🩺 Telemedicine and Telehealth / Humans + Tech - #27

The growth of Telemedicine and Telehealth to provide medical access to rural areas, reduce exposure of healthcare professionals during the pandemic, and as a way to bypass restrictive laws.

Hello :)

There are two primary people I trust with health advice. I didn’t ask for permission to use their names, so I am not going to mention them by name here.

👨‍⚕️ One is my GP.

He’s probably in his 70s. He’s an old school doctor. He’s calm, relaxed, and always greets everyone with a smile. However small or minor my ailments or symptoms, he checks all health indicators thoroughly on each visit. Then, he explains all the medical reasons behind my symptoms in layman’s language so it’s easy for me to understand what’s going on in my body that is causing my symptoms. He only prescribes medicines when it’s absolutely necessary, often telling me to fight things out and to be patient and let my immune system do its job.

He has an aura of healing around him and I feel half-better just being in his presence and listening to his calm and detailed explanations. He still keeps a record of all my visits on small pieces of paper stapled together, the details written in typical doctors’ handwriting that’s encrypted by default. Only pharmacists have the decryption keys. It’s great for privacy :)

🧘‍♂️ The other is my yoga teacher.

I was fortunate enough to learn yoga from him for around two and a half years before he moved to another country a little over three years ago. Most of the students in the class had some injury or the other and we all used to take his advice on how to heal our injuries, what exercises to do to strengthen our joints and muscles, move better, and go about our daily lives with more efficient movement. Like my GP, my yoga teacher also has an aura of healing around him and his classes always left us invigorated and energised.

After he moved to another country, I took up parkour. A year and a half later, I had a fall and dislocated my right elbow. I immediately emailed my yoga teacher my Xrays and the orthopaedic doctor’s notes to get his advice. Once my cast came off, he helped me over email by sending me exercises with detailed explanations every week to rehabilitate my elbow. The intensity of the exercises increased week by week until I regained full mobility in my elbow joint. This was my first major experience with Telemedicine.

He is a subscriber to this newsletter. So, to my yoga teacher, if you happen to read this one, thank you so much for helping me, both with my elbow and all the advice and knowledge you gave us during your yoga classes. I’m forever grateful.

💊 Telemedicine and Telehealth are not new

Although both terms are used interchangeably, they are slightly different.

Telemedicine is the use of telecommunications and information technology for clinical services, while Telehealth focuses on all health services. A video, phone, or email consultation with your doctor falls under Telemedicine, while a health care professional taking an online course falls under Telehealth.

Telemedicine and Telehealth have recently come back into the spotlight and experienced a huge resurgence with the pandemic in our midst and social-distancing the norm. Both are not new. They have been talked about as far back as the 19th century [VSee]. With the ubiquity of internet access over the last decade, along with a combination of vastly better technology like robotics, AI, machine learning, and advanced sensors, along with digitised health data, Telemedicine and Telehealth have become much easier and much more useful.

With social-distancing guidelines and lockdowns in place worldwide, Telemedicine is going to become more popular than ever. Let’s take a look at various cases of Telemedicine use currently in place, both COVID-19 related and otherwise.

Telemedicine in the 21st Century

In last week’s newsletter, I linked to articles that talk about how robots are assisting doctors and nurses during this coronavirus pandemic to monitor patients, measure their vitals, and even consult with them through video via iPads and cameras mounted on the robots. As trained doctors and nurses are in short supply in the regions that are heavily affected by the pandemic, any reduction in exposure that frontline healthcare workers can get is beneficial to everyone.

🇳🇱 Netherlands

Philips has developed a telehealth solution [Philips] to help ease the burden on doctors and hospitals as well as reduce exposure for healthcare workers in the Netherlands. Their solution provides capabilities to screen and monitor patients remotely through external call centres and online questionnaires. The online questionnaires are evaluated and additional follow-ups are scheduled. If at any point, high-risk patients are identified through the questionnaires, they receive a call from the call centre and are asked to consult their GP.

Philips has also developed an eICU [Philips]. The eICU enables remote monitoring of patients in ICU through cameras that can detect vital signs and various other remote monitoring equipment. The eICU hubs are independent of patient location so they can monitor patients in different hospitals in any part of the world. A multi-disciplinary team of intensivists and critical-care nurses can remotely monitor patients from an eICU hub equipped with telemetry, analytics, data visualization, and reporting capabilities to assist frontline healthcare workers. They can optimize the time spent on patients by doctors and nurses. Using all the real-time data, the eICU’s AI algorithms are also much more accurate and adept at identifying when a patient’s condition is going to deteriorate, increasing response times and chances of recovery.

🇺🇸 USA

In the U.S.A. abortions are now taking place by Telemedicine [The New York Times]. Catapulted in part by restrictions from conservative states, restricted access to abortion clinics by the Trump administration, as well as the coronavirus pandemic, many women are turning to TelAbortion, a research study being conducted with permission from the Food and Drug Administration. TelAbortion allows women to have video consultations with certified doctors and then receive abortion pills by mail to take on their own. 611 abortions have been completed as of April 22, 2020.

🇧🇷 Brazil

Portal Telemedicina founded in 2013 in São Paulo, Brazil, delivers healthcare to thousands of patients with an AI-assisted diagnostic service solution. They help over 500 hospitals and clinics serve thousands of patients in more than 300 cities in Brazil and Angola. Their system extracts information directly from medical devices from AI helps doctors to diagnose and report more quickly and accurately. Their mission is to provide universal access to quality healthcare.

🇸🇪 Sweden

Doktor.se founded in Sweden in 2016, is the most popular healthcare app in Sweden and third in Europe. It connects patients with healthcare professionals through chat, phone calls, and video calls. They help patients with everything from skin conditions, infections, contraceptives, mental health and renewal of prescriptions.

🇨🇳 China

JD Health, a Telemedicine company was founded in China in 2004. They had 200,000 users at the beginning of this year. After the coronavirus outbreak, they grew their userbase to 2 million users within a few weeks. There are several other Telemedicine services in China backed by big tech companies. There is WeDoctor, an app by Tencent, Ali Health by Alibaba, Ping An Good Doctor run by a big insurer, plus around 1,000 more telemedicine companies in China [The Economist].

🇿🇼 Zimbabwe

The Mbaoua Group in Zimbabwe is starting a pilot project to test Telemedicine in rural areas of Zimbabwe to provide access to specialists in areas where there may not even be any doctors [MobiHealthNews].

🇳🇬 Nigeria

In Nigeria, BeepTool has launched The Lafiya Telehealth platform [Disrupt Africa] which provides video interaction along with medical device attachments all in a private setting via a smartphone, tablet, pc or a virtual healthcare kiosk. The uniqueness of Lafiya is the proprietary solar-powered, satellite-enabled Telemedicine device. Combined with the Telehealth platform, it provides remote physicians with almost the same clinical tools they are used to working with. This will help extend healthcare to rural areas with doctor shortages. 

These are just a small list of the Telemedicine and Telehealth solutions and use cases around the world.

Data, Privacy, Credibility, Ethics

There are undoubtedly several benefits of Telemedicine, both for patients as well as healthcare professionals. The potential to help those in rural areas is particularly immense. However, there are several aspects that need to be considered more deeply.

Where will all this data be stored? Who controls the data and who has access to all this data? Is your privacy preserved in all these interactions? How much information is shared with insurance companies? How much is shared with pharmaceutical companies? Are the doctors credible? Are they properly certified? What ethical issues do doctors have to consider when treating patients remotely? How does it affect patients who are in ICU and have a camera recording them 24/7?

There are lots more questions I have. The data and privacy aspects concern me the most.

Patient Trust and Satisfaction

With my GP and my yoga teacher, they know me personally and have met me physically. They are in a much better position to advise me from a remote setting, and I would be completely comfortable seeking their advice remotely as well.

However, I would personally be very sceptical to consult a doctor remotely, whom I have never met in person. After several interactions with the same remote doctor and proven results, it’s likely that the trust will be built over time. My belief and experience is that patient trust in their healthcare provider is a vital part of recovery. Having full confidence in your healthcare providers influences the speed of recovery positively.

Most probably, younger generations who grow up with Telemedicine will not think twice and wonder why older generations are so sceptical :)

I’m interested to know your thoughts on Telemedicine - reply to this email or leave a comment on the post.

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💬 Quote of the week

“We’re seeing an interesting convergence of technology, medicine, social issues, and human progress.”

—John Nosta, Digital Health Philosopher

I wish you great health and a brilliant day ahead :)

Neeraj