At the Hospital Leadership Summit 2017, Dr Kevin Lofton, CEO Catholic Health Initiatives, revealed telehealth, and telemedicine, to be the first tool in his New Healthcare Toolbox – a collection of major healthcare trends that have the potential to improve healthcare delivery.
Telemedicine refers to the clinical application of technology for providing medical care over a long distance. Telehealth, a broader term, encompasses the range of applications in the field, incorporating patient and professional health-related education and training, and health administration. Telehealth can bring basic patient care to areas where it is a luxury. Dr Lofton gave the example of rural hospitals under CHI that are now served by e-pharmacists, e-nurses etc. through telehealth. The trend is fast picking up in the USA, where about 71% of healthcare providers use telehealth and telemedicine tools in their practice. The subject was also a topic of discussion at the 2017 Medicine 3.0 town hall.
Traditionally underserved populations stand to benefit tremendously from telemedicine in terms of savings, time and travel. Telemedicine has immense potential in India, where the bed-to-patient ratio is extremely skewed. Successful examples in India include Apollo Telehealth Services and Kokilaben Dhirubhai Ambani Hospital (KDAH). The former offers regular clinical care and emergency aid at its two remote centres in Himachal Pradesh. It is equipped for scanning / converting, transformation and communicating the patient’s medical information. KDAH, meanwhile, operates its teleclinics in Surat and Rajkot, where a specialist is made available every day (as per a rotating calendar) to interact with patients and monitor and evaluate their progress. The two teleclinics have reduced the rush of patients from these cities to the main Mumbai hospital.
Healthcare providers who seek to integrate telemedicine in their services should consider the following:
- Clarity over purpose - Determining the reason - such as improving patient outcomes, attracting consumers, reducing costs and expand reach etc. - helps in better planning of operations, such as selection of telemedicine solutions and identifying the site of care (outpatient, inpatient, ER etc.).
- Educating and training – Communicating with the team can go a long way in making the adoption of telemedicine smoother, especially with regards to physician resistance. The distance and inability to physically examine the patient may make some physicians wary. But telemedicine equipment and software are getting more and more sophisticated, making teleconsultation, telemonitoring, tele-home-health monitoring and remote assistance in surgery possible. Legal and regulatory issues, operations and technological aspects of telemedicine are other areas where providing clarity helps.
- Capital expenditure - Presently perceived to be prohibitively high, capex for telemedicine is only expected to decrease as telecommunication infrastructure improves. Audio-video equipment and clinically certified digital variants of stethoscopes, microscopes, 12 lead ECG, glucometers etc. are already available in the market. Third party telemedicine providers such as HealthFore, HealthPresence, Polycom etc. also offer end-to-end, and often customised, telemedicine solutions that can help reduce capital expenditure.
- Return On Investment - ROI on telemedicine goes beyond just revenue. To understand the full benefits of telemedicine, the metrics must account for reduced readmissions, reduced outreach expenses, reduced care management expenses due to remote monitoring, continued patient engagement and the rise of out-of-network patients in the healthcare system.
As far as patients are concerned, the popularity of mHealth points to people getting comfortable with telemedicine in daily life. Apps and devices that track fitness, sleep, diet etc. have achieved mainstream usage, while online drugstores and appointment-booking services are fast gaining mainstream acceptance too. The mHealth marketplace is likely to get populated by even more complex apps in the future, the data from which can be consolidated for better healthcare delivery. The current 4G platform, moreover, supports two-way video, enabling doctor-patient communication that most closely resembles face-to-face consultation. With increased penetration of 4G and greater accessibility to mobile devices in India, the healthcare of the future no longer needs to be inaccessible to those who need it.