Telehealth has been around for nearly 150 years, but until recently, it has primarily been leveraged by those, isolated from the rest of the world, by the measure of geography. Researchers in Antarctica and Australians living on remote cattle stations have been the typical candidates for telehealth in the past. Now – it is literally anyone living on the planet.
The COVID-19 pandemic has shifted our societal sense of normality. Not since the Spanish Flu, more than 100 years ago, have we witnessed deaths, worldwide, concurrently, from one disease. Amidst the tragic pandemic, one positive that is arising is the evident transformation of the healthcare system. After the COVID-19 crisis, healthcare will not be the same, and telehealth will take a central role in keeping us alive and safe.
A history of telehealth
The origins of telehealth stretch back to the day the modern telephone was first tested. On that famous day in 1876, Alexander Graham Bell spilled acid on himself – and called out for help, his associate Mr Watson hearing him through the telephone.
Just three years later, in 1879, an early telemedicine instance was evident in The Lancet where an anonymous writer describes a doctor providing a child with a successful diagnosis over the phone in the middle of the night, giving rise to the notion of Remote Patient Care. Telehealth is also evident in the American Civil War with the use of telegraphs to deliver medical care to soldiers.
In the early 1900s, wireless communication began to emerge. Remote areas increasingly made use of radio communication to deliver healthcare. The adoption of radio in telehealth is also evident with the Royal Flying Doctor Service of Australia.
Telemedicine was vital to monitor astronauts in space, so spacecraft and spacesuits included telemedicine capabilities. Likewise, within this period, the promotion of telemedicine and telehealth is evident in North America.
The Nebraska Psychiatric Institute made use of television links for educational and consultation purposes to enable two-way communication with the Norfolk State Hospital in 1964. Additionally, the Logan International Airport, located in Boston, linked their in-house medical stations to Massachusetts General Hospital in 1967 to provide consultation services to patients.
During the 1980s, various hospitals in North America launched telehealth initiatives. During this time NASA also started experimenting with their ATS-3 satellite, eventually starting their SateLife/HealthNet programme to increase developing countries’ health services connectivity.
The early 2000s saw the dawn of an immense acceptance of technology, such as the use of the Internet – as seen with the dotcom boom, where investors put significant sums of money into Internet-based startups. Today, the increase in portable devices, mobile devices, high bandwidth wireless availability, and other relevant innovative technologies, are making telehealth more accessible than ever.
The impact of COVID-19 on Telehealth
As the number of COVID-19 patients dramatically rises globally, the use of telehealth services is rapidly on the increase. Through telehealth interfaces, patients can consult with doctors via the phone, video or direct messaging. The use of telehealth services enables patients to avoid being physically present at hospitals if they are showing symptoms of COVID-19. However, the increase in telehealth services presents two main challenges for providers, namely access and capacity.
In Australia, those in isolation due to the virus have access to telehealth screenings with the new Medicare item for telehealth. These services are bulk billed and available for medical personnel to deliver services over the phone or video conference.
In the United States, most patients with private health insurance can access telehealth screenings for COVID-19. In some states, there has been an expansion in Medicare to cover telehealth, where the elderly can gain at-home access to care. As time goes on, we can expect remote treatment to expand to an increasing number of patients in the USA, and of course to other affected countries.
Telehealth uptake by General Practitioners
Before the pandemic, the use of telehealth by US General Practitioners in urban areas was minimal. But, with the widespread social distancing measures, new patients are signing up for telemedicine apps, for a variety of reasons, not just COVID-19 related.
In the United States, telehealth physicians must be licensed in the specific state where the patient resides. This, limits practising across state lines and hinders the reach of telehealth apps. Regulatory barriers such as these have previously prevented the United States from fully integrating telehealth into their healthcare delivery system. We see many such regulations being challenged owing to the current pandemic.
In Australia, General Practitioners who are at increased risk from Coronavirus can now use telehealth for all consultations with their patients amid the ongoing coronavirus outbreak, without impacting government funding. This unprecedented change in policy, announced by the Australian federal government in late March 2020, opens the door to new and innovative telehealth applications and practices to be developed and adopted. Again, we expect to see this regulatory shift continue, and likely persist well beyond the pandemic.
How the technology powering Telehealth will change
There are various methods of telehealth, including live interactions, store-and-forward telehealth systems, remote patient monitoring (RPM), and mobile health. All of these are under pressure to change and adapt right now.
Live interactions are video-based and are made available due to video services. Live video telehealth technologies include online video conferencing systems, patient assessment applications, and patient portals.
With video services, a patient and a caregiver can interact in real-time without being in physical proximity. Consultations, patient observation, patient monitoring, health education, and training are all possible via live video.
Benefits of live videos include an increase in accessibility and a reduction in costs. It gives isolated communities the chance to receive healthcare services. Doctors can also collaborate with video conferences to assist in the remote diagnosis and treatment of patients.
However, these pros come associated with downsides. For example, this technology requires a dependable power supply and a stable Internet connection, which is not always available in remote areas. Video conferences need specialised data management equipment, and doctors need technical training when engaging in video-based interactions.
We foresee governments provisioning better Internet bandwidth and ensuring better network uptime, to facilitate reliable delivery of live interactions. We also see medical practitioners being trained to use video and other live formats as a core part of their initial training.
Store-and-forward telehealth systems include collaborative patient assessment applications, web-based systems, EHR systems, and mobile applications for uploading data. These systems have numerous advantages like better access to information where several hospitals can share and discuss information, more effective patient-doctor communication, an improvement in professional education, and the enablement of second opinions via the sharing of MRIs and X-rays. In addition to this, there is an increase in the accessibility of electronic health records.
Disadvantages of store-and-forward Telehealth include the possibility of low-quality records giving a rise in faulty clinical treatment, poor Internet speeds making effective communication challenging, the inability to provide immediate treatment, and the requirement for a high-quality security module in all software solutions.
We already see an increased uptake of these systems – particularly for hospitals, public health professionals, and governments collaborating to track and report on the incidence of COVID-19 infections. As more countries, states, and medical practitioners need to collaborate through this time, they will get increasingly used to, and dependent on, store-and-forward telehealth approaches.
Remote patient monitoring (RPM)
Remote patient monitoring (RPM) is mainly for chronically ill patients but is expanding to monitor potential symptoms of illness. Telemedicine refers solely to clinical health care services, involving electronic monitoring and digital communication, whereas telehealth refers to a broader scope of remote health care services. Telemedicine technologies include special devices and sensors that transmit biometric data to servers or the cloud, medical devices with short-range sensors, mobile applications, and specialised platforms.
The collection and transmission of patient data to a provider takes place in another location for support. Patients have better control and understanding of the condition, while clinicians, address any adverse changes promptly.
The benefits of RPM include an increase in attention of at-risk patients, continuous patient care, proactive communication, more effective nurse availability, and better patient engagement. Disadvantages, however, include the need for specialised medical devices, the safety and protection of data transmission, and the possible faults that come with monitoring devices.
Again, more RPM solutions are being leveraged at this time, especially to monitor high-risk patients not yet infected with COVID-19. We see this trend continuing, as our population ages, and a greater ratio of patients require monitoring.
The final type of telehealth service we will mention is mobile health. With mobile health (or mHealth), health care takes place through smart devices. mHealth solutions include mobile-enabled connected medical devices, mobile apps, and wearables.
The advantages of these are the improvement in accuracy, efficient diagnosis, better patient commitment and workflow support for practitioners. Disadvantages are data security, the need to continuously update apps and the fact that there is no unified and formalised system. Some of these apps also run foul of outdated legislation, as mentioned earlier.
Necessity is the mother of invention: as we need to use mobile health to help with this pandemic, the slow wheels of government will get a boost. This will pave the way for increased usage in future years.
What next, after COVID-19?
The Coronavirus pandemic has driven technology adoption for a wide array of purposes. These include remote workforces, social networking, self-service diagnostics, real-time communication and telehealth and telemedicine. Work is rapidly changing from an in-person norm, to a digital default.
Paper is decreasing in relevance, and digital technologies are becoming core. Physical location is becoming immaterial. Digital accessibility is increasing in significance. COVID-19 is giving us a glimpse of the future of healthcare.
We believe the future of healthcare is telehealth – and the future of telehealth is the cutting edge of patient-centred care.
Fluffy Spider Technologies builds custom software solutions for the healthcare industry, bringing together specialised medical devices and cloud services. We work closely with our clients to take ideas to a cutting edge commercial reality. In the telehealth space, we have partnered with world-leading Australian company, Visionflex, to bring their devices and cloud products to market. Get in touch with me for more information on healthcare software, advice, or to discuss new product concepts.