Jeff Nadler, CIO, Teladoc
Bending the trends in healthcare costs, while at the same time delivering a best in class consumer experience, are at the core of healthcare innovation. Specifically in tele-health, the industry is leveraging technology to enable the automation of the doctor visit, from appointment scheduling all the way to filling a prescription at the local pharmacy. The traditional doctor’s visit is being disrupted by a new business model that provides affordable access to quality healthcare, irrespective of time or location.
Removing the Pain Points with Innovation
Looking into other industries, we find in-use everyday technologies that have addressed pain points of everything from making travel or dining reservations, to making check deposits, to even securing and paying for taxi rides. By making manual processes frictionless and automated, overall costs to the healthcare system are lowered, value is achieved among payers and employers, and the patient experience is revolutionized for the better. Thanks to the virtual healthcare visit, seeing the doctor now gets high satisfaction scores averaging 95 percent. How? By using automation to reduce the multi-hour process of waiting to schedule an appointment, insurance eligibility verification, travel to the office and pharmacy wait times, to what can be completed in minutes.
"Being at the forefront of virtual healthcare, visits start with consumer-friendly front-end technologies like a web portal or native mobile app"
Being at the forefront of the virtual healthcare, visit starts with consumer-friendly front-end technologies like a web portal or native mobile app for the visit scheduling and request. It relies on sophisticated application layer and database technology including a high-performance routing engine that matches and filters requests based on geography, to ensure compliance with state regulations, age, gender, and request type (General Medical, Dermatology, Behavioral Health, Sexual Health, or Tobacco Cessation). Here’s a look at three of the technologies critical to this virtual visit revolution.
Matching Providers to Patients
The right physician-patient match is paramount, both from the perspective of state medical licensing requirements and condition-specific appropriateness and patient preference. The ability to automatically route visit requests to the correct pool of providers is a complex function that must scale and be lightning fast to deliver that match within seconds. There are many dimensions to these real-time visit requests, starting with the routing engine which should be a very light-weight standalone service, with a self-contained data store that monitors all eligible providers and their state. Are they licensed in that state? Currently online and available? Already – or about to be – conducting a visit with another patient? The engine processes requests concurrently leveraging Erlang/Elixir technology and maintains a unique standalone service for each provider and for each visit request based on the provider’s state and the filter rules above.
The physician queues should be updated concurrently when new visits are requested, visits are completed, or providers indicate that they are no longer available, with updates occurring in less than one millisecond using a low latency publish and subscribe paradigm.
As the number of virtual visits continues to explode, the system scales easily without dependencies on traditional external data stores.
And, of course, it must be designed to be self-healing during network splits or other subsystem outages without needing intervention. Automatic recovery from a catastrophic failure that requires a complete rebuilding of all queues can be done in less than one second.
No one enjoys waiting around in a pharmacy for their prescription. Through online search and selection tools integrating Google Maps technology, virtual care users can select their preferred pharmacy, leveraging a mobile device’s location functionality, and select the option to have one or more default pharmacies stored with their profile.
On the provider side, if a prescription is clinically appropriate, everything from selecting the medication, to prescribing the right dosage, to interaction checks to assure no contraindications or allergies, is automated for accuracy and efficiency.
Leveraging an electronic messaging interface with the SureScripts pharmacy-network eliminates patient wait time at the pharmacy. Working with 95 percent of retail pharmacies in the United States, SureScripts electronically sends the medication details, the patient’s name, address and phone number, and the provider’s information in real time to the selected pharmacy for fulfillment.
The Visual Element
Inherent to virtual care is connecting video and photo streams, and thanks to technology, the virtual visit is a highly connected, highly secure visit. For live video chatting, an encrypted and HIPAA compliant peer-to-peer video/audio stream should be used to connect both parties and ideally support more than two participants. In addition to the patient and the physician, support for adding a specialist or family member to the video chat is needed. A technology that accommodates for higher quality video as bandwidth increases is ideal for an optimal viewing experience. It should also be WebRTC compliant, meaning that embedded video chatting is supported in WebRTC compatible browsers with no plug-in needed. Currently, Google Chrome and Mozilla Firefox are WebRTC compatible with support from other browsers coming soon.
Looking to the future
Yes, much of the futuristic electronic doctor’s office visit is already here! But innovation means more exciting things on the way as healthcare continues to borrow from other industries. Integrating Amazon Alexa and Google Home will enable patients to request a visit simply by talking to the Alexa or Home device. And new multifunction biometric devices, like those that can capture and send data for blood pressure, heart rate and sounds, blood glucose levels, weight, and blood oxygen levels, will soon enable a broader range of ailments to be diagnosed and treated remotely. Virtual healthcare automation 2.0 is the future.