The document discusses how technology and consumer demand are driving changes in healthcare delivery away from traditional in-person settings. It describes how electronic communication, remote monitoring, telemedicine, and patient portals allow for virtual care that is more convenient and efficient. This virtualization of care helps address issues like chronic disease management, provider shortages in rural areas, and rising costs. The presentation concludes that good patient care requires collaboration between providers and patients, and that technologies must be optimized to facilitate remote collaboration and scale the healthcare system to meet growing needs.

1. 3/21/14
1
ì
Would
You
Like
An
Office
With
That
Visit?:
Changing
Our
Thinking
About
Health
Care
Delivery
Daniel
Z.
Sands,
MD,
MPH
@DrDannySands
Society
for
Par=cipatory
Medicine
Beth
Israel
Deaconess
Medical
Center
Harvard
Medical
School
Boston,
MA
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
Commercial
Disclosures
ì Best
Doctors,
Inc.
–
consultant
ì Kinergy
Health,
Inc.
–
consultant
ì SeniorLink,
Inc.
–
consultant
ì PostWire,
Inc.
–
consultant
(2013)
I
will
not
be
discussing
products
or
services
of
any
of
these
companies
in
my
presenta8on.
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands

2. 3/21/14
2
Source:
ReachMail.net
and
DZ
Sands
▶ 1969:
Internet
born as
ARPAnet
at UCLA.
◀ 1998:
First
guide-lines
for
e-mail w/
patients
(AMIA)
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
History
Lesson
Boston’s Beth
Israel
introduces
e-mail
1991:
Danny
e-­‐mailing
pa=ents
Dr.
Sands
not
seeing
patients
“Sorry,
Dr.
Sands
no
longer
sees
people.
He
e-­‐mails
them.”
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands

3. 3/21/14
3
What
Have
We
Learned
About
e-­‐Messaging?
ì Includes
encrypted
e-­‐mail
or,
more
commonly,
secure
web
messaging
ì Enables
efficient
communica=on
because
it
is
asynchronous
ì Is
cost-­‐effec=ve
and
benefits
both
pa=ents
and
physicians
ì Enhances
rela=onships
ì Is
a
channel
for
care-­‐at-­‐a-­‐distance
Sources: Kane B, Sands DZ, JAMIA 1998. Delbanco T, Sands DZ, NEJM 2004.
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
The
Consumerization
of
Health
and
the
Virtualization
of
Care
Diagnose
and Treat
Prevent
Anywhere
Virtual
Resources
Home
©
Copyright
2014
D.
Z.
Sands,
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Rights
Reserved
-­‐
@DrDannySands
and
Maintain
Physical
Resources
Drivers:
• Burden
of
chronic
illness
• Ageing
popula=on
• Resource
maldistribu=on
• Cost-­‐containment
• Consumer
demand
Treatment Health
Hospital
Built
on
ideas
from
Michael
Gill
$$$$$
$

4. 3/21/14
4
Care
Delivery
Costly
in
Traditional
Settings
©
Copyright
2014
D.
Z.
Sands,
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-­‐
@DrDannySands
Yet
There
is
Relentless
Demand
for
Services
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Copyright
2014
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Z.
Sands,
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-­‐
@DrDannySands

5. 3/21/14
5
And
Our
Systems
Are
Optimized
for
©
Copyright
2014
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Z.
Sands,
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Rights
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-­‐
@DrDannySands
Managing
Acute
Care
So
We
Must
Focus
More
on
Chronic
Disease
Prevention
and
Treatment
©
Copyright
2014
D.
Z.
Sands,
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Rights
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-­‐
@DrDannySands

6. 3/21/14
6
Also
Have
Maldistribution
of
Resources
~40%
Fewer
Clinicians
Outside
Major
Ci=es
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
Therefore,
We
Must
Adopt
New
Care
Models
More
care
op=ons
for
pa=ents
§ Bring
care
to
pa=ent
rather
than
pa=ent
to
care
§ Care
and
services
when
and
where
is
needed
§ Pervasive
care
availability:
formal
to
informal
secngs
à
beder
service,
sa=sfac=on,
outcomes,
value
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands

7. 3/21/14
7
…
Eventually
Providing
Care
Anywhere
©
Copyright
2014
D.
Z.
Sands,
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Rights
Reserved
-­‐
@DrDannySands
Online
Population
Rising…
©
Copyright
2014
D.
Z.
Sands,
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Rights
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-­‐
@DrDannySands

8. 3/21/14
8
…And
Health
Info
Seeking
Popular
©
Copyright
2014
D.
Z.
Sands,
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Rights
Reserved
-­‐
@DrDannySands
Online
Health
Habits
of
US
Adults
Sources:
www.pewinternet.org;
PwC
HRI
Social
Media
Consumer
Survey,
2012
ì 80%
of
online
adults
have
looked
for
health
info
ì Rising
over
=me
ì Each
day,
more
people
search
for
health
informa=on
than
see
a
physician!
ì More
than
half
act
on
the
informa=on
ì 1/3
have
read
about
others’
health
experiences
ì 1/4
have
tracked
their
health
informa=on
online
ì 1/3
use
social
media
for
health
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands

9. 3/21/14
9
Patient-­‐Generated
Health
Information
©
Copyright
2014
D.
Z.
Sands,
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Rights
Reserved
-­‐
@DrDannySands
Many
Patients
Want
To
Be
Engaged
Communica=on
Involvement
in
Care
Informa=on
Convenience
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands

10. 3/21/14
10
Bringing
It
All
Together:
Patient
Portals
hBps://www.paEentsite.org
©
Copyright
2014
D.
Z.
Sands,
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Rights
Reserved
-­‐
@DrDannySands
Services:
§ Prescrip=on
refills
§ Appointment
requests
§ Referrals
§ View
bill
EducaEon:
§ Search
§ Info
prescrip=ons
§ Pa=ent
selected
links
§ Predefined
collec=ons
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
Mail:
§ Secure
§ Automated
rou=ng
§ Task
assignment
Records:
§ Secure
§ All
system
records
§ Upcoming
appointments
§ Meds,
Problems,
Results
…
and
Notes
§ Personal
records

11. 3/21/14
11
Feedback
from
Dave,
a
56
yo
M
consultant
This is too cool. It's almost SILLY
that things can be this easy. I am
having a very good patient/customer
experience so far. (Seriously.)
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
Ideally,
What
Is
Patient
Care?
©
Copyright
2014
D.
Z.
Sands,
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Rights
Reserved
-­‐
@DrDannySands

12. 3/21/14
12
Health
Care
Is
a
Collaboration
…
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
…
But
Collaboration
≠
In
Person
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands

13. 3/21/14
13
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
Many
Tools
Can
Be
Used
for
Collaboration,
From
Simple…
©
Copyright
2014
D.
Z.
Sands,
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Rights
Reserved
-­‐
@DrDannySands

14. 3/21/14
14
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
…
To
Sophisticated
Source:
Philips,
American
Well,
Cisco,
InTouch
E-­‐messaging
Is
Just
the
Start
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands

15. 3/21/14
15
Attributes
of
Collaboration
Channels
Technology
Synchronous?
InformaEon
Density
Telephone
þ
««
E-­‐messaging
o
«
Text
messaging/IM
o/
þ
«
Remote
monitoring
þ
«
Telemedicine
þ
(usually)
«««
Advanced
Telemedicine
þ
««««
Office
visit
þ
«««««
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
Attributes
of
Personnel
PaEent
Self-­‐care
Counselor/
Educator
Clinical
Nurse
NP/PA
Physician
§ Different
personnel
can
provide
care
§ Each
has
adributes
§ Each
should
prac=ce
at
“top
of
his/her
license”
§ Can
add
others
to
this
list,
even
perhaps,
Watson…
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands

16. 3/21/14
16
Optimizing
Channel
and
Personnel
PaEent
Self-­‐care
Counselor/
Educator
Clinical
Nurse
NP/PA
Physician
Telephone
E-­‐messaging
Text
messaging/IM
Remote
monitoring
Telemedicine
Advanced
Telemedicine
Face-­‐to-­‐face
visit
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
Because
of
the
Web,
Patients
Can
Connect
to
Information
and
Each
Other
(and
to
Health
Care)
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands

17. 3/21/14
17
We
Have
The
Tools
We
Need
Self-­‐Care,
Transparency,
and
Pa=ent-­‐Provider
Collabora=on
Can
Save
Healthcare
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
Conclusions
ì Good
pa=ent
care
is
a
collabora=on
ì Technology
can
facilitate
remote
collabora=on
ì The
drive
to
offer
telehealth
services
comes
from:
ì Need
to
manage
chronic
disease
effec=vely
ì The
over-­‐extended
health
care
system
ì Pa=ent
demand
for
convenience
ì We
must
op=mize
technologies
and
personnel
for
each
encounter
to
both
meet
our
customer’s
needs
and
to
scale
our
health
care
systems
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands

18. 3/21/14
18
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
Questions
and
e-­‐mail
address
Questions?
Danny@DrDannySands.com
hBp://www.DrDannySands.com
©
Copyright
2014
D.
Z.
Sands,
All
Rights
Reserved
-­‐
@DrDannySands
@DrDannySands