Lessons from the inverted paradiddle can help telehealth move forward

By day I run a health care company. At night and on weekends I play the drums. My hobby often gets me thinking about the rhythms of work.

As I’m drumming away, I’ll ask myself, “Why do I play the bass drum on this beat?” Because it’s always played there? Actually, it may sound better if I change it up, so I try altering the rhythm.

Since the pandemic burst upon the world, my colleagues in health care and biotech and other industries have been moving around the sequences; patterns and rhythms scrambled by Covid-19 have shifted the thinking on old routines. That can be a good thing.

When I ran hospital emergency departments as a physician, I got a deep sense of the rhythm of the work underlying countless medical procedures, the ebb and flow of urgency and even life-or-death decisions. Proper timing and following established processes were essential. Sometimes, though, after thousands of cases, insights emerged into how to modify procedures just slightly to get better outcomes.

Here’s one example from early in my career: At the time, care for people experiencing strokes was evolving. Medicines known as thrombolytics were being used to dissolve clots blocking blood flow in the brain. We knew that how quickly someone got these drugs — what came to be called time to thrombolytics — was a measure tied to saving brain function. When an ambulance transporting someone who might be having a stroke arrived, the process involved rushing the patient into a bay to be evaluated while their insurance and demographic information was gathered. They would then be hustled off for a brain CT scan, a requirement before the thrombolytic could be administered.

Over time, we looked at the procedure and adjusted it. Patients went directly from the ambulance to the CT scan. They were examined en route and their medical history obtained. This adjustment allowed us to administer thrombolytics much faster, speeding the process by five or six minutes, minutes that could mean the difference between a good outcome and a poor one.

That’s the kind of innovation that works best in health care: small adjustments borne out of experience.

In drumming, an example of that kind of adjustment is the inverted paradiddle. Though it may sound like a medical term, it’s actually a pair of diddles, a simple but regimented rhythm: right-left, right-right, left-right, left-left. When played, it’s supposed to sound regimented.

But one adjustment — like skipping the first note and starting on the left, not right — can make the rhythm sound livelier or more interesting. Ditto starting in the middle and playing the sequence from there.

It’s not improv — it’s still regimented, just like the work processes in medicine. But it means starting in or from a different place.

During the pandemic, health care practitioners have been forced to make sometimes dramatic adjustments. The industry should take the time now to look and listen and see where adjustments have resulted in improvements. One related to telehealth, the general field I work in, comes to mind.

The idea that all health care needs to take place in a medical facility has been upended. When cities and states began locking down, and rules on telehealth were relaxed, clinicians were extremely productive, patients were thrilled to avoid the waiting room, and access-challenged individuals found it easier to connect with caregivers.

Health care providers have started to understand how to deliver last-mile services that complement new telehealth and telemedicine capabilities. Through services provided by companies like mine, a relatively unskilled caregiver can visit a patient in her or his home and, working with a remote physician or nurse practitioner, conduct a thorough exam. It’s possible to bring a lab, and even an X-ray machine, into someone’s home. This kind of video and medical equipment is now being found in remote work sites, like offshore oil rigs, and even in some newly constructed homes.

The proposed nationwide upgrade of WiFi will be vital to help speed these improvements and reach patients without easy access to the internet, such as those eligible for the Federal Communications Commission’s Connected Care Pilot Program, which covers most of the cost to connect digitally excluded Americans.

The newly released AMA Physician Practice Benchmark Survey confirms the growing role of telehealth: 70.3% of physicians polled say they work in practices that used videoconferencing for patient visits in September 2020, seven months into the pandemic, compared with only 14.3% in September 2018. Numerous surveys have found widespread patient satisfaction with virtual medicine, with most respondents typically citing its convenience. And the Centers for Medicare & Medicaid Services introduced two programs last year — one called Hospitals Without Walls, another called Acute Hospital Care at Home — offering hospitals flexibility by allowing them to provide off-site services, including in patients’ homes.

It appears that we are finally headed in the direction outlined by Eric Topol, widely viewed as one of America’s most influential physician leaders, that the hospital of the future will be focused on intensive care units and operating rooms. The remainder of what has traditionally been hospital care will be delivered in the home, safely and more cost efficiently, as part of the growing number of telehealth services.

Just as a drummer can make a difference in a musical piece with an inverted paradiddle, health care can also make small changes that lead to key differences — sometimes big differences. And in a measured way, health care providers can remake the system, one beat at a time.

Mark Prather, an emergency medicine physician, is the co-founder and CEO of DispatchHealth, a provider of in-home health care.