Before hospitals, patients were treated by family doctors in doctors’ offices/homes or in patients’ homes. Healthcare was simple: pay a fee for services received. With the advent of small hospitals came the delineation between in-patients and out-patients, where in-patients were defined as having room and board at a facility where they were treated by doctors. Modern medicine has expanded the requirements of facilities offering hospital in-patient services from the classical doctor and room and board. Today, US hospitals are regulated by the FDA, Joint Commission, the department of health, as well as many other accrediting agencies. Buildings are required to have special walls for X-ray insulation, up to date medication carts on each floor, and meet many other special building standards. The Joint Commission requires hospitals to have 24/7 ancillary staff, 24/7 pharmacy, 24/7 doctor coverage, special quality and safety standards and protocols, as well as many other requirements. The list goes on and on and for many hospitals costs hundreds of millions of dollars a year.

These increased requirements lead to substantially increased costs which is why a standard hospital in-patient admission costs $10,000 to $200,000 merely for a few days of service. The patient pays a copay for a few hundred dollars and health insurance/Medicare/Medicaid pays the rest. In contrast, out-patient care at doctor’s offices and surgical centers cost about $75 for the visit and a few hundred for service. Healthcare has evolved into an all-or-nothing dichotomous structure where in-patient care is VERY expensive.

These heightened hospital requirements are not all bad. For critically ill in-patients, the regulation keeps the hospitals safer and more effective. However, admission to the hospital is not always used for critically ill patients. Because of US healthcare’s dichotomous structure, a large proportion of admitted patients are not critically ill, but rather low risk. These low risk patients receive high level expensive management that is above what is needed for their condition. This all-or-nothing structure has contributed to the US healthcare crisis of over $500 billion a year in wasted spending.

Today, a new system is set to transform and evolve this age old system. ePatient care is not a hospital and it is not a doctor’s office or surgical center. The ePatient is in-between care, a level between in-patient and outpatient. It uses wireless interconnectivity to manage patients through video conferencing, continuous contact to remote doctors, remote monitoring, remote blood work, remote prescribing, and a remote code team. It offers the process control to better manage a high volume of patients at less cost.

This third level of management is the new class and status of patient, the “ePatient.” Doctors can take care of their critically ill patients in the hospital (in-patient), moderate to low risk patients by Remote Medical Management ( ePatient), and standard care patients in doctor’s offices (out-patient). This trichotomy matches the appropriate level of care needed for each patient. This introduction of the “new-hospital” technology brings efficiency to the entire system.

Dr. Chiu coined the ePatient term in April 2014 after seeing the first ePatient using a platform of wireless interconnectivity known as COTTER. ePatients are able to leave the hospital while still maintaining the same level of medically necessary care as a hospital. The ePatient hospital is the cloud and the community. The hospital walls are not medically necessary.

US healthcare spends over $500 Billion per year on low and moderate risk admissions to the hospital, hospital stays that could be managed appropriately as an ePatient. ePatient care costs a fraction of the total cost for low risk in-patients. It has the potential of annually saving over $400 billion in United States healthcare spending across all facilities.

The ePatient is spawned by technology that connects people. There is no denying that mobile technology, global connectivity, and sensors are all improving at an exponential rate and are affecting every industry. The next largest effects will be on healthcare. Economic and operational need is driving the advent of the ePatient to mainstream healthcare. A study by Forbes puts hospitals, medical liability, and defensive medicine as 45% of the US healthcare spending. The ePatient reduces all of these.

The ePatient means more access to medical care at less cost. It will save hospital and health insurance companies money, and improve emergency room and hospital efficiency and turnover. The ePatient concept has the potential of reducing total healthcare spending in the US from $2.7 trillion to $2.3 trillion per year, an almost 15% reduction.

Eventually, ePatients will outnumber inpatients and outpatients. People will be continuously connected to healthcare services, with instant primary care catching diseases before they happen and progress. People will live longer. Primary causes of death and disability will change. CRMM is the leading physician group providing ePatient care. CRMM doctors are proving the concept that will change healthcare not only in the US, but internationally as well. There is no denying that the ePatient represents an evolving international structural change in healthcare.