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Envisioning a System of Healthcare without Walls

Man on a kayak in the wilderness

When I contemplate the phrase, “healthcare without walls,” I think of a patient whom I’ll call Dave.

Dave doesn’t really exist, but he easily could. He’s a hypothetical stand-in for patients across America, who deserve the finest healthcare that the nation can provide. And in our intelligent and internet-enabled age, they should have access to it wherever across this fine land that they choose to live.

In my mind, Dave is a natural scientist in his early 40s, who’s chosen to live and practice his profession on Kodiak Island, Alaska. A healthy man and a nonsmoker, who thrives on being active in the outdoors, he nonetheless comes down with a hacking cough that just won’t quit.

After several months of putting up with this coughing – Dave, somewhat of a stoic, is no hypochondriac – he finally takes himself to the critical access hospital on Kodiak Island to learn what’s wrong. A good workup from the physicians there, coupled with a scan, show that he has a lung tumor that is probably a manifestation of a form of lung cancer.

Dave, a dedicated researcher, isn’t one to take that news lying down, so he devotes several days to sifting through his options. He deduces that, as a nonsmoker, it’s likely that he has non-small cell lung cancer; that there are new, targeted therapies that have proved highly effective against this condition; and that the institutions best equipped to treat him are in major U.S. cities that are thousands of miles away. Going there in person, and staying for days of consultations and treatment, would require major investments of Dave’s time and money, and no doubt add considerably to his emotional stress.

Consider the Possibilities

So, in the internet age, why shouldn’t Dave expect to be able to do the following:

  • Have his tumor biopsied and sent to a state-of-the art lab for a complete genetic typing, and have his own genome sequenced, to boot?
  • Have the results sent to premier oncologists at the sophisticated cancer center that he has researched, which happens to be in New York City, more than 3,000 miles away?
  • Have telehealth visits with those clinicians to arrive at the optimal treatment plan, after they’ve buttressed their own decision making with the aid of a cognitive computing system that has sifted all the applicable research?
  • Have the targeted therapy treatment shipped to the hospital on Kodiak Island, where the local clinicians – having also been trained in the administration of the therapy via telehealth – then begin Dave’s treatment?

The answer is that, if the U.S. had a truly state-of-the-art, patient-centric healthcare system – a system of healthcare without walls – all of the above would be possible. But the reality is that none of it would probably happen in the system that we actually have, since practically innumerable barriers – related to payment, regulations, work force limitations and other issues – stand in the way.

We know that much of healthcare requires the “laying on of hands;” trauma patients will probably always need to be treated in trauma centers, for example. But so much of the rest of healthcare mainly involves exchanges of information that, in contexts outside of healthcare, increasingly take place virtually. Why should healthcare remain so far behind?

The unleashing of a system of healthcare without walls could spread and democratize medical knowledge; meet patients where they are, in their homes, communities, or other locations; focus new attention on the social and economic circumstances in which patients live most of their lives; and defy the conventional boundaries of time and distance to get the right care to the right patient when it is most needed. Patients like Dave, along with millions of others, would benefit.

Five Elements of Healthcare Without Walls

To achieve a system of healthcare without walls, we as a nation would need first to set ourselves an overarching goal: to support the health – and provide the best healthcare possible – to the greatest number of people, wherever they are in the country, and at the lowest cost.

Then we would need to set ourselves in pursuit of discrete tasks in five areas.

  1. First, we’d tackle the challenge of applying the technology that we already have to healthcare. We would need to figure out how to best deploy telehealth, remote monitoring, self-administered lab tests, drones and a variety of other information technologies in the delivery of healthcare outside of conventional institutions.
  2. Next, we would tackle payment and reimbursement. It’s clear that we would need new payment models to support the delivery of such technology-enabled care, while displacing or supplanting other forms of care and contributing to a more cost-efficient system.
  3. We’d also examine the issues posed by well-intentioned regulations from an earlier era that now stand in the way of more modern modes of delivering care. We’d look at these issues across the board – state-based health professions licensure and scope of practice; healthcare information privacy and security – and ask how we’d need to adapt these to enable the modern care delivery modalities we propose.
  4. We would think carefully about the healthcare workforce, and how to educate and train providers for a very different distributed system that spent much of its time helping people protect and preserve their health.
  5. Then we’d examine the so-called human factors pertaining to the take-up and use of technology. Plus the range of issues that arise from adapting technologies to the vast range of patients, healthcare workers and others who will use them, and accommodate their capabilities and limitations.

A true system of healthcare without walls could constitute more truly universal care that better served patients, and better united individuals, populations and their care providers in direct pursuit of better health.

Dave could stay at home on his beloved Kodiak, and yet receive the best possible care for his cancer. The scientific and medical knowledge that our nation has invested in over decades would truly be his to share.

His healthcare would transcend not only walls, but time, and distance.

Who could ask for more?

 

 

 

 

 

 

 

 

 

Watch Susan Dentzer and Sara Vaezy, chief digital strategy officer at Providence St. Joseph Health, discuss the value of bringing care to patients where they are with HIMSSTV.

The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.

Originally published March 2, 2018