The Access Revolution Comes to Healthcare

By Delos M. Cosgrove, MD

Healthcare wants to be free, not locked in a hospital or a doctor’s office. Today, health services can be accessed through a laptop, mobile phone or tablet. Vaccinations are available at neighborhood pharmacies. Stroke treatment takes place miles away from the emergency room.

Healthcare is getting faster, better and more affordable — and access is the key.

At the most basic level, the Internet is making it easier to make appointments with your doctor or other caregivers. Millions of Cleveland Clinic patients have requested appointments online. Offline appointments are also getting easier. Anyone who calls us before noon can get a same-day appointment. The call center uses a sophisticated computer program to route your request to an appropriate caregiver somewhere in our system and makes sure you get seen that very day.

Mobile treatment in a crisis

Even the treatment of life-threatening diseases like stroke is having an access revolution. At Cleveland Clinic, we’ve got a couple of very special vehicles parked outside our Emergency Department down the street from my office. From the outside, they look like shiny new ambulances. But they’re actually Mobile Stroke Units, fully equipped with a CT scanner, two-way video interface and everything you need to deliver optimal acute stroke care, fast.

When you ride in one of these units on an emergency call, you know you’re in the 21st century. It’s a compact, video-linked, computer-packed life-saving machine with a siren. The Mobile Stroke Unit team can do a scan wherever the patient is experiencing symptoms. The scan is instantly transmitted back to a stroke expert at the hospital.

Meanwhile, a doctor is examining the patient and assessing his or her symptoms over a high-definition audio and video connection. If appropriate, anti-stroke therapy, like the delivery of clot-busting drugs, can begin immediately. In a situation like stroke, where time equals brain tissue, every second saved is critical.

Care at home for chronic illness

The biggest challenge for healthcare in the coming years will be chronic diseases like heart failure, diabetes and pulmonary disease. These conditions need frequent monitoring, which in the past required visits to the hospital or doctor’s office.

However, Cleveland Clinic is moving more and more chronic disease care into the patient’s home through caregiver visits or technology that allows distance monitoring.

In one pilot program, Cleveland Clinic has collaborated with cable TV providers on telehealth technology that allows caregivers to examine, talk to and otherwise engage patients in their homes. Participating patients have a videoconferencing device attached to their video screen. Using this device, they can interact with the caregiver through secure, encrypted, two-way video through their cable TV connection.

Healthcare kiosks for walk-in care

We’re also activating intermediate areas between the home and hospital. Over the past year, we’ve been placing attended healthcare kiosks at local retail pharmacies, on college campuses and in the lobbies of our own family health centers.

Patients can enter one of these kiosks and be advised or treated for low-acuity conditions like fever, cold, flu, rashes, sore throats or allergies. An attendant helps patients check in through a touch screen, and a high-definition video monitor provides a face-to-face experience with a medical provider. According to caregivers, these health kiosks have broad demographic appeal, being used by older people as well as the younger, tech-smart generation.

We’re also affiliated with a major pharmacy chain to serve as medical directors for Minute Clinics at their stores in Ohio and Florida. Staffed by nurse practitioners or physician assistants, these Minute Clinics can do point-of-care diagnostics, treat low-acuity health issues, and sometimes even issue and fill prescriptions — all on a walk-in basis

Test results and second opinions online

Do you want to check your medical record, communicate with your doctor, study your X-rays or find out your cholesterol level? You can do all that online or on your mobile device through a secure connection known as MyChart. Cleveland Clinic is one of many hospitals now offering MyChart, which also prompts you when it’s time for periodic tests or health screenings, and allows you to request appointments online.

You don’t even have to be in the same city as Cleveland Clinic to get a second opinion from a Cleveland Clinic doctors. We have a service called MyConsult that allows anyone in the world to contact us online and arrange for a top Cleveland Clinic specialist to review their medical record, test results and images, and offer a second opinion. Thousands of people have taken advantage of this service, many of them with very complex or serious diseases.

Sometimes our specialists agree with the original opinion, and sometimes they are able to provide an entirely new perspective on the disease or condition. In any case, it’s something that could never have been accomplished before the age of broadband Internet.

Monitoring from miles away

Every year, Cleveland Clinic adds new distance health services. Our electrophysiology team can remotely monitor implantable cardiac devices like pacemakers or implantable defibrillators, allowing them to detect potentially dangerous arrhythmias wherever the patient may be.

Our Sleep Center patients can have their sleep monitored remotely from home to help identify obstructive sleep apnea. Top Cleveland Clinic specialists offer frequent live online health chats through our website at clevelandclinic.org. Anyone in the world can sign in and ask these knowledgeable doctors about whatever they need to know.

An app for your healthcare

If you want to tap into Cleveland Clinic’s “central nervous system,” download our popular Today app. Today allows you to find a doctor and make an appointment request, and delivers a constant stream of health-related news and information from the Cleveland Clinic content team. (Today can be downloaded from the App Store and from Google Play.)

As new wearable mobile devices are developed, we’ll begin to rely on them to report on our day-to-day health, vital signs and exercise results, and to keep track of how we eat and whether we’re keeping up on our regular health screenings.

These are only a few of the ways that healthcare is moving out of the hospital and into all the places where people live, work, sleep and play. Of course, sometimes you need to go to the hospital or doctor’s office for treatment, but even this is much easier and more accessible than it used to be.

Shared appointments, faster access

Cleveland Clinic patients with a variety of conditions can now see a doctor much sooner by taking part in a shared medical appointment. These appointments bring a dozen or so patients together for a brief visit with a doctor or other caregiver, followed by a longer session in which the patients, who have similar conditions, can voice what are often shared questions or concerns.

Shared medical appointments have proven very popular. They allow patients to learn from their doctors, and to exchange information and support with other people who know what they’re experiencing.

At Cleveland Clinic, we’ve got a shorthand phrase for the whole access revolution. We call it “right care, right time, right place.” It’s all about putting patients first, and making their care and convenience our priority. There’s still a lot of work to be done to make quality healthcare services easily available to everyone, but I’m confident that the changes I’ve described are bringing this dream closer to reality.

Delos M. Cosgrove, MD, is CEO and President of Cleveland Clinic.