Routine telemedicine visits at the present time are usually restricted to low-intensity patients with the exception of telemedicine as it relates to "remote ICUs" (see: Remote ICUs). Here is a description of remote ICUs from this article:
Telemedicine is most commonly used in one-on-one scenarios between a physician and a patient or between two physicians. Increasingly, however, remote ICU’s are being implemented to help extend the range of intensivists, as well as allow them to monitor multiple patients in multiple facilities. By utilizing advanced medical imaging, video conferencing, and computer software technology, specialists can effectively monitor a larger group of intensive care patients, and consult with on-site nurses and physicians when hands-on care becomes necessary. Remote ICUs have resulted in a number of positive outcomes, including decreased patient mortality, shorter ICU stays, and rapid return on investment for hospitals.
Because the technology has existed for years for sophisticated remote monitoring of critical care patients, I am convinced that it is only a matter of time before it becomes cost-effective to assess vital signs and more during "routine" patient televisits. I use the word routine here to indicate that the range of ambulatory patients who can be served by telemedicine is about to greatly expand. A recent article discussed how American Well, a major vendor of telemedicine software, is incorporating remote examination tools in collaboration with TytoCare (see: American Well taps TytoCare to incorporate connected health tools into video visits). Below is an excerpt from this article:
Telemedicine provider American Well has teamed up with Israel-based medical device maker TytoCare to combine video telehealth visits with remote examinations. With the partnership, TytoCare’s examination platform will be integrated into American Well’s telehealth platform. In turn, TytoCare’s customers will have access to the network of healthcare providers who use American Well’s platform. Patients will be able to replicate an in-office visit at home by using TytoCare’s platform to examine the skin, heart, lungs, abdomen, ears, throat and skin. Then, they can share the examination with a clinician prior to or during a telemedicine visit. TytoCare, which recently received FDA clearance for its digital stethoscope, offers several FDA Class 1 devices: a connected otoscope for ear examinations, a high-resolution camera, and a thermometer that is placed on the forehead for a reading. The devices pair with smartphones to capture, store and share data via a cloud-based telehealth platform with video conferencing...."Our partnership with Tyto Care arms remote telehealth physicians with the physical examination they traditionally needed to safely diagnose, treat and follow medical conditions while the patient remains in their home,” American Well CEO Dr. Roy Schoenberg said in a statement.
There will obviously be significant patient training necessary for the TytoCare kit to be used to record heart sounds and murmurs, uploading them to the cloud, and then making them available during a telemedicine visit by a physician. Much sooner, however, will be the use of such technology using the product called TytoClinic. Increasingly, nurse practitioners (NPs) are working independently in their own practices (see: What's an NP?). I envision NPs providing independent services to a wide range of patients as part of large health systems. When they encounter patients with problems beyond their expertise, they can use such TytoClinic kits, combined with the American Well software, to consult with a physician. Such a workflow will enable health systems to serve far more patients and also triage those with the more serious problems.