Telehealth post-COVID 19: Break stereotypes and embracing the potential of technology

Despite the continuous research and improvement in telehealth, its uptake has been nominal, especially in low-income countries which stand to benefit the most from it.

The next big thing in healthcare? For more than a decade, advocates of telehealth have tried to convince the world that it can transform healthcare but their efforts had largely gone in vain until the COVID-19 pandemic left people with no other choice.

Telehealth has been around since the only option to deliver health care services remotely was through a 'telephone' but it has evolved since then. The scope of telehealth now includes 'video visits', AI-enabled delivery of alerts and reminders, remotely monitoring patients who are in hospital wards or even their homes, and so on.

Despite the continuous research and improvement in telehealth, its uptake has been nominal, especially in low-income countries which stand to benefit the most from it. Many factors have negatively impacted the growth of telehealth and the biggest among them are regulatory concerns and reimbursement issues.

Excessive, unclear regulations and cautiousness of lawmakers have hampered widespread adoption of telehealth. Difficulties in getting permissions, unclear licensing requirements, lack of rules on insurance coverage, and geographical barriers are some of the challenges faced by telehealth professionals.

But recognizing the potential of telehealth in reducing the burden on the healthcare system during this pandemic, many governments have temporarily loosened certain regulations, paving the way for widespread adoption.

In March, the US Government allowed utilization of Medicare to pay for healthcare services received via telehealth. The Indian government also introduced telemedicine practice guidelines on March 25 as it imposed the biggest-ever lockdown confining over a billion people in their homes.

Australia, Indonesia, Philippines, and Singapore are some of the other countries that have embraced the potential of telehealth in fighting the pandemic and have eased regulations to support their healthcare system.

Apart from the regulations, resistance from patients and even doctors have hampered the adoption of telehealth. Doctors don't easily get on-board due to concerns about missing something while remotely monitoring a patient and reimbursement issues.

But after using it with the latest technological advancements, many medical professionals have become believers particularly because telehealth allows their patients to be more comfortable and improves engagement. Telehealth is not adequate for every case but it can be on par or even better than in-person visits in suitable cases.

People are resistant to telehealth because of general resistance to technology, lack of access, and training. Even the tech-savvy individuals are cautious about telehealth because many people are just wired to feel better by the in-person reassurance from another human being in the room. A virtual conversation won't cut it for them until they experience and get comfortable with the idea of telehealth, something that the pandemic has forced them to do.

The pandemic has shaken the bedrock of every sector but the healthcare sector has been exposed to the core of this crisis and experts say that it will never go back to where it was before the pandemic.

Why telehealth?

• Reduces burden of healthcare staff

Telehealth is especially important at this time because the COVID-19 pandemic has stretched healthcare systems to their maximum capacity. Doctors and nurses are overworked everywhere as hundreds of thousands of people with a highly contagious disease have to be admitted to hospitals. But not all of the infected patients require constant medical care and are really the perfect case for telehealth.

Telehealth helps reduce the burden on healthcare staff by minimizing or automating administrative responsibilities and also reduces potential exposure to infectious diseases.

• Increases productivity

Instead of nurses routinely checking patients' vital signs, these tasks can be automated which not only allows nurses to focus on more advanced tasks but also reduces the chance of human error. The devices that allow these tasks to be automated can also be operated remotely even when the patient is at home to ensure comprehensive care.

Widespread adoption of telehealth will pave the way for new possibilities like outsourcing of routine tasks like collecting data from these automated devices and promptly reporting it to medical staff to further reduce their burden and increase productivity.

• Improves quality of healthcare

Telehealth can actually improve the quality of healthcare in the cases it is best equipped for. By giving patients the comfort of their home, telehealth can improve engagement and help medical staff better understand the problems.

By automating routine tasks like taking vital readings of equipment also reduces the chance of human error and medical staff is promptly alerted to intervene if the patient's health deteriorates at any time. Studies have shown that telemedicine equipped units can overall mortality and length of stay.

• Lower cost of healthcare

Telehealth reduces costs for hospitals and also reduces the travel burden of patients. Clinics and hospitals that adopt telehealth infrastructure require lesser staff and can reduce overhead costs in the long run. Improved productivity of medical staff also allows them to handle more patients simultaneously.

Patients, on the other hand, benefit not only from lower costs of healthcare but also from reduced travel burden. The case is particularly strong for people living in remote areas who have to travel dozens of kilometers to see a doctor. Reducing the travel burden also encourages non-urgent visits, thus reducing hospitalizations and emergency room visits.

• Improves access

Telehealth allows doctors to reach patients that might be living in remote areas with the click of a button. Equipped with the right technology, patients living in these areas can also have tons of alternatives and can change doctors if they are not satisfied, unlike traditional healthcare where in many cases patients have to rely on unqualified individuals for their healthcare needs because of lack of alternatives.

Improved accessibility will also encourage non-urgent 'virtual' visits in cases feasible for telehealth, which can increase life expectancy, according to various studies.

• Democratization of technology is faster than that of traditional healthcare systems

Mobile penetration has reached billions of people in just the last 3 decades and more than 3 billion people have smartphones. Sub-Saharan Africa, a region that has struggled for years, has utilized these mobiles to improve access to energy and banking by becoming a leader in mobile money. With further improvements in the democratization of technology, people living in low-income regions can also have easy access to healthcare.

Technology deals with many issues at the core and its scope are much broader than just healthcare, which could ensure better returns in terms of human capital for governments.

Expansion of traditional healthcare systems is still important since telehealth is not equipped to deal with many scenarios, which would increase further in rural areas because poor people can't keep advanced equipment at their homes.

Challenges

• Digital divide

One of the most advertised benefits of telehealth is its ability to reach remote areas and improving healthcare access. But the coronavirus pandemic has exposed the digital divide that exists in communities in even the most developed countries.

Globally, only 55% of households have an internet connection, according to the data by UNESCO. In developed countries, 87% of the population is connected and the penetration drops to 47% in developing nations. Only 19% of the population is connected in low-income countries. In total, 3.7 billion people don't have internet access, making the expansion of telehealth harder.

• Regulations

Regulatory hurdles and cautiousness of lawmakers have hampered widespread adoption of telehealth. Several countries have vague regulations about licensing requirements and liability of medical staff for telehealth, which increases red tape and discouraging the fraternity.

Lack of rules on insurance coverage allows insurers to exclude telehealth from their policies, which encourages people to choose in-person visits even if the cases are suitable for telehealth consultations.

Privacy-related issues and risk to sensitive medical data have also propped up in recent years as medical professionals, as well as consumers, engage with unsecured platforms not suitable for telehealth. Several technology companies without any experience in the healthcare sector are also getting involved in telehealth because of the financial incentives, negatively impacting overall telehealth experience and posing security risks.

• Geographical barriers

Only a few countries have clear regulations about international telehealth whereas many countries don't even address the circumstances in which a foreign practitioner remotely provides advice or care to local patients. Some countries, on the other hand, require a doctor to be licensed locally for practicing telehealth.

While licensing is necessary to ensure quality healthcare, there can be alternatives like exceptions where similar standards exist and mutual recognitions. Addressing geographical barriers is particularly important for countries where health infrastructure is overburdened due to a shortage of healthcare staff.

• Concerns over quality

Struggling with low adoption rates and shortage of doctors that are willing to be associated, telehealth app makers have started working with inexperienced and even unqualified individuals to provide services. Not only this lowers the quality of services but it is also unethical and can put patients in danger.

As mentioned earlier, technology companies or rather startups without any healthcare background have started getting involved in the sector which is negatively impacting the quality of health care delivery. Some of these startups are building a customer base to sell their company and make some profits, other startups have allegedly engaged unqualified individuals to deceive patients and exploit vague laws regarding telehealth.

• Cybersecurity

Cybersecurity is increasingly touted as one of the main challenges for telehealth since companies working in the sector deal with sensitive medical data. Technological developments in the sector aim to make healthcare interconnected so that it improves the efficiency of the system but it poses an increased threat to the data as well and could increase vulnerabilities.

Medical data is becoming increasingly lucrative as it makes it easier for cybercriminals to deceive their target and an increasing number of medical fraud is evidence of that.

• Lack of training

In many cases, healthcare staff isn't trained to operate high-tech devices that support the delivery of telehealth. Considerable disparities exist between demographic groups and lack of training could further degrade the quality and revenues of rural healthcare in case of widespread adoption of telehealth.

Many patients also struggle with medical devices and technology, hindering the community from achieving the full potential of telehealth because many cases would require patients to self-diagnose and report to healthcare staff.

• Lack of devices

To ensure high-quality delivery of healthcare, telehealth requires adequate devices capable of transmitting vital data and measurements to medical staff. Due to the low rate of adoption, these devices aren't mass-produced so they aren't easily available and even if they are available, their costs are exorbitant, making them unviable for many hospitals.

To unlock the full potential of telehealth and reaching patients at their homes, doctors require vital measurements like blood pressure, body temperature, etc, which require patients to also have at least basic medical devices at their homes.

Future

• Clinical protocols and workflows should be revisited

Telehealth can be beneficial for everyone, including hospitals as they can reduce costs and increase margins, giving them a reason to overutilize the benefits of telehealth. While telehealth has the potential to transform healthcare, it is not suitable for every case. Regulatory and ethical protocols for medical professionals should be revisited to ensure that telehealth is only utilized in appropriate cases.

• Investments in user-friendly medical equipment

To effectively consult patients over remote visits, doctors require measurements of vital signs. Technological developments can ensure that these signs are automatically transferred to doctors but patients would need to have these devices at their homes.

Investments in at-home equipment should ramp up as telehealth becomes mainstream. Mass-production of basic medical devices can help companies achieve economies of scale and make products more affordable. These devices are critical for doctors to ensure quality care for remote patients.

• Training

Many current educational courses for healthcare professionals don't include training for telehealth but it should be introduced so that the workforce is ready for the change and its full potential can be achieved.

Apart from using AI-powered devices that enable remote monitoring, doctors need to be trained to ensure that the quality of healthcare delivery is not compromised during video visits as it's possible to miss critical signs during remote patient care.

• Prescription issues should be addressed

Telehealth has made it easier to consult patients in remote areas but in many cases, it's reported that patients have trouble getting medicines on the digital prescription issued remotely. Because of the lack of adequate platforms, these prescriptions can also be exploited to get unnecessary drugs.

Framework and protocols regarding digital prescriptions should be made and apps that can generate immutable prescription files should be licensed for telehealth delivery.

• Regulations

Adequate and clear regulations for telehealth are important to ensure that it is facilitated but not exploited. Easy delivery and financial incentives of telehealth can lure inexperienced companies into the sector that will not only reduce the quality of delivery but also pose a threat to patients.

Regulations regarding payments and insurance policies are also important to ensure that there is parity between in-person and video visits so doctors aren't discouraged from using telehealth.

• Minimizing geographical barriers

Strict licensing requirements prevent physicians from providing care internationally and in many cases, these requirements were set for traditional healthcare due to concerns over quality. But modern telecommunication technology could forever change the delivery model and the reach of healthcare.

While licensing is necessary to ensure quality healthcare, countries can explore alternatives like mutual recognitions and exceptions where similar standards exist. Addressing these barriers is particularly important for countries where health infrastructure is inadequate or overburdened due to a shortage of healthcare staff.

• Cybersecurity and equipment regulations

Cybersecurity is increasingly becoming a problem for telehealth and vague regulations about equipment that can be used to collect the sensitive medical data further add to it.

Low-quality equipment might be cheaper but they increase vulnerabilities for hackers to exploit and might even be purposed for stealing data. The regulatory structure for the collection and storage of sensitive data is important to ensure that patients are secured from additional risks.

Centre of Excellence on Emerging Development Perspectives (COE-EDP) is an initiative of VisionRI and aims to keep track of the transition trajectory of the global development sector and works towards conceptualization, development, and mainstreaming of innovative developmental approaches, frameworks, and practices.