The COVID-19 pandemic has brought severe challenges to the healthcare sector, with the two having battled head-to-head since the crisis began. Amidst the many tales of grim that dominated the news, a much-needed transformation accelerated through the healthcare sector, laying stories of inspiration and a promising new foundation. From telehealth expansion, the deployment of temporary hospitals to remote consultations and even tele-rehab – remote-care technologies ably took the lead. We’re in tumultuous yet heartening times, where tragedy and desperation have sparked a healthcare revolution. Let’s dive in and understand the idea and reasons behind telehealth care and where this road can take us.
COVID-19 brought us to a nightmare of unimaginable proportions. The vulnerability of the healthcare fraternity was visible as hospital beds became scarce, and oxygen supplies were pinched to the extent that doctors were faced with unimaginable decisions – to choose between lives they must save or let die.
Such a scenario also meant that in-patient visits, a common part of life before the crisis, felt reckless, with people terrified of catching the virus. This created an unsustainable situation where people were prohibited from visiting clinics and hospitals, missing necessary care and facilities, exacerbating an already deteriorating healthcare situation. Additionally, the absolute thoroughfare of patients that medical teams handle daily revealed cracks in the traditional approach. It was high time for a change.
Where essential human interaction could prove deadly, a digital option in the offing, suddenly thrust into the limelight. Consider this – studies published in JAMA Network Open point out that the onset of the pandemic reduced in-person medical services by 23% in March 2020 and 52% in April 2020. At the same time, telemedicine services saw a rise of an incredible 4000% (yes, you read that right). Telehealth utilization has stabilized at levels 38X higher than before the pandemic. Fast forward, the total venture capital investment into the digital health space in the first half of 2021 totaled $14.7 billion, which is more than all of the investment in 2020 ($14.6 billion) and nearly twice the investment in 2019 ($7.7 billion).
Aspire had an opportunity to speak with Dr. Sarla Kumari, Specialist Physician at Canadian Specialist Hospital, who believes that apart from improving the experience of discrete services within the healthcare system; harnessing the benefits of interoperability through digital medium opens up more opportunities to integrate different parts of the system more effectively and give people more control over their own care. “Technology has brought about a massive and welcome change to the healthcare industry. Patients now have access to some of the best diagnostic tools, new and cutting-edge treatments, and a myriad of minimally-invasive procedures resulting in less pain and quicker healing,” she said.
Telemedicine, and Telehealth – An Overview
These two terms may belong to each other in certain ways but are not the same. Let’s clarify it for you:
Telehealth: Telehealth is an umbrella term that encompasses the entire industry and technologies that enable healthcare in the ‘tele’ space. This may include telemedicine, provider training, augmented reality surgery, virtual reality training, health education, etc. Simply put, telehealth forms the very top of the hierarchy. “A telehealth technology may be a telephone, it may be a video conference capability, it could be an IVR system,” explains Julie Cherry, RN, MSN, CCO for Care Innovations.
Telemedicine: Telemedicine is one of the many forms of telehealth and is referred to as ‘practicing medicine at a distance’. Detailing the role that healthcare specialists play in examining and treating patients, a few examples of this include provider training, administrative meetings, and continuing medical education, in addition to clinical services.
Telemedicine is delivered by the following central methods:
Remote Patient Monitoring (RPM) – A system of monitoring and transmission of vital signs, including but not limited to blood pressure, oxygen saturation, glucose levels, and heart rate. Be it blood pressure monitors, ECG devices, maternity care trackers, and other patient wearables akin to a smart watch – these non-invasive devices gather, transmit, process, and store patient data—so that clinicians could retrieve it anytime.
Interactive Patient Care (ICP) – patients and healthcare providers confer through telecommunication consultations, over the phone, or video.
Store and Forward – The ability to capture an image, video, and sound for better understanding and communication between healthcare providers and patients.
Key Benefits of Telemedicine
Access to healthcare has always been a challenge. Telehealth can take medical treatment to any part of the world at reduced costs, both for patients and providers. In scenarios where patients living near well-established medical facilities may still have to endure wait times for admission; telemedicine helps them avail timely treatment in the comfort of their home, significantly reducing or eliminating travel expenses and fewer missed appointments or cancellations. Healthcare providers are also easily afforded access to the day-to-day update of a patient’s medical history and data.
“Through 2020 and beyond, the pandemic made it harder for patients with chronic conditions like diabetes to keep up with their medication and regular check-ups. This had the potential to cause an escalation of symptoms, leading to further medical issues. Telehealth played a vital role in delivering uninterrupted care to comorbidity patients, including diagnosis, treatment, home blood-monitoring, delivery of prescriptions, and most importantly, consultation when needed,” said Joe Hawayek, Head of vHealth Middle East & Africa at Aetna International, while speaking to Aspire.
Dismissing fears of inferior care, Dr. Joe further stated that telehealth doctors are highly qualified and specially trained in telemedicine. These doctors provide the full range of primary care — they take patient histories, consider the physical and mental impact of varied afflictions, use accredited assessment tools to ensure an accurate diagnosis, and work with patients to determine the right treatment.
Let’s muse over a simple case of back pain. Treatment can look like different things – perhaps self-help techniques and lifestyle changes are sufficient —the patient may be advised to adjust their diet, exercise, and posture in the ‘working from home’ context, with a warning against comfort eating and sedentary behavior. Or the patient may require a face-to-face referral to a specialist for further assessment. This is more difficult to achieve if the patient is consulting more than one medical professional in isolation, as would be the case with traditional primary care. This approach is also vital, particularly in a post-COVID world where the number of patients with comorbidities has surged.
Dr. Sarla Kumari adds that telemedicine definitely benefits patients with chronic medical problems; once the physician’s initial stage of diagnosis and check-up is done in person, it can be followed up with online appointments. It can help people have frequent follow-up remote consultations for chronic illnesses, management of which can prove to be safer and easier than in-person experiences. Besides this, it can also be used effectively to diagnose and treat new and short-term issues well.
Across the Middle East, services like vHealth even take it a step forward by combining primary care with concierge-style diagnostics and prescription services, where patient samples are taken and medicines are delivered to the office or home door. These services can greatly expedite the testing and diagnostic process. Also, all telehealth consultations notes and diagnostic reports are securely available to the patient to refer to anytime via the app. Given the services, it is no surprise that 54% of UAE expats are enthusiastic about the use of telehealth services in primary care, higher than the global average, as per the recent research by Aetna International.
The Smartphone Edge
Given the rise in telehealth usage, we expect that technology will, in many cases, supplement in-patient care and make it more efficient. The above benefits that telemedicine renders are only more empowered by the prevalence of a technological medium that is quite literally now an extension of us. Smartphone application developers notice every trend, ready with apps that cater to our every need. A quick perusal of our tech article in last month’s edition will reveal how these applications and platforms make use of Internet of Behaviour (IoB) to track and monitor our habits and aspects of our well-being to suggest remedies or even direct you to a doctor.
These platforms are hardly in the emerging stage either. In July 2021, an app called ‘Abs workout’ registered 3.2 million downloads; another app, MFit, registered 2.6 million downloads from global users. ‘Headspace’, the most popular wellness app, registers millions of downloads every month. The Middle East and North Africa (MENA) region saw the second-highest growth in downloads, at a 55% increase, followed by Asia-Pacific with a 47% increase.
A recent study has shown that people who use fitness apps are far more active than those who don’t. Besides this, many people are just discovering the benefits of participating in fitness and wellness-based programs, thanks to the tremendous access and convenience that the digital mode offers.
Areas of Applicability
Despite the vastness of telehealth, it cannot fully replace in-person care. However, its influence is being felt across the healthcare chain, especially in a few trending areas:
The Mind Matters: Never before has mental health been such a mammoth challenge to handle. COVID created another ensuing crisis – mental health issues due to isolation, unemployment, and a veritable tango of death and disease around us that spared no one. Mental health services are a must and must be extended to all rungs of the population.
The silver lining here is that conversations around mental health finally became normalized and were recognized as critical. This has paved the way for a surge in teletherapy (digital wellness programs) courses offered online. Notably, many employers are offering the same to their ranks. While many wellness programs like yoga sessions, aerobics, and nutritional education were traditionally delivered in the past, they have now found incentives to go fully digital.
Virtual Reality Rehab: One of rehab’s profound functions is its ability to facilitate neuroplasticity – the brain’s ability to form and recognize synaptic connections. In normal parlance, rehab could help the brain recover from injuries and traumatic conditions as critical as stroke.
However, it is tedious; the mindless and repetitive tasks that people perform on a daily basis wouldn’t help their brains form any meaningful connections. The brain needs functional and meaningful goals to respond positively, which Virtual Reality can provide – a technology that delivers engaging content in an immersive setting. Market implementers suggest that a combination of visual and auditory cues from a Virtual Reality system could improve outpatient physical therapy.
Manoeuvring The Obstacles
Telehealth is a whirlpool that brings abundant benefits that can shape the future of healthcare, along with a few challenges that cannot be overlooked. To start with, the very medical strategy that is designed to provide widespread access to medical care cannot act as its own impediment. The prime objective should be to make certain that digital healthcare access is provided to the furthest corners of the world, to places historically devoid of healthcare infrastructure or capabilities. And before it is so extended, the intended consumers must be educated on what’s and how’s of the digital platform and its benefits. 5G is essential to enable continuous access to information with speed and efficiency.
COVID-19 has stormed in and changed lives, perspectives. Like every crisis period does, it helped us reflect on our many archaic ways and come up with practices that are proving a difference across the world. Telehealth is a revolutionary concept that can make this world a truly global village, a world that gives precedence to equity and affordability, where access to healthcare isn’t difficult or impossible, and home could be where healthcare resides with you.