Does Remote Health Monitoring Mean the End of the Exam Room?

Technology is an ever increasing presence in our everyday lives, and with the ever increasing costs of providing healthcare to an aging and newly-insured population, innovators and entrepreneurs see the potential in the healthcare industry to have a transformative influence. But what does new technology mean for the spaces we design for healthcare? This series looks at specific emerging technologies in the healthcare market and how they might impact the spaces that we design.

Outpatient spaces and in-home health monitoring
Three major factors are influencing healthcare systems to increase their capacity for outpatient care spaces: the migration of traditionally inpatient services (diagnostic treatments such as MRIs, and procedures that can now be accomplished less invasively, like many cardiac procedures) to outpatient settings and anticipated increases in patient visits by a newly-insured population under the Affordable Care Act, as well as increasing demands by an aging boomer generation that will naturally consume more healthcare services than previous, smaller generations.

Two major factors are influencing healthcare systems to increase their capacity for outpatient care spaces: the migration of services to outpatient settings that were previously only possible to provide in an inpatient environment, including both diagnostic treatments such as MRIs, and procedures that can now be accomplished less invasively, like many cardiac procedures; and anticipated increases in patient visits by a newly-insured population under the Affordable Care Act, as well as increasing demands by an aging boomer generation that will naturally consume more healthcare services than previous, smaller generations. At the same time that the Affordable Care Act is providing millions of new patients for outpatient care centers, healthcare providers are feeling pressure to reduce costs. The pressure of cost reduction is compounded by an aging population who will require care to match their longer expected life spans. Surely the result of these two factors is that healthcare systems will need to continue their building spree of outpatient care centers to meet rising care needs. But if we, as healthcare designers, and the healthcare providers who are our clients, are to consider innovative solutions that meet both the needs of a growing patient constituency while addressing concerns about rising healthcare costs, we should look to the emerging technologies that may change the way that healthcare is delivered and change the way we think about designing healthcare spaces.

In-home medical monitoring devices that connect remotely to healthcare providers for remote diagnosis and tele-medicine are a growing trend responding to these demands. These types of devices range from an advanced thermometer that measures multiple vital signs that can be logged regularly over time to establish individual trends [Scanadu Scout], to an advanced in-home urine test kit that can share results with your doctor [Scanadu Scanaflo], as far as microchips to monitor vital signs embedded in flexible adhesives that you wear as a temporary tattoo that might one day be able to delivery medicine in addition to monitor symptoms [MC10]. The key to all of these devices are two-fold: they can monitor vitals and symptoms at regular intervals over a period of time, and the data can be shared with a physician remotely who can analyze the data and provide a diagnosis without the patient leaving home. The first of these benefits is one that may become more popular as our society becomes increasingly receptive to wearable devices that monitor various health data [Beyond Fun: The Vital Future of Wearables] (how many people do you know who regularly wear a Fitbit or Jawbone? We’ve even had a fitness competition in our office using wearables). But it is the second benefit of connecting remotely to a healthcare provider and supplying data about a patient that will have the greatest impact on how we think about outpatient spaces.

These types of devices can respond to cost reduction demands by reducing the number of doctors’ office visits, while reaching patient populations who live in areas that may not have easy access to healthcare providers, or for whom travel to the doctors’ office may be a challenge. But what do they mean for how we think about the design of outpatient buildings meant to serve these populations?

It is unlikely that outpatient and ambulatory care centers will completely disappear as a healthcare building type. Many of the services that were once considered the sole purview of inpatient hospitals are shifting to outpatient centers, and technology allows a greater number of procedures and surgeries to be performed non-invasively. It is unlikely that healthcare systems and hospitals that are investing in outpatient spaces will suddenly decide to convert all of their outpatient buildings to call centers staffed by physicians giving advice solely over remote tele- and vid-medicine services. However, it is worth considering how we might design outpatient buildings to take advantage of those spaces and services that must be provided in brick-and-mortar facilities, like imaging and procedure spaces, versus spaces that may require greater flexibility in the future as models of care delivery provide more options for reaching patients.

In the design of research laboratory buildings, we are seeing a shift toward high-technology core facilities that actually provide greater flexibility to the majority of lab spaces [The Core of Flexibility and Core Facilities Respond to Changing Scientific Research Needs]. By focusing resources, equipment and infrastructure into these core facilities where they are needed the most, the remainder of the laboratory spaces can be designed more generically, ultimately giving more flexibility to the laboratory institutions to change the generic spaces more quickly. Could we think about outpatient care buildings in a similar way? Building cores of high-technology imaging, diagnostics and procedure spaces separately from more generic examination and consultation spaces would allow greater flexibility in how those lower tech spaces are changed in the future.

Of course introducing in-home monitoring devices and telemedicine services are not going to eliminate the need for exam rooms in outpatient clinics and ambulatory care centers tomorrow. The reduction of demand on generic exam space, however, is a result of this technology that is highly attractive for healthcare providers interested in reducing costs. Waiting times in waiting rooms and exam rooms for general care visits are often cited as the greatest source of dissatisfaction among patients. Shifting some of the care that is usually carried out in exam rooms into patients’ homes through remote monitoring and telemedicine could significantly reduce the number of visits that patients need to make to outpatient care environments. With reduced demand on generic exam rooms resulting from this shift in care setting, healthcare providers and healthcare designers could creatively rethink what is the highest and best use of an exam room. Exam spaces that are now needed for consultation and routine care could be transformed into much more specialized spaces for care. Healthcare designers could think about designing exam spaces today in a way that would allow them to be converted easily into hybrid exam/procedure spaces that would more actively meet the needs of patient visits that could not be addressed remotely.

Will higher-technology core spaces for procedures and imaging surrounded by more generic exam spaces provide more flexible outpatient facilities for changing future use? Can we reduce the number of exam rooms and the size of waiting rooms if patient visits are reduced and put that square footage to a higher and better use? Are we designing doctors’ offices that are video-conference capable? Is there a new type of healthcare provider who we need to consider when providing work space – a nurse practitioner or physician’s assistant who is solely focused on providing support for remote medicine services? As individual health data monitoring and collection becomes more commonplace, and regulations are developed for ensuring the security of that data, will we see clinical and translational research become an even more dominant component of ambulatory care?

Some of these questions are better answered by the healthcare systems, but healthcare designers have the ability to impact how adaptable outpatient care buildings can be to shifting models of care. Approaches that we take now to designing adaptable outpatient care buildings will ensure that the investment made in brick-and-mortar facilities meet the needs of expanding care models.

Remote health monitoring and telemedicine is only one emerging technology that is impacting how we think about designing healthcare spaces. Wireless biotelemetry, mobile imaging and diagnostics, real time locating systems, and software that connects electronic health records and data with all of these devices safely and securely, are just some of the advances in technology that we will explore through the lens of how they could transform our approaches to the design of healthcare environments.

Related:
Cultural Shifts Transforming Healthcare Design: An Introduction