The Virtual Doctor – Extending the Reach of Healthcare in the Digital Age

stethoscope and pocket full of pens

Thirteen years ago, a surgical robot named Zeus made history when a team of physicians in New York performed surgery on a patient in Strasbourg, France. The Lindbergh Operation, as it came to be called, represented a confluence of technical achievements, namely the dexterity of the digital Zeus Robotic Surgical System and a broadband transmission capability with optimized compression that limited the time delay between the doctors’ commands in New York and the resulting action in France.

Since that breakthrough in 2001, the idea of treating patients remotely has touched almost every aspect of healthcare. Neurologists can now “beam in” on stroke victims to provide instant assessments that can save lives. Patients recovering from surgery at home can have the equivalent of an electronic house call with a video link to their surgeon for follow-up appointments. And, in one of the newest applications of telemedicine, psychiatrists can create avatars to meet patients in virtual worlds where they can act out difficult scenarios.

“We are not that far away from a future in which seeing a doctor does not require being in the same room or even the same building,” says Yulun Wang, founder of InTouch Health and president of the American Telemedicine Association. “I think telemedicine will become the core methodology of healthcare delivery in the future,” he says. “It has to, because that is where we are going to get the efficiencies we need to meet rising needs created by an aging population and provide affordable care.”

One of the original imperatives for telemedicine was to bring better care to underserved and remote areas with few medical facilities or where there were long distances between patients and doctors. But even in well-served areas, there are compelling reasons to incorporate telemedicine into many practices. There are not enough specialists—neurologists, cardiologists, dermatologists and psychiatrists, to name a few—to meet rising demand. Someone suffers a stroke every 40 seconds on average in the United States, but there is not always a neurologist available in the first few crucial minutes to provide a diagnosis. Telemedicine can also reduce costs and improve outcomes. For example, home health monitoring for people with chronic conditions, such as diabetes, can mean fewer missed appointments and hospital stays, not to mention reduced travel time for patients.

These imperatives are driving unprecedented innovation and entrepreneurial energy in the field of telemedicine today. However, none of this innovation would work without a reliable network capable of carrying a detailed image from one location to another, or to control a robot miles away, or simply to access an electronic record safely and securely.

New imaging systems, for example, save lives, but they also create massive digital files. “The hospital has to have a really strong network to take advantage of this brilliant machinery,” says Tomas Yanez, director of enterprise marketing at Comcast. “Everything may work great at the main hospital facility, but at the edge of the network, at the radiologist’s office a few blocks away, it might not work very well at all if the network isn’t robust enough,” he explains. Sending video files takes even more bandwidth.

“Everyone gets excited about the performance and the glory of a new application that promises to make the patient experience better or make a hospital more competitive, but it won’t work unless there is a solid network foundation underneath to support it,” says Yanez. “The network is behind the scenes, it’s not in the lights where people are clapping. But the connection is real, and critical to the performance of any telemedicine application.”

Ethernet is a protocol that can run on both fiber and coaxial cables, and it can be expanded with a single phone call. So if a new imaging system starts producing files that are choking the circuits, an existing Ethernet service can be expanded exponentially without digging new holes or laying new fiber.

Most hospital systems need to connect multiple locations, from the main facility to outpatient clinics, physician’s offices, imaging facilities and record archives—all of which may be miles from one another. Any hospital system that relies on digital medical records needs to ensure constant access to those records, and that requires a reliable network across all locations with multiple paths and multiple redundancies.

At Inspira Health Network, which was formed in 2012 after the merger of South Jersey Healthcare and Underwood-Memorial Hospital, a Wide Area Network (WAN) connects three medical centers, two health centers and dozens of outpatient sites. Physicians at any of Inspira’s facilities can access test results, surgery notes, home health visits, diagnostics and other data as they move from one patient to the next. Instead of juggling paper files, doctors can spend more time with their patients. Patients are also benefiting from the network via a dedicated portal where they can review test results, pay their bill, schedule classes and access a library of health care information.

“The more services we run over the network, the more we can reduce the cost of those services,” says Thomas Pacek, vice president and CIO of Inspira Health Network. Inspira is “collapsing everything onto the network,” he explains, from cardiology equipment to the medical records of physicians’ offices associated with the hospital. With so much of the daily workload moving over the network, reliability is key. “The more we become electronic with our records—and everything we do related to patient care is becoming digital—the more we can’t afford to have any downtime,” says Pacek.

Security and privacy matter as well. Healthcare providers have to meet HIPAA requirements to protect patient privacy. A psychiatrist speaking with a client, for example, can’t use standard free videoconferencing applications to hold a session. Instead, they must use an application with HIPAA-compliant architecture that comes with a host of security features. Patients, for example, might enter a virtual waiting room and then be invited into a virtual exam room that can be opened only by the room’s owner.

Much of telemedicine takes place over the public Internet. “The Internet is inexpensive, it’s nearly ubiquitous, and you don’t need to program anything,” explains Yanez. Those qualities have laid the groundwork for the growing ubiquity of telemedicine. For a doctor answering an emergency call by logging on to a mobile device or paying a virtual visit to a patient in a remote location, the public Internet is the only option that makes sense.

But security is still a real concern. “What could happen when you pass medical records around over the Internet?” asks Yanez. Data is handed off from one network to another, exposing the sender to the possibility of an embarrassing security breach. That is why many hospital systems use private networks that don’t traverse the public Internet.

Thirteen years ago, a surgical robot named Zeus made history when a team of physicians in New York performed surgery on a patient in Strasbourg, France.

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