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The Doc in the eBox

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By Carl Weiss

As healthcare grows ever more expensive and complicated, more and more people are turning to the Internet for everything from diagnosis to treatment options.  More telling still is the fact that doctors are also using the web for everything from consultation to telesurgery.  Even computer giant IBM has anted up, retooling their Jeopardy winning Watson computer into Dr. Watson the diagnostician.  For those of us who lead active lives, not to mention the mobility impaired, turning to the doc in the “eBox” can not only save time, but lives.

Is putting the e in the doc’s inbox, helping or hurting Americans?

Whether it’s to order non-prescription drugs, diagnose what ails us, or get the lowdown on practitioners, the web is rapidly becoming to go to resource for medical issues.  With malpractice in this country at an all-time high, who can blame the public for doing their homework online?  The problem for physicians is that while they have a medical degree, patients and parents do not. 

From a special report aired by TV station WVVA entitled: E-medicine, helping or hurting?

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"We have a lot of patients who have done their homework. They have concerns. They've done the research and when they come in, they have solid information and questions. Very often, the patient may be right. They may say, I'm worried my child has this, and sometimes, they're dead on," said Rainbow Pediatrics physician John Fernald.  

But sometimes, they're dead wrong. The most common mistake Fernald sees are patients who quit necessary medications after reading about a rare side effect. "Every patient is different. And for your child, the benefits may very well outweigh the risks." 

Check out the video at:

The report goes on to state that while 60% of Americans now use the Internet for self-diagnosis, 40% never follow up with a trip to the doctor’s office.  This can lead to misdiagnosis, mistreatment, complications and possibly death. 

Not What the Doctor Ordered

Even worse is the public proclivity to order pharmaceuticals online.  While taking the wrong medication is dangerous enough, the National Association of Boards of Pharmacy (NABP) reports that thousands of websites distribute illegal or even counterfeit drugs.  A press release on PRWire reported that;

NABP has reviewed over 11,000 Internet drug outlets, finding that 96.13% of the sites reviewed operate out of compliance with US pharmacy laws and practice standards, and identifying these sites as "Not Recommended." Approximately 85% of Not Recommended sites are selling prescription drugs without requiring a valid prescription. Nearly 50%, offer drugs that are either foreign, or not approved by the US Food and Drug Administration. Further, of the 10,588 Not Recommended sites, 87% can be traced to affiliate networks of rogue Internet drug outlets.

If you have ever ordered a drug online, what you need to ask yourself is whether you are absolutely certain that what you received in the mail was what you paid for.  The US along with Great Britain and China have recently cracked down on Internet “drugstores” that were selling everything from fake weight loss pills to bogus cancer drugs. A sweep by Interpol netted 156 arrests in 115 countries, which resulted in a whopping 51 million Euros worth of fake pharmaceuticals being confiscated. Interpol reported that organized criminal networks were switching from dealing in illicit drugs to manufacturing and distributing fake pharma, since the penalties are far less if they are caught and the profits are as good or better.

Return of the House Call

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That being said, legitimate medical practitioners are taking advantage of a number of niches being created by the Internet.  A number of physicians, nurses and other medical professional are embracing the Home Health movement, offering everything from in-home therapy and treatment to the return of the house call.  Many large metropolitan areas around the country have physicians that offer in-home care.  After Googling “House Calls Jacksonville, FL,” I found a handful of practitioners, including one called Little Black Bag Medical.  Their homepage offers the following:

Although it may seem anachronistic, physicians seeing sick patients in their homes is quite natural.  It was only in the past 50 years with increasing large pieces of technology and insurance pressures on physicians to see more patients that house call medicine disappeared.  Now, thanks to miniaturization of technology and increasing desire of patients to have more meaningful time and relationship with their doctors, House Calls are back

Not only is home healthcare more convenient for people who lead busy lives, the elderly and the mobility challenged, it’s a highly profitable business for those who practice it. In an April 2013 report by ABC News titled, “Boom predicted for At-Home Industry,” it was reported that,

Watch it on
The BLS's Occupational Outlook Handbook says the median yearly pay for home health and personal care aides is $20,170 ($9.70 an hour). That's less than the rate for other personal care and service workers ($20,420) and well below the median for all occupations ($33,840).  But though the pay may be low, so are the barriers to entry: a starting job requires "less than high school," says the Handbook. 

The report goes on to say that by 2020, the ranks of home healthcare workers is expected to swell by more than 1.3 million. That’s the good news. The bad news is that Medicare typically picks up none of home healthcare expenses and Medicaid only picks up some, providing that the provider is Medicaid certified. However the added out-of-pocket expense has to be taken with a grain of salt. According to ABC News, while the cost of having a part-time home healthcare worker can average $18,000 per annum, the typical cost for full-time nursing home care runs $70,000 per year or more.
That doesn’t mean that other major players aren’t itching to get into the healthcare business. The birth of the Internet of Things (IoT) is already a multibillion dollar industry with everything from medical devices to wearables that monitor vital signs. According to Dr. Safavi of Accenture,

The technology that allows us to sense the human body is being used in two ways. Part of it is for general fitness and awareness and part of it is really deeply connected to biological care.
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“For example, there is a very specific electronic device that is put on a pill and when you ingest it the digestion sets off a small wave that allows you to know the pill has been ingested. That is used to monitor patients with serious conditions to figure out if they are taking their medicine.

“Then you have the Apple Watch on the other side which a healthy person might wear to monitor sleep or activity and have no input to a doctor.”

More to the point, where much of modern medicine is concerned with treating illness, IoT devices are being used by the public to stay healthy and avoid winding up in either the doctor’s office or the hospital.  Today’s healthcare practitioners, including those who labor in hospitals are using Internet technology to remotely monitor and in some cases treat their patients.

Is There a Doctor in the Mouse?

Even more incredible is the fact that a doctor can be a dozen, hundreds or even thousands of miles away, and still be called upon to diagnose disease with new Telepresence devices such as the TouchHealthRP-71 Telepresence robot pictured below. 

Unlike typical videoconference screens, the RP-71provides physicians with mobility enough to make the rounds at a busy clinic or hospital.  Even better is the fact that patients can see, hear and interact with the doctor.  This allows physicians to work at a number of far flung locations during the same day.  Until recently, organizations like Doctors Without Borders were the only way in which many people in the Third World could receive advanced medical care.  This necessitated a number of physicians to uproot themselves to fly onto foreign and sometimes hostile shores in order to treat patients.  With advances in Telepresence and telesurgery robots it is now possible for US doctors to diagnose, treat and if necessary operate on patients around the world without having to leave town.

Dr Watson - Courtesy of
Recently, a new class of artificially intelligent computer has begun assisting doctors in diagnosing disease.  IBM’s Watson, famous for beating the world’s best human players on the game show Jeopardy, has been repurposed to serve the healthcare industry.  In a July 30 blog by CIO Today entitled, “Dr. Watson Will See You Now,” Watson is being re-tasked to assist healthcare professionals and insurance providers to better diagnose and treat chronic disease. What gives Watson a technological leg up is that unlike humans, he has the capability of sorting through and comparing millions of pieces of data in order to arrive at a clinical decision.  Also, unlike human clinicians, Watson is cloud-based, which means that he, unlike busy pathologists is available 24/7 anywhere in the world he is needed.

Of course, with every technological advantage there is a complimentary disadvantage.  Like any other computer-based system, Watson, as well as telesurgery and Telepresence robots, along with web-enabled medical devices such as patient monitors, surgical devices and defibrillators are subject to hacking.  As far back as 2013 the FDA issued warnings tomedical device makers to beef up their cybersecurity. 

Love it or hate it, the Internet has become an integral part of modern healthcare. With the costs of healthcare rising much faster than wages, technology might just be the shot in the arm that will make medical care available to one and all.  Either way, just like the mythical genie of lore, once out of the bottle it will be all but impossible to put the “eDoc” back in the box. 

In this article I have discussed how telemedicine is changing the way healthcare is being deliver in the US and around the world. New developments in remote medical monitoring, devices and software are having a positive impact helping lower medical care cost. Like all technologies, these are double edged swords, they can help to cut cost but also bringing vulnerabilities as well. Even the use of AI software like Dr. Watson is proving to be a big help. The future of Telemedicine is changing rapidly and will have long term implications that cannot be undone.

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If you found this article useful please share it with your friends, family and co-workers. If you would like to learn more about this subject, visit the notes page on this blog for the BlogTalkRadio show dated 8/4/15. I recommend checking out "New Advances in Telemedicine - Taking Your Medicine Online", "Is The Internet of Everything Really, Everything They're Cracking it Up to Be?", "Wearables 2.0 - The Rise of Trackers"  or "Something Very Small Will Soon Be Very Big – Are You Ready?".  You can also search for other related articles by typing in “medicine or telemedicine” in the search box top of this blog.

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Carl Weiss is president of Working the Web to Win, an award-winning digital marketing agency based in Jacksonville, Florida.  You can listen to Carl live every Tuesday at 4 p.m. Eastern on BlogTalkRadio.

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  1. This was an interesting look at how the internet is changing healthcare, sometimes in ways that are good and sometimes in ways that are not. I wonder how many people have been adversely affected by counterfeit drugs ordered over the internet.

  2. I can understanding doing some research, but I, for one, prefer to go in and see my Dr. when it comes to getting a formal diagnosis and treatment. I'm just not ready to trust my life, health and wellness to a PC (or its operator).

  3. The internet is such a powerful tool. I can see where the medical field could really use it to its advantage, but the consumers still need to be cautious.