Making Health Care Universally Accessible

The emergence of telemedicine as a core necessity

Can a case of the flu be diagnosed over Skype? Is it possible to learn the results of your computed tomography scan after midnight? Can a young mother receive care where a trained pediatrician can’t visit? The answer to all of these questions is yes. With the latest revolution in information technology and the availability of advanced computer systems worldwide, telemedicine has made all of this possible.

In the past few decades, hospitals have become smarter, safer, and more sophisticated, which has accentuated health care costs and generated a rural-urban health care divide. Telemedicine has stepped in as an instrument to bridge the gaps and provides the ability to exchange medical information, such as patient health records, using telecommunication technology, including video calls, smartphones, and wireless tools [1]. The use of telemedicine offers huge potential in disease diagnosis, consultation, monitoring, treatment, education, and management; thus, it makes the emergent intelligent health care infrastructure universal and more accessible to the common masses.

A brief history of telemedicine and related technology progression (from 1844 to the present): the inventions and innovations have been relentless and still continue today. The years after 1976 are the period of maturation and rapid growth of telehealth technologies.

A brief history of telemedicine and related technology progression (from 1844 to the present): the inventions and innovations have been relentless and still continue today. The years after 1976 are the period of maturation and rapid growth of telehealth technologies.

As most economies steer in the direction of unsustainable health care costs, telemedicine offers significant promise as an efficient health care delivery and management tool. Limited access to adequate medical care, especially in remote settings, the growing pressure of aging patient populations, increasing life expectancies, the increasing prevalence of chronic conditions, and the shortage of medical professionals continue to burden health care systems worldwide.

There is growing evidence to support the cost-effectiveness of implementing telehealth technologies. For example, a research article published by the Center for Information Technology Leadership in November 2007 observed that the savings generated by eliminating the transfer of patients between emergency departments could fund the installation of hybrid telehealth technologies across all emergency departments in the United States. The authors reported that 2.2 million patients are transported each year between emergency departments at a cost of US$1.39 billion and that telehealth technologies can avoid 850,000 transports at a cost savings of US$537 million annually [2]. Recent reports from HealthCursor Consulting Group observe that remote health care and E-health can give hospitals an easy return on investment with a lucrative profit margin in a short period of time. Health care operators such as Apollo and Fortis in India are lured by the pan-India reach, and lower operating costs have escalated their entry into the vast untapped domain of telemedicine.

Moreover, newer and smarter health devices have provided an impetus to the industry’s growth. Heart and blood pressure monitors can now wirelessly transmit the patient’s data to mobile phones or to a central online database accessed by telemedicine centers [3]. This has encouraged more academic research on point-of-care devices [4], and more companies are coming out with devices with mobile health care capabilities [5].

The consumer demand (see “Industry Outlook”) for high-quality health care has also played a fundamental role in the overall acceptance, as well as integration, of these technologies. In addition, patient satisfaction has gained vital importance in this expanding era of personalized medicine. Some studies suggest that telemedicine has been able to achieve high levels of patient satisfaction as it allows for easy and rapid access to health care. A study by Gustke et al. concluded that 98.3% of patients (n = 495) were satisfied with interactive telemedicine clinical consultations [6].

Industry Outlook

Modern computing, communications, medical devices, and health informatics technologies, when integrated in a holistic manner to create telemedicine and e-health services with skill development and business model, have the potential to solve the health care delivery problems that the large population of the world faces. Today, teleradiology can be considered as an established telemedicine model where technology, cost, quality, convenience, and information safety aspects have been addressed. Simultaneously, there is a range of areas where telemedicine practices are being newly applied. Some of these areas include, but are not limited to, ophthalmology, surgery, dentistry, dermatology, pathology, and public health. The success of public–private partnership programs offering telescreening services to rural and semiurban premature infants, viz., Karnataka Internet Assisted Diagnosis of Retinopathy of Pre-maturity (KIDROP) in India, stands testimony to the emergent trend. In this government-funded program, the health care industry provides medical expertise and helps in skills development, whereas technology companies provide the customized communications, storage, and computing services along with innovative features that improve diagnostic value of the information being communicated [7].

Another novel application of the telemedicine solutions has been found in continuing medical education (CME). CME that is vital for professional development is also a mandatory requirement for extending license practice in many countries. CME helps those in the medical field to maintain competency and learn about new and developing areas of their field. Currently, a significant portion of CME activities takes place as live events such as conferences, publications, and e-learning or online CME, which is a convenient, cost-effective alternative with the potential to reach a wider audience, and is expected to seize the majority market share in the near future [8].

(Input from: Hrushikesh Garud, Texas Instruments, India.)

According to GlobalData’s estimates, the telehealth and telemedicine market will increase at a compound annual growth rate of 14% to be worth an estimated US$32.5 billion by 2018. Telehealth pilot programs and regulatory and standardization initiatives to attract investment by private organizations have been adopted by governments in several regions of the world. One sector where telemedicine has been accepted rapidly is disease diagnosis. For example, teleradiology has witnessed considerable growth in recent years.

Teleradiology encompasses medical imaging information systems that improve the ease of capturing, storing, and exchanging medical images between providers, including remotely located medical practitioners and patients, through integrated electronic health records. Picture archiving and management systems equipped with clinical decision support systems enable the efficient management of remote diagnosis and faster clinical management. Teleradiology is gradually being adopted throughout the world to meet the growing gap between the demand for and supply of trained radiologists. Furthermore, it has also opened avenues for making specialists available around the clock. For example, if an emergency occurs at a time when European radiologists are not available, their counterparts in Asia can evaluate the patient to provide immediate assistance.

However, as with most new technologies, data security and privacy concerns have been raised and are key impediments to the adoption of telehealth solutions and services. Inadequate data security and transmission could lead to inaccurate diagnosis and erroneous prognosis. These issues negatively impact the overall utilization of telemedicine. In addition, the penetration of telemedicine solutions and services in the emerging markets is currently limited by the sparse availability of broadband technologies. As most of these developing countries have a significantly larger rural population, the low penetration levels and the associated higher up-front costs substantially limit the deployment of telehealth models. Thus, we can conservatively opine that, while the information technology-enabled approach to health care can virtually extend the services of the tertiary hospital to urban homes and remote rural health care centers, there is a sea of challenges—both technical and human factor related—that needs to be surmounted before we develop a truly intelligent system that connects the teeming millions across geographical boundaries.

References

  1. National Leadership and Innovation Agency for Healthcare. (2014, Aug. 14). FAQs. Telemedicine/telehealth. [Online].
  2. P. Eric, C. Cusack, J. Hook, A. Vincent, D. C. Kaelber, D. W. Bates, and B. Middleton, “The value of provider-to-provider telehealth,” Telemed. e-Health, vol. 14, no. 5, pp. 446–453, 2008.
  3. D. Lalmalsawma. (2014, June 4). Telemedicine in India might be just what the doctor ordered. India Insights. [Online].
  4. S. Mandal, K. Basak, K. M. Mandana, A. K. Ray, J. Chatterjee, and M. Mahadevappa, “Development of cardiac prescreening device for rural population using ultralow-power embedded system,” IEEE Trans. Biomed. Eng., vol. 58, no. 3, pp. 745–749, Mar. 2011.
  5. H. Garud, A. K. Ray, S. Mandal, D. Sheet, M. Mahadevappa, and J. Chatterjee, “Volume visualization approach for depth-of-field extension in digital pathology,” in Proc. 2011 4th Int. Congr. Image and Signal Processing (CISP), Oct. 15–17, 2011, vol. 1, pp. 335–339.
  6. S. S. Gustke, D. C. Balch, V. L. West, and L. O. Rogers. “Patient satisfaction with telemedicine,” Telemed. J., vol. 6, no. 1 pp. 5–13, 2000.
  7. A. Vinekar, C. Gilbert, M. Dogra, M. Kurian, G. Shainesh, B.Shetty, et al., “The KIDROP model of combining strategies for providing retinopathy of prematurity screening in underserved areas in India using wide-field imaging, tele-medicine, non-physician graders and smart phone reporting,” Indian J. Ophthalmol., vol. 62, pp. 41–49, 2014.
  8. J. M. Harris, B. M. Sklar, R. W. Amend, and C. Novalis-Marine, “The growth, characteristics, and future of online CME,” J. Contin. Educ. Health Prof., vol. 30, pp. 3–10, 2010.