Healthcare has changed dramatically over the past century. You can’t get children’s medicine with morphine in it anymore and the gap between what looked like rusty gardening tools and lifesaving medical equipment is larger than ever. Oddly though, leeches are still very, very much a thing.
One big change has been around how healthcare services are provided. At the turn of the century, doctors visited their patients at home. This was the norm. But as specialised medicine took hold, hospitals and clinics replaced house calls. Medical technology proliferated as did access to healthcare and people’s expectations to receive it. House calls were hard to scale, and large pieces of expensive and delicate equipment were not ideal for carting around. So, it’s easy to see how the modern medical establishment was born out of necessity and an oath to provide the most care for the most people.
Though this practice-centric approach has revolutionised public health, it’s coming under increased scrutiny and pressure due to a multitude of factors including changing patient expectations, aging global populations, and continuous advances in medical and personal technology, computing, and data networks. Add to these factors the increased costs of providing healthcare.) in hospital settings and it’s clear that as healthcare providers and patients big changes are on the horizon. While the days of the doctor’s in-person house call may be long gone, the idea of more personalised in-home care is not.
The concept of Distributed Healthcare, typically thought of as the networks and services required for providing decentralised healthcare like monitoring vital signs and diagnostic tests, helps move critical services closer to the patient. In turn, this reduces pressures on a healthcare system’s carrying capacity and keeps people in their own home. With Distributed Healthcare it’s about identifying patients’ needs and providing the right care at the right time.
Distributed Healthcare is a hot-topic in public health circles and since the Covid-19 induced exposure of systemic weaknesses in many health networks, planning over how to make the concept a more widely practiced reality has accelerated. Even more aspects of healthcare are now being considered for home-based implementation. In a paper published by the Mercatus Center at George Mason University, the author provides a helpful scope of what home healthcare spans by elucidating 4 service models:
(1) medical house calls or home-based primary care, (2) health agency care or peer-to-peer health service delivery, (3) telehealth or remote medicine and mobile health (mHealth), and (4) exponential technologies for healthcare.
Disrupting hospital and clinic-based care isn't without its challenges though. A recent Harvard Business Review article calls out a few big hurdles to home-based care including overcoming clinician's concerns, ensuring patient safety, and regulatory unknowns and barriers. Add to this, the fact that changing people's behaviour is very difficult (this is a fascinating read about how to do so in healthcare)! As patients, we are accustomed to the process of visiting a physical location, checking in with the staff and seeing a doctor in the flesh. How do we deal with the impersonal aspects of remote health? Who will be there to observe our pain and put a stethoscope to our chest as we inhale?
In the emerging world of tele-health and virtual medicine these actions may be superfluous but our familiarity (and comfort) with is not. Is there a suitable replacement for the human touch? While we do not fully know what the future holds, but we do know there will be a huge need for eliciting and managing patient preferences and data. This begs the question; how can Practice Management Systems bridge the gap and ensure continuity regardless of healthcare delivery method?
We'll investigate this question and wrap up the entire month's discussion next week!
