Since the coronavirus emergency began, telemedicine has become an important tool for health providers. And although this has already existed for some time as a possibility of performing medicine, in recent months it has move from being a form of caring for the health of “the next generation” to revolutionizing the way in which medical care is delivered. So, is telemedicine here to stay?
It is a fact that this tool has demonstrated the ability to bring an essential service to anyone using communication technologies and digital information. This can benefit patients in isolated areas, rural areas, people with mobility problems, with few transportation options or with little time to get from one place to another. In addition to saving time, this type of consultation can also save costs for the health system.
On the other hand, telemedicine has opened the possibility of accessing specialized medicine with greater agility, which generates a positive result in diagnosis. In fact, in medicine is mentioned that patient’s history is 80 percent of the diagnosis; thus, virtuality allows the patient to be brought closer to a complete check-up – and even a solution – without the need to enter a medical facility.
According to a New York Times report, healthcare professionals should feel comfortable using this service, as it is the only way for remote appointments to be successful and worthwhile. In addition, it is necessary to train medical groups and equip them with the necessary technology, which includes a good internet connection.
This tool’s potential lies not only in bringing people closer to health, but also in making health services more efficient and better coordinated by documenting all appointments virtually. The use of telemedicine for providing a first diagnosis or continuity to a treatment is just the tip of the iceberg of this technology.
It can also remotely monitor emergency rooms or homes, remind patients when to take a medicine, send educational material regarding a disease or even implement artificial intelligence that detects diseases.
Medical specialties that telemedicine can address
Although not all patient diseases and conditions can be treated through telemedicine, there are many people who would benefit from it. But like all new technology, there are still many fields to explore.
In the case of chronic diseases, especially those of certain individuals who have stable conditions but must have routine check-ups, telemedicine is the ideal tool. People with diseases such as diabetes, high cholesterol or high blood pressure, are patients who can take advantage of telemedicine, especially at times like the coronavirus crisis, given they form part of the most vulnerable groups.
Likewise, this technology is ideal for consultations that happen to prescribe medicines that have been used for a long period, such as contraceptive pills, gastritis or chronic pain medications. Along the same lines, a check-up appointment for a short-term illness, such as a urinary or respiratory infection, or a check-up visit after a hospitalization, are ideal settings for virtual appointments.
On the other hand, a point that has come to light during the pandemic has been telemedicine for mental health care. In principle, these types of consultations were a response to strict quarantine in several countries. However, “teletherapy” proved to be effective to treat, for example, post-traumatic stress, depression and anxiety.
In addition, this new approach could also be useful for therapists to have a window into the patients’ homes, and for the latter to feel more comfortable because they are in their private space. However, there are some challenges in teletherapy, such as finding places with privacy or the lack of regulation for this type of consultation in some countries.
Even in countries like the United States, telemedicine has been useful to follow up people with opioid addiction during the months of the pandemic, expanding effective treatments and reducing deaths from overdose. In addition, this type of consultation has provided patients with privacy to face their addiction, something that did not happen when they had to go to a consultation in a hospital.
Furthermore, according to telemedicine expert Dr. Cynthia LeRouge, this tool can have more diverse uses when coupled with the delivery of medical devices to people’s homes. For example, a heart rate monitor, a Bluetooth device to monitor a person’s temperature, a device to remotely perform a simple operation, or a kit to test for certain diseases could be sent.
In summary, there are many areas that can be covered with telemedicine that go beyond a conversation with a healthcare professional. In the end, the most important aspect regarding this tool, according to the expert, is the possibility of taking any expert to a person who would otherwise have a hard time reaching.
Although this technological advancement is changing the way people receive health services, there are still matters that telemedicine cannot do. For example, sometimes a detailed physical examination is necessary, which may include taking a heart rate, checking lungs, or feeling an abdomen. Other procedures, such as removing skin lesions, inserting contraceptive devices or giving injections, are difficult to achieve from a distance.
More specifically, according to a study issued by the Inter-American Development Bank and the OECD, an obstacle could be the lack of professionals with the necessary skills and experience to perform virtual health projects. Also, the study highlights that implementing an infrastructure for virtual consults is expensive and, in addition to the initial investment, a sustainable model must be created so the systems can survive and modernize.
Likewise, there are limitations that go beyond the medical service, such as the lack of internet access, the high cost of electronic devices (smartphones, computers, tablets) where appointments take place, lack of electricity to be able to charge them, and even a poor cell phone signal that would not enable the telephone appointment.
On the other hand, direct regulation measures, also known as “command and control instruments” according to IDB and OECD, have been difficult to implement, especially in the Latin American region. This occurs because governments have regulated specific objectives in order to achieve the rendering of a virtual health service, without considering the ecosystem surrounding these appointments.
In this regard, strong protection of patient safety and privacy has lacked robust approaches to achieve widespread telemedicine adoption. Although the number of Latin American countries with privacy laws has grown, its application has been difficult because no country in the region has a comprehensive domestic privacy program. Only two countries in the region (Mexico and Uruguay) have an independent national data protection authority, while in the other countries this section forms part of a Ministry.
Finally, the lack of regulation for telemedicine, as well as the lack of a patient data protection and privacy system, does not allow patients to feel full confidence towards this tool. To achieve this, especially in the Latin American region, it is necessary to receive the government’s help, since they are the ones that can provide telemedicine the boost it needs.
Situation in Latin America
In the case of Latin America, according to Guillaume Corpart, CEO of Global Health Intelligence, there is very good hospital infrastructure. However, it is fragmented and has small players, which – for telemedicine – means that there are few hospitals that can become expertise centers or locations that may have the capability to acquire the technology needed to achieve telemedicine appointments. Despite this, telemedicine has made significant progress in the region.
A significant progress has been the penetration of this technology in the public sector, which is 30 percent higher than in the private sector, with countries like Chile and Uruguay leading the way in the region. According to Gustavo Menéndez, Director of Digital Transformation and Telemedicine for Cisco, this occurs because the public sector has had the capacity to invest in this tool and has been able to directly influence each country’s regulatory decisions.
Specifically, in countries like Peru, alliances between NGOs, Universities and Development Banks resulted in aiding more than 3,000 inhabitants in eight isolated communities in the Peruvian Amazon jungle. This was achieved because they provided the population as well as rural health centers with broadband services.
Colombia, for its part, has held more than 9 million telemedicine appointments since the coronavirus crisis began, increasing virtual appointments by more than 7,000 percent compared to last year. Likewise, the Ecuadorian government set up a “call center” so people could have access to an appointment through telemedicine in case they had a respiratory problem.
In the case of Argentina, the use of telemedicine in the public sector was already routine, mainly to enable appointments with specialists who are located in distant provinces. Also, it is common for virtual appointments to be used to get second opinions from a health professional. In addition, the country has a National Telehealth Plan and a Telehealth Advisory Council, which aim to promote programs that facilitate the use of this technology and create all-around good practices.
Experts such as Juan Blyde of the Inter-American Development Bank (IDB), suggest that the entire region’s common language (except for Brazil) be used to perform cross-border tele-appointments. In situations such as the Guayaquil hospitals’ collapse during the pandemic or after a natural catastrophe, other countries can help leverage the health system in order to avoid greater repercussions.
The coronavirus pandemic has opened the possibility of using telemedicine in Latin America as a daily and common tool, and its use will drive its innovation and coverage in all countries. Like all technological tools, it still has many fields to explore and possibilities to offer patients, but there is no doubt that telemedicine is here to stay in Latin America and around the world.
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What can you use a telehealth consult for and when should you physically visit your GP?