In July 2017

The doctor is shaped like an old-fashioned oatmeal box and sits on a tabletop. “Alexa, check my blood pressure,” the patient says, and she — or it — does so on the spot. A nurse at a clinic across town assures the recent heart-surgery patient that all’s well.

In a different case, at Greensboro’s Moses H. Cone Memorial Hospital, flagship of Cone Health, the drama is more intense. A farmer with a possible stroke has been rushed to the network’s smaller Annie Penn Hospital 25 miles away in Reidsville, and a young physician assistant is uncertain how to proceed. The wrong diagnosis could prove lethal. Annie Penn links the farmer to more experienced stroke specialists in Cone Memorial’s intensive-care unit.

One consumer-based, the other institutional, they’re ends of the virtual-medicine spectrum in which patients access remote care from their doctors, nurses, pharmacists and hospitals. The technology is helping transform North Carolina’s nearly $70 billion annual health care economy.

For less than $130, a patient can obtain Lenovo Group Ltd.’s recently introduced Smart Assistant, which uses Amazon’s Alexa voice-recognition platform. “The home itself,” says Tom Foley, Lenovo’s director of global health strategy, “is what we now call a setting of care.” The Hong Kong-based technology company, which has a headquarters in Morrisville, acquired IBM’s personal-computer business 12 years ago. Lenovo says the device is part of a home-automation market loosely called the Internet of Things that will top $1.7 trillion by 2020.

Cone, which became the first hospital in the state to establish a virtual intensive-care unit a decade ago, represents the spectrum’s other extreme. Its e-visit MyChart system and other technologies enable patients to access records and providers with smart and regular phones, tablet computers and other devices. A query to a physician, for example, might be answered in 30 minutes.

John Jenkins is a primary-care physician and the senior vice president who heads Cone’s connected-care division. “Say a patient is in one of our emergency departments and there’s not an ICU bed available at that hospital,” he says. “They can roll the ICU cart into the emergency-room space and set up a tele-ICU right there.”

Despite the temptation to view devices such as Lenovo’s as entertainment, insurers, health care executives and others in the business of medicine say they have an increasingly serious role in a concept called bedless hospitals. “There’s a whole movement toward moving care into the home, with visiting nurse services and others coming in and treating patients versus having to go to a brick-and-mortar facility,” Foley says. “The patient can set up the home with different medical devices such as blood-pressure cuffs, glucose monitoring and scales that interact with devices like Alexa that can actually communicate that information to a physician.”

Such devices can be structured to perform other tasks. They’re particularly useful in keeping tabs on post-surgery patients, the elderly and those with chronic conditions such as diabetes or continuing radiation or chemotherapy treatments for cancer. Cone’s chemo program allows the hospital to release patients sooner, reducing costs and the need for beds, Jenkins says.

There are limitations because many consumer-based devices merely access curated internet information such as WebMD. “Even IBM’s [Jeopardy-winning technology] Watson is basically answering your questions,” Jenkins says. “Sometimes, even when you interact with a physician, you don’t know the questions to ask. The questions the physician asks you help lead to a diagnosis.”

Security questions also loom. Though hospitals fully encrypt telehealth, patient-based systems may be no more secure than the patient’s basic internet service, potentially exposing sensitive medical records. Health care providers also have struggled since the dawn of electronic medical records to maintain bonds with patients, and virtual medicine could be a step in a less personal, hands-off direction. Cone, for example, coaches doctors to look up from their laptop computers during exams to maintain eye contact. “Of course,” Jenkins says, “we had doctors in the old chart days who never looked up from their charts.”

Virtual medicine is an increasingly large part of Charlotte-based Carolinas HealthCare System’s $890 million capital budget. “The competitive landscape’s changing rapidly,” says CEO Gene Woods. “We’re no longer competing just with other health care systems but a host of different retail competitors, so connectivity and convenience are differentiators at the top of my goal list, especially when it comes to the millennial generation.”

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