Telemedicine in action

The COVID-19 pandemic has shined a strong spotlight on the technologies and developments in the healthcare sector. Whilst most eyes would be on the search for a possible vaccine, there are other advancements that too have the potential to not just aid in the fight against the current pandemic, but also revolutionise healthcare practice as a whole. One such development is telemedicine.

Telemedicine is by no means a recent invention, but its adoption has drastically accelerated in 2020. The McKinsey COVID-19 Consumer Survey found that the percentage of US consumers using telemedicine had more than quadrupled, from 11% in 2019 to 46% in 2020 – a trend that is likely to be mirrored across the world.

Dr Tan Jit Seng, Founder, Director, and Senior Home Care Physician of Lotus Eldercare Private Limited presented his telemedicine setup and practice workflow at the Healthcare Frontiers 2020 Conference last month. Dr Tan has had extensive experience working on bringing technology into the healthcare space, and has been involved in the development and adoption of a range of technologies such as AI and assistive robotics into the medical scene.

More than just a video call

Whilst many might assume telemedicine to be simply a video call with a doctor or medical practitioner, there are in fact four main types of telemedicine, and knowing the differences can help better incorporate telemedicine into healthcare.

The first is the adoption of Telemonitoring systems that help monitor the vital signs and conditions of patients as they go about their daily lives. These systems usually involve the use of medical wearables that can measure medical information such as heart rate, blood pressure, or oxygen level, and feed the information immediately to their doctors. This allows doctors to accurately and conveniently monitor patients day-to-day to identify possible risk factors or irregularities, instead of depending on the patient’s self-reporting or single measurements for their diagnosis.

Dr Tan shared one example whereby the monitoring systems had shown a sudden increase in the heart rate of a stroke patient whilst she was at home. Sensing that something was wrong, her caregivers rushed down to her place to discover that she had dislocated her knee, and she was quickly sent to the hospital for treatment.

The data from telemonitoring feeds into the second type of telemedicine, which is teleconsultation. This may be the form that most people are familiar with, whereby your consultation with the doctor takes place over a virtual platform. Since these consultations can be conducted from the home, office, or any other location, it makes it extremely easy for patients to seek help promptly and conveniently.

The third type of tele-medicine is telecollaboration. The increasingly complicated nature of our healthcare needs means that we are often not taken care of by just one doctor or specialist, but a number of different practitioners and caregivers. The use of virtual platforms makes it significantly easier to bring everyone together to discuss next steps with the patient, save the man-hours that might be wasted in organising and attending a physical meeting, and build trust between the different people involved in providing the best care for the patient.

The last type is telesupport, where medical practitioners can share resources, expertise, and services over long distances. This service is particularly useful for medical centres in smaller or more rural areas, which may not have the need or demand to have more specialized services on-site. For example, patients with specific needs such as physiotherapy or speech therapy can tap on trained specialists in other locations from the comforts of their own homes.

Towards ‘value-based’ healthcare

The increasing use of telemedicine is in tandem with a major movement in the medical sector towards the creation of a value-based healthcare system, which tracks the success of healthcare interventions more closely to the outcomes and quality of medical services.

Dr Tan shares that one way of implementing such a system is to establish clear and measurable KPIs such as a reduction in blood sugar levels or stroke prevention, and use these targets to determine the success or failure of any healthcare intervention. This gives practitioners an objective framework to determine the most efficient and effective course of action for their patients.

This is in comparison with the current fee-for-services system, whereby patients are often charged for the number of treatments they receive rather than its positive impacts, which may incentivize medical providers to suggest an increasing number of treatments at the expense of the patient’s physical and financial health. 

The implementation of telemedicine is supporting this push towards value-based healthcare in a number of ways. Firstly, the use of telemedicine significantly reduces the resourcing demands on patients, doctors, and caregivers when attending face-to-face consultations. This is especially so for patients who require assistance to move around, such as those with mobility issues or the elderly. Oftentimes, these patients and their caregivers would need to spend half a day or one full day just to attend their routine medical follow-ups. Telemedicine can bring the doctors and healthcare services to them instead, eliminating the hassle of travel.

The ease of providing medical support through telemedicine has also heavily reduced hospitalisation and re-hospitalisation rates amongst patients. Patients with early symptoms can easily reach out to their physicians for early diagnosis and treatment, instead of waiting for symptoms to deteriorate and become unbearable before seeking professional help. After treatment, they no longer need to spend extended periods of time in the hospitals for monitoring, as telemonitoring systems and be set-up to quickly facilitate their return back home for their safe recuperation.

Another intangible benefit of implementing telemedicine is the empowerment that it allows to the caregivers and patients in the healthcare process, as they are given more agency and information to make important medical decisions. For example, the patients themselves can have access to the medical data shared with their doctors through telemonitoring, and keep track of their own progress on the path of recovery. Caregivers also have an easier time seeking advice from doctors and completing routine tasks such as obtaining prescriptions and refilling medication.

These benefits all work towards providing high-quality and impactful healthcare services to patients at a fraction of the resources required in traditional systems.

Challenges facing Telemedicine and the future

In spite of the huge potential of telemedicine, there are still a number of challenges that may pose an obstacle to its adoption and implementation. First of all, the increased responsibility on patients to take charge of their own health means that resources must be dedicated to patient education and compliance to ensure proper diagnosis.

Second, the extensive amounts of data collected for telemedicine also means adequate safeguards must be put in place to maintain the integrity and security of patient data. Already we have seen cyber attacks on the databases of some medical facilities in recent years, and as information becomes more valuable, more emphasis needs to be given to its protection

Medical providers themselves would also need to devote the time and resources to grow their capacity and capabilities to adopt telemedicine. It is likely that new workflows and processes would need to be adopted to facilitate its use, and doctors would also need to become familiar with the uses and functionalities of the new technology.

Regardless of these challenges, it is likely that telemedicine will play an increasingly large role in the suite of services provided to healthcare consumers of the future. The rapid development of technology has opened up even more possibilities than before.

“Even the mobile phone that you are using now can be used to tell your heart rate, oxygen concentrate, blood pressure, and your respiratory rate,” says Dr Tan. “Soon, we may even be able to connect ultrasound devices or stethoscopes. The future will be exciting, and these developments are only accelerating.”