Father of telemedicine: Take the exam room to patients

By Neil Versel

An example of remote doctor visits: meVisit's app

Telehealth holds enormous potential for transforming healthcare, but, to telemedicine pioneer Dr. Jay Sanders, the primary barrier is not financial. Instead, physician and patient attitudes about healthcare and health itself must change, said Sanders, who often has been called the father of telemedicine.

"The critical issue is really not telemedicine," Sanders said in an interview with MobiHealthNews, noting that the term can include telehealth, mobile health, digital health and other forms of e-health. "What's important is the needs of the healthcare delivery system."

Sanders defined telemedicine as the "transfer of medical data from where it exists to where it needs to be." Telemedicine and telehealth can allow physicians to make medical decisions based on real-world conditions over long periods of time, not just from snapshots of a single moment in the sterile environment of a doctor's office, according to Sanders. His long CV includes the current titles of president and CEO of The Global Telemedicine Group in McLean, Va., chair of the technology board at Vesalius Ventures, a founding board member of the American Telemedicine Association and an adjunct professor at Johns Hopkins School of Medicine.

"We need to bring the exam room to where the patients are," Sanders said. Taking blood pressure in a doctor's office doesn't replicate the stress people might face in their everyday lives. The same goes with trying to measuring lung function in a clinical setting. "They're not breathing the air in our office all day," Sanders explained. "This is an issue of good medical care."

Readings taken during office visits tend to be viewed in isolation, too. "Nobody has the slightest idea when a patient gets sick," noted Sanders. This is where he believes remote patient monitoring hold so much promise.

According to the Mayo Clinic, a person has diabetes when fasting blood sugar tops 125 milligrams per deciliter. By this definition, as long as the level remains below 125, the patient does not have diabetes and thus does not need to be treated like someone with the disease. But seeing a single lab value does not indicate an upward trend that could indicate high risk of developing diabetes, according to Sanders.

Similarly, Sanders said his wife has been hypertensive for five years, but her physician said she is normal based on blood pressure tests in the office. "It's been going up for years but still in the 'normal' range," Sanders said. "Look at trends, not absolutes," he advised.

Remote monitoring devices allows healthcare professionals to take continuous readings and, when paired with the proper software, including an electronic health record, map out trends.

"I am excited about wearable monitors," said Sanders, who is an advisor to Zephyr Technology, maker of the BioHarness and other wireless monitoring devices. "The technology and the computer analytics will be built into our smartphones," Sanders predicted.

People already wear continuous monitors of time, otherwise known as wristwatches, Sanders noted, so it should not be much of a step to get them to put on something to monitor health.

"Would you ever buy a car without a dashboard?" he wondered. "Why not a health dashboard in cars?" Sanders responded, knowing that it is already happening on a small scale.

"Forget the ridiculous annual physical exam," he said.