Telehealth/Telemedicine: Disrupting Our Healthcare System

  • Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. For those living in rural communities, the nearest clinic or hospital may be as much at 100 miles away. Today, lack of transport, a lack of mobility, limited funding, or a lack of staff, restrict access to care. Clearly, telehealth may bridge the gap. (Wikipedia)

Disrupting Current Healthcare to Create a Better Future

This slide lists just a few of the issues confronting US healthcare.

Susan and I have been attending different healthcare conferences for many years.  This past week’s Telehealth Secrets conference was completely different.  

In the many years of attending conferences, the usual attendees: nurses, physicians, therapists, pastoral care ministers, administrators, etc., have all approached healthcare challenges from “within the system.”  Similarly, research continues looking at the same conditions, mainly pharmaceutical solutions, immunological procedures, and other innovations.

This conference offered insights into what is possible if data is collected on millions of people so that, using Artificial Intelligence (AI), we can gain insight and information that will lead to more accurate and earlier diagnoses, treatments, and better health outcomes.

Telehealth Secrets was attended by brilliant entrepreneurs, engineers, and clinicians, who are thinking out of the box, creating possibilities for disrupting our current dysfunctional healthcare systems.  They are creating the impetus toward an emerging grass-roots alternative to our current expensive, chaotic, siloed, uncoordinated healthcare system. But, all of this is not about insurance, premiums, or anything related to the economic model. Rather this is about evidence-based medicine facilitated by new technologies and economic models.

This slide set the tone for the conference early on.

Telehealth/Telemedicine is a healthcare delivery technology enabled by the internet.  Internet access is absolutely necessary for the delivery of Telehealth.  All of these healthcare delivery components lend themselves to automated computer processing and data storage operating from the Cloud. 

Examples of broad technology fields giving rise to disruptive technologies include:  genetic engineering, robotics, remote (internet) healthcare delivery, cloud processing and storage, and Artificial Intelligence (AI).  Each of these new technological fields deserves a more detailed analysis than I will be able to give in this essay.  My goal is simply to introduce the subjects.

This slide illustrates the model for distant healthcare delivery. In-person exams would only be necessary for the most acute cases.

This statement struck me:  Up to the present, healthcare has been led by clinicians supported by data.  In the future, healthcare will be led by data supported by clinicians.  Consider AI, Artificial Intelligence.  A computer running an AI algorithm can analyze X-rays and CT scans much faster and more accurately than a human clinician.  No physician can keep up with all the newest research and pharmaceutical products.  It was stated that new medical advances supported by research and publication double the body of knowledge every two months.  No human can keep up with this proliferation of new data.  However, a computer can hold all historical data, ingest  the newest data, and deliver diagnoses faster, cheaper, and more accurately than any human or group of humans.

Stressed and overworked healthcare providers create this shocking statistic in which the US compares very poorly in medically-caused deaths compared with other advanced countries.

The more data that can be collected and compiled, the better the AI processing.  Data analysis is practically instantaneous, compared with human/manual processing.  For example, a computer can process one hundred chest x-rays, whereas a physician specialist typically might take twenty minutes to examine and analyze a single patient x-ray.

Here is another amazing example of the revolutionary potential of AI, which I learned in conversation with a brilliant Chinese-American entrepreneur, founder of the company Carewell (  Using an AI-enabled cloud computer network created by Carewell, China has recorded the ECG/EKG-generated heart waveforms of forty-seven million (!) Chinese citizens.  Compiling and analyzing patterns emerging from the forty-seven million cardiac waves, this AI algorithm, housed in the cloud, can instantaneously analyze, compare, and predict with great accuracy, future potential heart problems, such as an impending heart attack.  This is because the computer can analyze and compare very subtle waveform anomalies that are invisible to the naked eye of the human analyst. The AI analysis of the huge databank of waveforms reveals minute variations that are identified through gross data analysis of millions of samples, which reveal advance markers of future cardiac problems.

The founder of Carewell is in a very interesting position.  He says that financing the compilation of data using his AI algorithm in China cost $150 million, but would have cost two billion dollars in the US.  (In the US, there is an additional issue of resistance among Americans to freely share their medical data, a resistance that in absent in China.) 

He says that he could easily sell the algorithm developed by his company for perhaps a third of the two billion dollars it would have cost to replicate the study in the US=$750,000,000.  Potential buyers include major corporations, such as Johnson & Johnson, Phizer, Genentech, Apple, Google, etc.  But he fears that any American corporate buyer would withhold and monetize the algorithm to maximize profit for themselves, while making it unaffordable, and thus unavailable for the masses, especially uninsured patients.  This AI-enabled cardiac test is widely available in China.  Carewell is in charge of international marketing, outside China, and is currently negotiating terms with countries in Europe and Africa. 

Carewell would like to control its rollout of this AI technology in the US, to avoid it being controlled and restricted by any of the US mega-corporations who would love to own it.  The founder could make himself rich for life by selling his AI algorithm to one of these American mega-corporations.  He figures that use of his algorithm could save thousands of American lives, if used freely and appropriately.  But he doesn’t trust any of the major healthcare corporations to do so.  Thus he is delaying its release in the US, pending creation of an acceptable universal distribution system.  He opposes the usual profit-driven pharma/medical device sales model which results in Americans paying twice as much for their healthcare as the rest of the developed world, while receiving poorer results despite the high cost.

Genetic analysis will tailor medications to the personal genetics of each patient instead of the current generic practice in which groups of diverse patients receive identical medications.

Another example of AI disruption of traditional medical labs is in analyzing MRI charts.  The more MRI charts that can be stored in the Cloud subject to AI analysis, the more refined and accurate the results will be.  It was suggested that in the Telehealth-future, everyone should have a full-body MRI scan to record a baseline for future scans,  when AI-powered analysis could identify changes early on, before they can develop into more acute conditions. 

Another disruptive technology impacts the field of advanced genetic analysis.  This technology enables the identification of genetic markers that announce future diseases that may not appear until later in life.  Technology is also emerging in the form of gene therapy, the modification of genes found to be present in infants, in which gene therapy, gene splicing, or gene replacement, might forestall the appearance of these otherwise genetically inherited future diseases or conditions.  Gene therapy is disruptive because by avoiding the onset of otherwise unavoidable diseases, there will be significant reductions in the number of patients needing expensive care later in life. 

One of the keynote speakers who promoted disruption spoke out very strongly against the pharmaceutical industry.  He pointed out that the industry loves medications that patients must take all their lives, as opposed to developing drugs that actually cure the conditions, which would obviate the need for those profitable lifelong drugs, such as statins, insulin, anti-depressants, etc.  Genetic engineering would remove the need for the lifelong ingestion of many of these drugs that currently earn billions of dollars for the drug companies.

Uberdoc, a disruptive app for healthcare, comparable to Uber’s disruption of the taxi industry

Another area of Telehealth cutting-edge product development is in the field of remote data monitors.  Instead of taping or sticking monitoring sensors to the body (for example ECG’s), new sensors do not need to be in direct contact with the body.  One Canadian entrepreneur showed his cloth shirt with sewed-in sensors, that stream on-going live physical data, such as heart rate, temperature, respiration, oxygenation, etc.  These monitoring garments are currently being worn by astronauts on the International Space Station. Can they be washed?  Yes, just like any delicate piece of clothing.  Different colors?  Any color, as long as it is black. 

There are many advantages of a Telehealth-enabled healthcare system, as opposed to our current system.  Patients won’t have to make appointments weeks or months in advance.  They won’t have to drive miles to appointments, to wait for hours in an uncomfortable waiting area, to be called in for a rushed examination with an over-worked physician.  Reducing the overall number of in-office patients will allow doctors to spend more time with the patients who cannot be examined remotely.  AI cloud analysis of x-rays, scans, pharmaceutical interactions, etc., will be instantaneous and almost free, certainly at a very low cost.  All the heavy analysis of the data is done by the AI cloud network, a globally-accessible health resource.

This fourth annual Telehealth Secrets conference held in the San Francisco Bay Area was organized by a Singapore-based company, VSee (  Susan was contacted by VSee to speak, joining a stellar roster of tech and business leaders. Vsee found Susan and HHS on the web.  Susan delivered a ten-minute talk as part of a three day TED-talk-style conference.  Because it was possible for us to drive from Reno with the harp and sound system, Susan offered for us to play music for the conference.  To ease their concerns about the logistics, we set up a video call with the AV director from Belarus.  (He flew to California for the conference two weeks later.)  We was thrilled and immediately said we HAD to perform!! So we drove down to conference not knowing exactly what to expect.

Susan spoke about pain management and virtual reality.

The Telehealth Secrets conference turned out to be beyond our expectations. We found ourselves in the company of an outstanding assembly of successful engineers, entrepreneurs, investment fund managers, and Telehealth startup-companies seeking investment funding.  This conference provided a forum that showcased the pioneers of Telehealth, who are creating a number of disruptive technologies that will drastically change our current healthcare system.  This included Stanford University, UCSF, and other large healthcare organizations who are doing immediate research into how to integrate these new technologies into practice. Thus, this was one of the most engaging, interesting, and informative conferences that I’ve ever attended. 

Hi, I'm Dallas Smith

My blogs offer the vicarious pleasure for my readers to learn of my travels and musical adventures.
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