by Rohit Jayakaran
The Telemedicine market was valued at $45 billion in 2019. Estimates based on trends prior to the Covid-19 outbreak appraised the market to be valued at around $175 billion by 2026. It is fair to say that these estimates will need to be looked at with a fresh set of eyes and disinfected hands in the light of the current global pandemic. Telemedicine seems to be the talk of the town today, but it is nothing new. It is the use of technology to enable remote healthcare. The term ‘technology’ however has changed over the ages.
Telemedicine provides a safe way for patients to access healthcare and to receive support virtually, wherever and whenever they need it. This is particularly important for individuals who need to self-quarantine or who have underlying health conditions. It almost seems like a lifetime ago, but there was a time when going to the doctor meant taking a day off from work, driving to the clinic, parking and waiting in a crowded waiting room. Telemedicine helps overcome these challenges however big or small they may seem.
Before we endlessly heap praises on Telemedicine and make it blush, we need to be honest about in-person doctor’s visits. There is something reassuring about having a conversation with your doctor who understands and comforts you. A friendly pep-talk or a pat on the back can help with the healing process. For years the healthcare industry has been working on making Telemedicine a mainstream solution, but its success has been limited at best. The limited success has largely been because those selling the solution to patients were themselves not convinced that it was a suitable channel to deliver healthcare. The coronavirus pandemic however has resulted in wider acceptance among leaders and practitioners in the healthcare industry.
My thoughts here are largely limited to urban areas but there is a huge opportunity to revolutionize rural medicine. Remote clinics with portable equipment and a nurse could reach far more people in rural areas and connect with doctors remotely. Imagine being able to transmit an x-ray or test results in real-time to specialists who can sell or share fractional time with patients globally. The possibilities are endless. Rather than have a specialist travel to a rural outpost to meet with only two patients with a specific condition, you could now treat them remotely without leaving your clinic, hospital or home.
I would like to argue that in some shape or form we have had Telemedicine for over 50 years. When I was growing up, we had a family doctor who we would consult from time to time over the phone. He would prescribe medication and on occasion would require us to visit his clinic if he suspected something serious. At that point in time, our family doctor was using the most advanced technology available to him (a phone) to deliver healthcare services. With the passage of time, we have merely started defining in greater detail the ‘technology’ that needs to part of the mix to be classified as Telemedicine.
Our family doctor’s ‘telemedicine service’ worked well because he knew the families he was consulting. The commercial terms of our arrangement were not laid out, but we knew that we could not take the relationship for granted. Antibiotics and certain drugs would only be prescribed at the clinic and would be treated as normal paid visits. An unwritten rule we all followed was that there would be a regular frequency of paid visits to the doctor to sustain his enterprise commercially with a few ‘free’ consultations calls thrown in. We lived in simpler times. There was no Dr. Google and the medical information we had was circulated within the family and cross-referenced across generations without the intervention of WhatsApp.
Driving Forces behind Telemedicine
The current global pandemic has seen legislations change and industry push to widen the Telemedicine net. For years however, there have been developments in this area, and it has been a major focus of the digital transformation efforts in the medical space. Currently there is a spike in the use of the service primarily because it is deemed too dangerous to visit a hospital or doctor’s office for fear of contracting the Coronavirus.
Fear can only drive growth in the short term. There will eventually be a time when we will be over this pandemic and fear will not drive us to use a technology that supported us while we were overcoming the crisis. Fortunately for Telemedicine there have been some interesting developments that give it an opportunity to go it alone even after the end of pandemic support.
I am going to highlight these developments using my Family Doctor’s ‘telemedicine service’ as a suitable contrast.
The current pandemic has somehow made us more open to meeting virtually for business-critical issues. As we do this more and more each day, we are softened to the idea of meeting a doctor virtually as well. Growing up, my family doctor had a landline you could call any time of the day. Today however Telemedicine is not limited to audio. The doctor can now ‘see’ the patient to ensure better diagnosis and prevent fraud. Being able to see your doctor has a calming and reassuring effect on patients.
Our family doctor’s prescriptions needed to be handwritten and signed. A physical visit to the pharmacy was required to pick up medicines. Over the last few years you might have noticed that some doctors and hospitals do not issue printed prescriptions. When this happens to you for the first time, it feels weird because traditionally we are used to going to a doctor and leaving with a piece of paper. E-Prescriptions change all of this. The doctor needs to simply issue a prescription against your name or account and you can pick up your medicines at the pharmacy or better still, have them delivered to your home or office.
Our family doctor dealt in cash and was able to bill us only when we physically met him at his clinic or if he made a house call. If you exploited the unwritten rules of ‘ancient Telemedicine’ and only called the doctor over the phone but never ever visited him, you would eventually find yourself being asked to meet him in person during your next illness. To be fair, the service the doctor provides is a professional one and should not be exploited for free. Now with Telemedicine becoming a formal service that is provided, a doctor could slot you in for an online appointment and you could make your payment online using your credit or debit card.
Essentially with these simple innovations, you can see your doctor, pay for the consultation, get a prescription and have your medicines delivered to you. The time you would need to take out of your day would be around 30 minutes. You could be at work or at home in bed and go through this entire process.
Challenges facing Telemedicine
For Telemedicine to be a sustainable healthcare solution, there are challenges that need to be addressed. These challenges can be incrementally solved to continually help the evolution of the service.
Measurement of Vitals
Before every doctor’s appointment at a clinic, you need to have your vitals checked and logged in the system for the doctor’s reference. Additionally, when you are consulting with the doctor, he or she may check your pulse rate, blood pressure or examine you with a stethoscope. Considering that an average home only has a thermometer, these self-measurements pose quite a challenge.
As technology grows in leaps and bounds, we will start seeing more medical devices that will be commercially available to end users. These devices will range from insulin readers to digital stethoscopes that will interface with your computer or smartphone. This reality is not far away considering the Apple Watch already records ECGs. As Telemedicine gets more sophisticated, we might be asked to take these measurements in the virtual presence of a doctor or nurse to ensure accurate techniques and readings. Multi-function wearables will enable us to maintain a record of our vitals over a period of time and share them with the physician when needed.
If Telemedicine is to become a mass reality, these devices will have to become cheaper, more sophisticated but user-friendly, and be approved by regulatory bodies by meeting and exceeding standards. Providing your doctor with accurate information helps with the diagnostic process. Equipment to measure vitals is often expensive and not something an average person would invest in. Getting equipment like this in the hands of patients might require creative out-of-the-box solutions like:
- Working with Insurance providers who can provide this equipment as part of their coverage.
- Delivering the equipment to the patient on the day of their appointment and collecting it from them when the medicines are being dropped off.
- Partnering with courier and delivery services who have vans driving around town to deliver equipment along their daily routes.
- Delivery drones that could deliver equipment and pick them up once an appointment has been concluded.
- Mobile kiosks that could be setup around a city where patients could go and have their vitals checked and reading recorded for a doctor to access during an appointment.
Video calls take up bandwidth at both ends. For Telemedicine to be a success, doctors and patients must have access to high speed internet. While dropping the video quality usually ensures a seamless video call, for a consultation with your doctor you would need to ensure that the video quality is at the highest possible grade. Accurate depiction of color and texture are vital to the diagnostic process. These calls will increasingly be made using smartphones and perhaps the introduction of 5G might prove to be another revolution in the evolution of Telemedicine.
Privacy and Security
In recent memory, it is hard to recall a time when hospitals have been hacked. A good reason for this has perhaps been the fact that hospital systems have had limited exposure to the wider internet. With the rapid need to deploy Telemedicine services, healthcare systems will be fully exposed to the internet and will be vulnerable to attacks. Hospital records are valuable pieces of data that can be used in identity theft and will not be spared by the unscrupulous. Doctors and patients share a confidentiality agreement that is protected by law and service providers need to ensure they have all the safeguards in place to protect their clients.
The Covid-19 Pandemic has seen Governments across the world relaxing rules that govern Telemedicine. These rules will eventually be tightened but while there is operational freedom, the suggested future framework must be drafted by industry bodies and shared with the relevant authorities. This participative process can enable this channel of healthcare to flourish in the future.
Whether we believe it or not, the current healthcare business model is being disrupted. This disruption however is unique because it still leaves the power in the hands of the current industry players. However, if the incumbent is complacent, external players will enter the market and harvest their customers. With Telemedicine, you don’t need a large hospital or clinic to transact business. You could easily do it from a small remote office with minimal staff and overheads. It is time for the industry to challenge its own business model before others do.
I admit that some of these solutions may sound bizarre and often unfathomable. But think about it, if I had told you on the 1st of January that this year would see us working from home for months on end and that we would wear masks and gloves when we went to the grocery store you would have called me crazy. These are crazy times and today we are using Telemedicine because we have no choice. A few months from now though, we will have a choice and then the concept needs to prove itself by either being cheaper, more efficient, faster or convenient. If we can achieve even one of these, we have a promising proposition.
If we believe that Telemedicine is here to stay, we need to ask ourselves one simple question – “Why are we providing Telemedicine Services?” Today our ‘why’ for providing and using the service is safety, however in a post-pandemic world, there needs to be a defined ‘why’ for both patients and healthcare providers. If you know the ‘why’, the ‘how’ and ‘what’ are merely next steps.
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