Miles Romney, cofounder and chief technology officer at telehealth company eVisit, paints a vivid, sci-fi-seeming picture of what virtual care will look like in the year 2050. 

He starts by describing a hypothetical person's morning shower.

The shower stall will be outfitted with a high-tech system, says Romney. Aided by an ocular or neurological implant interface, the system takes a full-body CT scan, while myriad instruments gently check various personal health metrics and vitals, cataloging and sending those details to a care team.

The person's daily data is analyzed in real time by artificial intelligence and validated by providers. A transdermal infuser then delivers a personalized cocktail of exactly what's needed – vitamins, relaxants, pain relievers, beta blockers, anxiolytics, TNF inhibitors. The shower begins and as hot water hits, one already feels the positive effects.

Romney spoke with Healthcare IT News about what he sees as the future of telehealth – when virtual care will no longer be virtual care, it will just be care.

Q: Before we head into the future, what is happening today in telehealth where you see inklings of changes that help you see what is to come?

A: I see three primary indicators of change today – what I call "innovation enthusiasm": increased use of telehealth, driven predominantly by the pandemic; consumerization of healthcare; and tech tool fatigue.

That telehealth is happening at all, and that its upward inflection has been so pronounced over the last 14 months, is one of the biggest indications of changes to come. It signals a clear and present motivation on the part of health systems to embrace new ways of managing the very core of their services: the interaction of a patient with a healthcare provider. This is the "wedge in the door" that will allow for the adoption of so many other tech-enabled efficiencies.

Closely related to telehealth adoption over these last few years, and the adoption of other consumer-facing health technologies, has been the transition of "patients" to "consumers" – what the industry is calling the "consumerization of healthcare."

This is an explicit acknowledgment that people now have a choice in where they go for healthcare, and that they demand not only successful outcomes, but also high-quality experiences. As consumer voices strengthen, and this sense of competition increases, the eagerness on the part of health systems and insurance payers to adopt new tools and technologies will increase in lockstep.

They have two very compelling reasons to do so – to increase patient outcomes and to keep patients within their networks, protecting and increasing their own margins.

Another very strong sign of innovation enthusiasm is what we call "tool fatigue." This may sound counterintuitive at first blush. But consider that the only way a purchaser can grow tired of buying too many new tools is by actually buying too many new tools. There is a hunger for advancements not only in treatments, but also for integrated care paths, patient management, provider efficiency, data portability, security and privacy, in addition to so many other categories.

Q: What do you think telehealth will look like in 2050?

A: "Telehealth" won't exist in 2050. It won't exist in 2025. It will just be "health." It won't be "virtual care," it will just be "care." The lines between remote treatment and in-facility treatment will become so blurred that any distinction will become vestigial.

My vision for integrated care in 2050, as a futurist and a health-tech innovator, is this:

Imagine waking gently at 6 a.m., not to the buzz of an alarm, but smoothly by a process that feels as natural as can be, steadily deployed by an app in your micro-implant. You stand and stretch, pass through the kitchen where you grab the cup of coffee that's already waiting for you.

You stare out at the sun rising over the landscape stretching at your feet while you peruse a few headlines, not on a mobile device or a hanging display, but rather, through your implant and its ocular, or maybe neurological, interface.

Then you walk to the bathroom, slip out of your pajamas, and step into the shower. Before the water starts, though, you hear the hum of a full-body MRI scan, and feel the soft nipping of a half-dozen instruments collecting samples and cataloging vitals.

Results are analyzed in real time by AI and sent to your care team for validation. A transdermal infuser pushes a cocktail into your blood: vitamins, relaxants, pain killers, beta blockers, anxiolytics, TNF inhibitors, even stimulants (your coffee is decaf). All synthesized in response to your current blood chemistry, and carefully balanced against one another.

When the steam roils up from beneath you and the hot water sprays down from above, you already feel like a new person.

Your doctors are still involved. And when it comes time for a conversation, you'll have it – remotely, over video or VR. It's all at your fingertips, but you're only as aware of it as you want to be. Until a crisis hits. And when it does, the local healthcare infrastructure will exist to treat it, because your care has largely been flowing through it, informing it, funding it.

There's no taking time off of work to drive down to a medical center, no hassle with parking, no fighting to schedule with five different doctors, losing your lab orders and having to drive into the clinic to get a replacement, no accidental drug-on-drug interactions, or a drop in drug efficacy because of your own evolving chemistry. No.

Many of your vitals are collected and monitored continually through your implant. Others come daily, when you step into your shower. All of them flow in real time through AI and your flesh-and-blood care team at a frequency and with a granularity that would be the envy of any Ferrari mechanic. Your body will be, as it were, a well-oiled machine.

Q: Are the technologies that make up today's connected health and remote patient monitoring getting close to this vision?

A: They're as close to that vision as a two-ton UNIVAC computer is to an iPhone. Close enough to put us on the path, ignite our imaginations and perform some of those end-state tasks, but decades away from the sophistication and finesse that make it all work well, work together, work affordably and work beautifully.

Q: What will have to happen to the doctor/patient relationship for this kind of telehealth to come to fruition?

A: It need change very little, actually. It may be that in 2050 we aren't employing very many more doctors than we are today, but we certainly won't be employing fewer. The biggest and best part of this 2050 vision is that it's commoditized, democratized.

Everyone, everywhere, will have access to this care because economic conditions, standard of living, energy and resource efficiency, agricultural and manufacturing improvements will all continue on their current striking-upward trajectories.

Yes, your average doctor will be caring for far more patients because she's focusing her time on the things only she can do (as opposed to the highly repetitive tasks that machines will be doing in support of her and the care team). But a far higher percentage of the world population will have direct access to her services. So, demand on her time will decrease on the one hand, and increase on the other.

Maybe this doctor of 2050 won't know you by sight. Maybe those relationships will be less superficially personal. But in the ways that matter – the knowledge she'll have of your holistic health and wellness – will be far, far greater.

The future is bright. The innovators in health technology are creating it. And with democratized healthcare, with equal access to life and health, the sky's the limit. No, even the sky will be no limit.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.