Affordable Healthcare – Virtual Visits and Vital Signs

Laura Homann

Information and Communication Technologies in Organizations

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Introduction

There is a growing need for convenient and affordable healthcare in the United States.

The use of Smartphone applications and video can fill this need by offering virtual medical visits

to patients in many locations. Providers can view and communicate with patients using video

calling in place of the need for traveling to a healthcare facility. Vital signs and basic information

can be obtained using smartphone applications to acquire needed information and prescriptions

can be electronically sent to pharmacies when needed. Utilizing virtual visits for general care

will allow health care for a larger portion of the population while minimizing the risk of

spreading viral and bacterial infections.

Support/Issues

The aging American population is causing increased demands on the U.S. healthcare

system. There is a deficiency in available medical providers to complete the needed care of these

patients in a reasonable amount of time. A review of medical records for elderly patients, found

that 38% of doctor visits, including 27% of Emergency Room (E.R.) visits could have been

replaced with telemedicine (Guttman, 2017).

People living in rural areas struggle with obtaining healthcare due to significant travel

required to access healthcare. The distance is even greater if they need to gain access to specialty

services. Many cannot afford to take time away from work for the time involved in visiting a

healthcare facility (Niemeier, 2019). There is a need for healthcare organizations to increase

available facilities in these areas, but that would require additional staffing and a large budget to

create and run new facilities.

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In 2016 43.4% of uninsured rural residents reported not having a usual source of care,

which was less than the 52.6% of uninsured urban residents reporting not having a usual source

of care. The brief reports that 26.5% of uninsured, rural residents delayed receiving healthcare in

the past year due to cost (Niemeier, 2019). These deficits could be minimized by offering mobile

health visits, allowing patients to receive care without the need to travel and healthcare facilities

a means to provide that care without the added expense of maintaining more facilities.

In 2020 the global COVID-10 pandemic caused many medical facilities to minimize

outpatient services due to the risk of spreading the infection to other patients and staff. This

pandemic created an immediate need for advancements in telemedicine and has led many

medical companies to implement video and telephone visits without the proper equipment and

implementation plans.

Disruptors

The use of mobile applications requires strong guidelines for data security and accuracy.

Strict standards could delay the approval of mobile applications for healthcare usage. Lack of

reliable information and secure options may cause regulatory agencies such as CMS, HIPAA,

ONC, and HHS to determine that this type of healthcare service is not approved for patient care

(“Guide to healthcare compliance resources and agencies”, 2015).

The success of any change to medical procedures relies heavily on the support of

government regulations and insurance companies. Insurance companies may be concerned with

the level of care provided through telehealth and prefer to only cover in office visits. If this

occurs patients may find that the convenience of telemedicine visits does not outweigh the

personal cost for the care and opt for continuing with face-to-face visits or avoid obtaining

medical care when needed.

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On the other side of things healthcare organizations could determine that mobile health

does not provide consistent care or causes a negative financial impact on the facility. Mobile

visits will initially be limited on the quality of care they are able to offer which could lead to

only a small amount of services being offered using this technology. If medical facilities offer

cost effective pricing for the mobile services to patients they may find that it negatively impacts

the company’s financial income and chose to continue with higher cost face-to-face visits in

order to maintain annual financial gains.

The success of mobile visits will also rely on patient acceptance of the technology. Many

elderly patients are uncomfortable with using new technology and this could cause them to avoid

the use of virtual visits. Accessing mobile devices and applications will need to be affordable to

patients or supplied by medical facilities. If the cost is too high for patients to acquire the needed

technology many will find virtual visits to be inaccessible for usage.

Background

Historic Trends

Mobile health has been around for over 75 years. The first notable application of

telehealth services occurred in 1940, when radiology imagines were sent between two towns in

Pennsylvania using telephone lines (eVisit, 2018). A few years later the University of Nebraska

created a two-way television that was able to send information from an instructor to medical

students (eVisit, 2018). In 1990 results of multiple studies determined that there is minimal

variance in diagnosis and treatment plans offered in person or via telemedicine (Nesbit, 2012).

These studies also displayed high satisfactions rates for patients due to the minimal delay in

receiving care (Nesbitt, 2012).

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Current technology

In 2008 advancements in technology presented the first wearable device for tracking

fitness activities, including heartrate, and blood pressure (Silbert, 2019). In 2011 the Pulse

Android app was released, which was able to capture biometric information such as heart rate,

heart rhythm, respiration rate, and blood oxygen saturation (Coxworth, 2011). By 2018 this type

of application was found on almost every smartphone device allowing users to track and view

medical history, vital signs and many other pieces of health information. Figure 1.1 demonstrates

several additional trends in mobile health that have occurred in the past 75 years.

Figure 1.1
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Technology Options

There are several applications that can be used to provide telephone and video

appointments. Many of these applications can also provide patients and medical staff with real-

time medical information. A couple of these applications include AMC Health and Doxy Me.

Telephone & Video Visits

Telephone and video visits have been implemented in several healthcare organizations in

the past few months due to the need to complete care outside of the facility to minimize the

spread of COVID-19. This technology was put in place under high distress causing many

organizations to implement technology that had not been thoroughly reviewed and tested. While

this did push the availability of mobile visits forward, it is also important that these companies

take the time to review their options and make adjustments as business begins to return to

normal.

AMC Health provides an algorithm-driven platform that includes Bluetooth, AI/BI data

intelligence, and a guaranteed return on investment (AMC Health, 2020). It is also the only FDA

Class II cleared care management platform (AMC Health, 2020).

Doxy Me does not require users to download the application for usage, which simplifies

the experience for patients and allows the application to have greater accessibility for non-

technical patients. Doxy Me is also HIPAA, GDPR, PHIPA/PIPEA, and HITECH compliant

along with being free for organizational use (Dozy.me, 2020).

Data Collection

Collection of vital signs including heart rate, blood oxygen saturation, respiratory rate,

and blood pressure is an important process included in most if not all medical appointments.
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Using smartphone applications to collect this information can help make virtual visits more

reliable and fill gaps that could occur in care. Most smartphones are now equipped with high

resolution cameras, high end processors, orientation-sensors, light-sensors, and accelerometers

(Chandrasekaran, 2010). These devices can be used with applications installed on phones to

collect important medical information. Most of these applications are still in early development,

but I expect to see them develop quickly based on current and historic trends in this area along

with the increased need created through the COVID-19 pandemic.

Obstacle Resolutions

Security

Multifactor identification could add security to patient identification. Guidelines for

applications could be created and facilities could enforce the use of only specific applications by

creating interfaces between EHR and mobile applications. It will also be important that the

applications that are used for visits and data collection have encryption and adhere to HIPAA,

PIPEDA, and GDPR data privacy requirements.

Insurance and Regulations

Mobile visits will be lower cost for the facilities based on minimal staffing and limited

space needed for these visits. They should pass this cost on to patients by offering these services

at a lower cost. They will also have a higher return of investment if they are able to reach a larger

patient demographic with these services and lower costs will increase the demand for these

visits. If healthcare facilities offer lower costs for mobile visits insurance companies should

prefer these visits to in office visits due to minimizing their costs associated to patient care.

Costs
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Awareness of the benefits of preventative care has increased leading to a higher demand

for healthcare and an increased patient base. Healthcare organizations are not able to provide the

needed staff and facilities to fill the gap without significant financial impacts. Providing care

using mobile technology will allow healthcare to be available to a large volume of patients

without the need for additional facilities. This will limit facility cost for organizations and travel

costs for patients.

In the past there have been government initiatives for increased preventative care (OCR,

2017). New incentives for healthcare employees could help fill the gap between the amount of

patients needing care and the amount of providers available to provide care. Government

incentives could give healthcare organizations that needed funding to expand facilities to rural

areas. The question would be if those options are more cost effective then mobile office visits

that do not require additional facilities and staff.

Outcome Actions

Increased usage of mobile technology in healthcare to provide virtual visits and patient

data collection will provide benefits to patients as well as healthcare organizations. Mobile visits

will increase access to preventative care by allowing physicians to see patients in any location

without the need for travel. This will also allow patients access to top rated medical care that

may not have previously been available in the area that they reside. The ability to schedule and

receive care in short timeframes using mobile technology will increase the amount of patients

receiving preventative care and should lead to an overall increase in patient health.

In addition to the benefits of quick access to care devices and applications having the

ability to collect and record patient data can alert providers of possible medical concerns before

they occur and allow additional medical data to be collected in situations that may have
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otherwise been overlooked. These higher levels of preventative care will lead to an increase life

expectancy across the world.

Short-term: Present – 1 year

The government should create HITECH Act 2.0 offering incentives to facilities that offer

mobile health visits and to application developers that create mobile applications that provide

accurate and secure data to Electronic Health Records. Patients will be able to roll out of bed,

pick up their phone and instantly send important vital signs to the EHR system through biometric

applications interfacing with EHR systems.

Once the information is in the EHR system the results can be electronically compared to

baseline and past results. If any deviations are recorded an alert can be sent to the patient and

their primary care provider to set up an appointment to review results. Most appointments would

be completed within 24 hours of receiving the vital signs using cell phones to complete video

visits.

Prescriptions can be sent to pharmacies and delivered to the patient’s home within hours.

Exercise programs can be automatically downloaded on the patient’s device and customized by

healthcare staff to provide reminders and record completion of tasks. Any needed consults can

also completed via mobile video conversations.

Patients will appreciate the convenience of healthcare and may feel that they are in better

control of their health with the use of mobile applications.

Long-term: 5-10 years

Figure 2.1 shows an example of how advancements in mobile technology and

smartphone applications may be utilized over the next decade.

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Figure 2.1
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Conclusion and Summary

Why is telemedicine needed?

The continued increase of aging Americans and those living in rural areas of the country

has caused a demand for more efficient and accessible healthcare. Healthcare organizations lack

funding and staff needed to build and operate a greater number of healthcare facilities.

Advancements in mobile technology and access to cellular devices have produced new

opportunities in healthcare. Cellular devices can be used to complete video appointments with

patients and healthcare providers. This would allow patients to have care while in their homes

and decrease the need for additional healthcare facilities. These appointments can be completed

by providers in any location making it easier for healthcare organizations to provide this care

without the need to hire additional staff.

How can it be implemented?

Mobile applications can be used to collect and distribute patient vital signs, dietary, and

activity records to medical staff from a patient’s cellular phone. More advancement will be

needed in order to accurately collect vital signs, but there are some existing applications to meet

basic requirements in this area. There is a need for these applications to have enhanced data

security and tools to deliver precise data to EHR systems.

What are the benefits?

The implementation of mobile health visits can fill large gaps in healthcare and change

the level of care available to patients. If advanced, secure applications are created; patients may

be able to collect important vital signs by just picking up their phone. Those can then be

transmitted directly to their medical health records for review by healthcare staff. EHR systems
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can be developed to alert providers if there are reported changes in health information and trigger

staff to create needed appointments with patients. Appointments can be completed quickly with

the next available provider regardless of their location by using mobile health visits.

These changes in healthcare can fill gaps in patient care, making it accessible to patients

regardless of their physical location or ailments that may make traveling difficult. It can reduce

costs for healthcare organizations due to minimalizing staffing and facilities required to provide

care. Eventually the added efficiency and accessibility can lead to better preventative care and

may even increase life expectancy.

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References

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