Virtual Healthcare: New Kid on the Care Delivery Block


Technology has transformed civilization in several ways and has become an integral part of our lives. Industrial Revolution, which replaced scores of jobs with machines and increased productivity by many a fold, was the harbinger of how advancement of technology transformed societies. Today, technology makes its presence felt in every walk of life, be it communication, education, food & drinks, financial services and productivity. And the healthcare industry is no exception.

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The discovery of X-rays, electrocardiograph, catheters and other technologies has made it possible to diagnose and treat patients in a better way. Great strides have been made in inventing microchip controlled artificial limbs with advanced materials, such as carbon fiber, high-tech plastics and light-weight metals. Computers too played a vital role in the advancement of modern healthcare. However, for a myriad of reasons despite all these advances, there are still many people who lack access to adequate medical care. This is where virtual or remote healthcare technologies (Telehealth & Telemedicine) and medical apps come into play.

The US Department of Health and Human Services (HHS) defines telehealth as broader in scope than that of telemedicine. Telemedicine is a subset of telehealth, which is the delivery of health care from a distance. In case of telemedicine, technology is be used to offer clinical services when healthcare providers and patients are separated by geographic distances. Telehealth not only includes clinical services but also medical training, research and administrative functions. Consequently, the American Telemedicine Association (ATA) interchangeably uses the terms, encompassing a wide definition of remote healthcare.

Emerging trends

The use of telemedicine devices, once a rarity, is now a common practice across the world. From diagnostic imaging devices, electronic stethoscopes and portable EKG appliances to medical software to telemedicine carts, telemedicine equipment solutions are completely changing the landscape of healthcare market. Health IT applications, such as electronic health records (EHR), administrative billing applications, desktops, laptops, handheld medical peripherals, and store and forward image transfer software, play a vital role in telemedicine and telehealth. Another latest emerging use of virtual technology in healthcare is robot-assisted surgery. The use of new technology in healthcare seems almost limitless from 3D printed prosthetics and medical implants to medical imaging.

Medical apps

Latest mobile apps allow doctors to carry out thorough retinal screenings. Psychotherapists also make use of mobile-based apps to monitor mentally ill patients on a computer screen and instruct them as needed. These technologies and other innovative applications are expanding the scope of virtual medicine to treat patients from afar. According to a recent study by US-based Kalorama Information, a division of MarketResearch.com, over the last decade there is a considerable rise in the use of medical monitoring (mHealth) apps in health industry. Several clinical trials are now increasingly using mobile applications as one component of the system. Diabetes and heart conditions are the most common areas of medical apps. In addition, cancer, obesity, pain, behavioral and mental health problems and respiratory disorders continue to witness increased adoption of telemonitoring.

The mHealth apps market witnessed growth from US$85 million in 2010 to approximately US$489 million in 2015 . Kalorama Information Publisher Bruce Carlson said:

“In terms of revenue, medical apps have grown a tad bit faster than other app categories. Price and a willing user base are factors.”

Software Advice, an Austin-based company which provides detailed reviews, comparisons and research to help organizations choose the right software, conducted a survey and found that 73% of patients are comfortable with their electronic health records (EHR) being accessible online. However, patients also expressed concerns about potential privacy violations of health information exchange (HIE).

Reaching out to rural areas

As there is a dearth of hospitals in rural areas, virtual healthcare technology is fast emerging as a replacement for waiting rooms and is leading to treatment of rural health patients in a cost effective manner . Many patients in rural areas still find it difficult to travel to clinics or hospitals. With the help of video conferencing and other telemedicine technologies, doctors can evaluate, diagnose and treat patients and thereby cut the costs associated with regular visits. Even after discharge, patients can be monitored, allowing uninterrupted communication between healthcare practitioners and patients.

Navigating the cost curve

In the US and Europe, companies and large hospital systems conduct video conferences with the help of telemedicine technology to connect specialist doctors and hospitals with patients and insurance companies. According to a report by investment bank RBC Capital Markets, telemedicine technology has the potential to save approximately US$60 billion a year by reducing around 67% of unnecessary emergency room visits and replacing 33% of physician visits. The US$250 million US telemedicine market is poised to reach US$20 billion over the next 10 years, and could reach US$50 billion as hospitals and insurers increasingly use the technology to monitor elderly patients and those with multiple chronic conditions, RBC report said.

Telemedicine works well for patients with chronic diseases or disorders, who require continuous monitoring and stay far away to make multiple trips to consult the doctor. Diabetes is one disorder that is really suited for remote healthcare as its diagnosis and treatment essentially depends on analysis of data and focuses on maintaining blood sugar level.

The below image based on a PwC report illustrates how virtual care in diabetes management can dramatically reduce costs.

Source: http://www.pwc.com/

Source: http://www.pwc.com/

American College of Physicians: Face-to-face contact necessary

With a slew of benefits such as decrease in costs and improved efficiencies, more and more healthcare organizations are gradually adopting telemedicine and telehealth. However, not all healthcare providers are in favor of universal acceptance of virtual healthcare technology. The American College of Physicians (ACP), the largest medical specialty organization and the second-largest physician group in the US, stressed the significance of balancing the benefits of telemedicine against its risks. In 2008, ACP published a position paper,

“E-health and Its Impact on Medical Practice”

. In that paper ACP observes:

“ACP believes episodic, direct-to-patient telemedicine services should be used only as an intermittent alternative to a patient’s primary care physician when necessary to meet the patient’s immediate acute care needs.”

ACP president Wayne Riley said:

“Telemedicine – the use of technology to deliver care at a distance – is rapidly expanding and holds the potential to improve access for patients, enhance patient-physician collaboration, improve health outcomes, and reduce medical costs. However, the potential benefits of telemedicine must be measured against the risks and challenges associated with its use, including the potential absence of the physical exam, variation in state practice and licensing regulations, and issues surrounding the establishment of the patient-physician relationship.”

Reimbursement conundrum

According to industry analyst at IBISWorld Sarah Turk the telemedicine boom is facing some stiff challenges and several health insurance firms are still slow in reimbursing for these services. Against this backdrop, experts opine that as technology has developed in monitoring patients in a better manner insurance firms have to reassess their payment criteria. On the other hand health policy analyst and professor at the Harvard TH Chan School of Public Health Dr. Ashish Jha says that health insurance firms have every reason to be hesitant. Dr. Jha points out that even though telemedicine offers good access to medical care it leads to more tests and follow-up visits.

Scenario in India

India is the second most populous country in the world, with over 1.27 billion people. However, the country has only 0.7 physicians per 1,000 people . In comparison, other BRIC nations Brazil, Russia and China have 1.5, 5 and 1.5 physicians per 1,000 people. As almost 70% of India’s population lives in rural areas and vast majority of doctors live in cities, visiting a specialist doctor is almost impossible for most of the patients. In addition, there is no nationwide health insurance policy in India and there is a wide gap in terms of quality and access to medical care between urban and rural areas. This can be rectified if telemedicine is adopted into the existing healthcare delivery system. Moreover, with around 976 million mobile phone connections and over 300 million internet users, experts are of the opinion that wireless technology can be best used to decentralize the nation’s healthcare industry, which is expected to touch $250 billion by 2020 .

The Indian telemedicine market has recorded growth over the last four years primarily due to the timely convergence of information and communication technologies (ICT) and healthcare, along with introduction of central e-health plans by the Ministry of Health & Family Welfare. Off-late Skype, biometrics and M-health (use of mobile phones) all forayed into India’s primary health centers (PHCs).

In India, most telemedicine activities are supported by the Indian Space Research Organization (ISRO), the Department of Information Technology (DIT), Post Graduate Institute of Medical Sciences (PGIMER) and Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) and few others are being launched through state government funding. Attracted by lower costs and a pan-India reach, hospital operators such as Apollo and Fortis forayed into telemedicine. Mediphone (a countrywide medical phone service formed by a strategic alliance between Airtel and Religare Technologies’ division Healthfore), health portal MediAngels and iClinic are some of the organizations that offer telemedicine services in India.

Initial prohibitive cost of adopting solutions, lack of clarity on return of investment and standardized technology platforms, and non-availability of a best-practices repository are found to be some key barriers to large scale adoption of telehealth and telemedicine solutions in India. To encourage the adoption of these services in the country, there is a need of creation of standardized technology platforms, and best-practices repository and knowledge-exchange platforms, improvement of existing legal frameworks and increased public-private partnerships.

Remote healthcare (both telemedicine and telehealth) is sure to transform healthcare delivery in India sooner rather than later. The body of evidence in support of remote medicine and its outcomes continues to mount in favor of remote healthcare and the resultant huge cost savings cannot be overlooked. The enhanced communication between healthcare practitioners and patients it facilitates is bound to make remote health technologies an integral part of several healthcare organizations. For that to happen, tele-diagnosis should be followed up by appropriate referrals for investigations and subsequent management, and introduction of universal insurance is an absolute necessity.

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