This is about the bond with members and the close connection we want to maintain with them," he said.
User experience is becoming increasingly important. According to Valentina Sena, Business Development Manager at KPMG Uruguay, although there have been some timid advances in Uruguay - especially in the digitisation of processes - there is still a lot of work ahead and there is a lack of awareness on the subject. "There is also a great waste of the volume of data that is handled in the health sphere and a real missed opportunity to work in areas of prevention. It's not just about capitalising on the data that comes from the patient's medical record, but also the enormous amount of data that can easily be generated with the introduction of the internet of things," he said.
Another aspect highlighted by Sena is the "digital empowerment" of patients, which leads them to be more and better informed and to demand better service.
For his part, CPA Ferrere partner and director of CPA Innovation, Bruno Gili, said that new trends in interpreting information are "in their infancy" in Uruguay. "There is little experience. This is a trend that is on the table and there is an extraordinary field to work on. The health system still uses little information linked to these aspects. There are many things happening today that could be more effective if one had more interpretation of health system data," he said.
For security in accessing medical records, Gili referred to blockchain as a technology that will end up "having an impact on healthcare, because it will add trust to many operations in the sector".
Humanisation of medicine
The director of iSalud, Cecilia Hackembruch, pointed to the concept of the "humanisation of medicine". The educational institution trains medical and non-medical professionals in the areas of health management, from a transversal perspective "not only in management, but also in soft skills, which are the ones that are most needed today".
According to Hackembruch, for the patient to be contained, there must be a "functional ethic": "If you don't provide elements for the doctor to have another relationship, from the consultation time, to the building, to the bureaucracy, it doesn't work. There are simple things that are important for the patient to have what is needed. In addition, he reaffirmed the concept that the patient requires information. "Today's patient is informed but with a bias. What he needs is to have reliable tools to know what he has and that determines the treatment," he explained.
Ventures linking health and technology
Connectus Medical
The start-up that connects patients with dialysis centres opened a business unit that provides services for medical companies. Together with the Swedish company Diaverum, they provide virtual reality glasses for patients who are on dialysis for four hours and need to be distracted. "What we have is a 360° walking area, a play area for children and adults, and a yoga and mindfulness area to calm down," explained Connectus Medical CEO Javier Artigas.
Armor Bionics
The company focuses on 3D models for surgical planning. "When you have to be operated on, you prefer the doctor to plan and test the surgery beforehand," said commercial director Pablo Pereira.
Armor Bionics provides you with a model exactly identical to the body part to be operated on, as it is based on CT scans.
"It shortens the time. Before opening the skin, the doctor knows what he is going to find on the other side. You can show it to a professor and discuss the operation with other doctors," explained Pereira, who works as commercial director. Operating times have been reduced from 15 to seven hours.
"One of the important things is the importance of cost reduction for the sanatorium. The surgical block time with all the equipment is very expensive. If you do it faster, you save costs and you can do more surgeries per day," Pereira summarised.
ViperMed
The company offers materials to educate patients about different types of diseases. According to ViperMed CEO Ignacio Oliveri, there are many areas of intervention to educate the patient. "You can educate them when they have an established chronic disease or when it has to do with procedures and how to perform them," he said.
In addition, there is another line, which is prevention. "It is key but a very broad word. Prevention has to be very focused and segmented to the niches of people with the most problems, which generates a high cost for health institutions," he said.
They are currently working with 17 Latin American laboratories in Chile, Uruguay, Guatemala, Costa Rica, Bolivia, Mexico, Peru, among others. What the hospitals don't do on their own, the laboratories finance," Oliveri explained. "The health visitors give the cards with the educational material to the doctors so that they can provide patient education.
Doctari
Doctari has been operational in its B2C version since August 2017, and is currently running pilot tests in Argentina. "Many video consultations have been carried out, and we are sure that, little by little, the digital channel will gain acceptance in healthcare and will be as valid a resource as any other. We have always postulated that, far from replacing face-to-face consultations, our platform complements them to improve accessibility and the use of time, both for doctors and patients," said CEO Omar Paganini.
In addition, they have developed a new tool for rapid inter-consultation, aimed at institutions that have teams of specialists and want their doctors to be able to consult them "at the touch of a button", without travelling or delay, using their mobile phones.
Source: The Observer
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