TeleHealth: A critical look at its uses and limitations
HealthTech is an explosive industry in which the latest advancements in technology, such as smartphones, cloud computing, and Artificial Intelligence are applied to solve the many information gaps in healthcare and fast- track care delivery. TeleHealth is a specific form of HealthTech that entails remote monitoring, mHealth, tele-treatment, online services, and tele-collaboration, in which various care providers can communicate through a single platform. Unsurprisingly, TeleHealth is drastically improving access to care in emerging markets, in which physician-densities are sparse and the number of facilities are limited. In developed economies, such as Singapore, Japan, and Hong Kong, TeleHealth accommodates the rise in ageing populations in which the elderly benefit from monitoring their conditions at home, and receiving real time support from physicians. Frost and Sullivan predicts that TeleHealth market in Asia-Pacific is expected to reach US$ 1.79 billion by 2020, with an annual growth rate of 12%.
The emergence of TeleHealth proposes tremendous advantages to Asia’s developing nations due to an absence of healthcare services in third-tier cities and rural areas. mHealth, a subsector of TeleHealth, allows users to access doctors and receive live video consultations from their smartphones. Practo, the leading TeleHealth platform in India, allows smartphone users all over the country to access doctors and specialists, and boasts over 40 million medical appointments per year. The platform addresses the scarce doctor-patient ratio in India, in which one doctor exists per 1,681 individuals, particularly in rural and remote areas. TeleHealth, which extends beyond the use of the smartphone, has also revolutionized diagnostic and treatment processes, improving access to services in emerging markets. LifeTrack Medical Systems is a tele-radiology service based in the Phillipines, that addresses the deficit of expert radiologists in Southeast Asia’s developing nations, in which radiologists make up only 1% of practitioners. The technology enables doctors in emerging markets to send X-rays and scans to senior radiologists overseas to obtain accurate diagnoses on a patient’s condition.
TeleHealth does not only prove to be fruitful in economies in which the supply of healthcare services is subpar. In developed economies such as Singapore, TeleHealth platforms can maximise remote monitoring services and minimise inpatient visitations and acute deteriorations that lead to emergency units or hospitalization. These platforms thereby increase efficiency of services and reduce overall costs in the long-run. TeleHealth will be of service to the rise in Asia’s ageing populations: in Singapore, senior citizens are predicted to make up 20% of the population by 2030. Digital technologies will therefore assist in the management of specific patient populations, and bridge the relationships between patients and doctors. Also known as tele-monitoring, doctors can check in with patients to manage their condition and inform them when they need to come in for a visit. The National University of Singapore is trialling a tele-rehabilitation program, in which stroke patients can use their iPads to have video consultations with their doctors, and doctors can guide patients towards certain exercises to regain their movement. Motion sensors are placed to track a patient’s metrics, and the data is captured on the TeleHealth platform for the provider to track the patient’s progress. The Singapore Ministry of Health, in collaboration with a commercial platform provider and SATA CommHealth, are piloting a tele- monitoring service targeted towards a community of indigent patients.
While the application of TeleHealth is promising, and tackles the many inefficiencies in today’s healthcare system, there are several barriers to its implementation, especially in developed nations where there are more regulations and guidelines towards the usage of technologies. The most obvious limitation regarding TeleHealth is the inability for new patients to formally register via a TeleHealth platform to a specific clinic. TeleHealth platforms lack a proper registration interface, and patients cannot prove their identity without transmitting photos of their passports or identity cards, which may be subject to fraud and/or identity-theft. Furthermore, TeleHealth platforms hinder the ability of a physician to physically examine and diagnose a patient. TeleHealth platforms do not allow a doctor to perform a standard physical examination, which encompasses a standard four stage personal examination of the body in relation to specific complaints, or as a general medical examination. Clinical examination parameters may include a test for vital signs, and the condition of the heart and lungs, all of which are mandated at least in a patient’s first visit to the doctor, but also often subsequently in order to evaluate clinical progress. TeleHealth cannot facilitate the necessary physical examination procedures that accompany a fair number of health enquiries. Therefore, it has been concurred that TeleHealth can instead be implemented as a follow-up and routine care service, catered towards specific patient populations that need to monitor their condition, but do not necessarily need to enter the doctor’s office, to retain communication with their physicians.
While TeleHealth platforms may deconstruct communication barriers by enabling frequent and consistent interactions between patients and doctors, online interfaces do not improve the quality of the doctor-to-patient relationship. Doctors need to communicate information to patients sufficiently to enable them to exercise autonomy in deciding what treatment to receive. Through digital platforms, the information exchanged is highly fragmented and occurs in stages at each online encounter. Furthermore, the quality of doctor-to-patient relationships is not only shaped by information exchange and the overall output, but also a doctor’s ability to empathize with patients, and a patient’s body language. These factors of care cannot be executed or captured through a TeleHealth platform.
Evidently, the most advanced technologies cannot replace the necessary physical check-ups between patients and doctors. Furthermore, technology on its own can never be singularly held accountable for the delivery of care and patient outcomes. National healthcare guidelines will always state that clinicians are bound to their patients through a duty of care, in which clinicians are held liable for all aspects of care delivery, such as information exchange, follow-up procedures, patient records, and ordering tests. As a part of the clinicians’ obligation to their patients, doctors must conduct preliminary evaluations to ensure that their patients are prepared to, and are capable of engaging with a telemedicine platform. According to Singapore’s National Telemedicine Guidelines, healthcare providers must ensure that “the delivery of care via telemedicine must not compromise the overall quality of care provided as compared with non-telemedicine delivery.” Therefore, care providers must be confident that their patients are trained and well-equipped to use TeleHealth platforms- be it apps, devices, or cloud infrastructures- with precision.
In theory, patients should be up-to-date with the latest technologies, but in practice, that is not the case. Dr Chi Chiu Tan, a Gastroenterologist at Gleneagles Medical, a Council Member and Chairman of the Medical Ethics Committee of the Singapore Medical Council, and a member of the committee that drafted the National TeleHealth Guidelines in Singapore, clarifies that much of the sick and elderly patient populations that require telemedicine services such as tele-monitoring and tele-rehabilitation are not familiarized with the latest technologies, and require hands-on training to engage with such platforms.
To conclude, TeleHealth technologies have the capacity to improve the accuracy and delivery of care, and enable real-time access to doctors and care providers. However, TeleHealth cannot displace traditional medical services on its own, as there are many facets to care provision that require a hands-on approach to render the most optimum quality of care to patients. TeleHealth could work as a supplement to traditional practices, and could be applied to patients suffering from chronic ailments and who need consistent feedback from doctors. For TeleHealth to reach the height of its potential in developed markets, it would need an advanced registration interface, that could bypass a multitude of data-protection and identity-theft concerns that accompany current TeleHealth infrastructures.
Authored by: Dr Chi Chiu Tan
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