The acceleration of telemedicine and its challenges for adoption

Telemedicine is booming around the world and Bart Collet provides us with his insight on why, what’s happening, and the challenges ahead. Bart is the founder of Hyperadvancer, a healthcare innovation  company focused on super fast delivery of concrete results. He has vast experience in running a nursing home, and was the co-creator of healthcare hackathons (Hack4Health, Hack Epilepsy, and mHealth Hackathon).

In his role as innovation Architect at in4care, Bart is hosting the Beyond Telemedicine track of Hack Healthcare.  The track will explore new technology applications for patient monitoring and consultations, and develop business models for novel telemedicine use cases. These are the two challenges that this track is tackling: 

• Expand hospital services with telemedicine: Develop new telemedicine-based services that would help hospitals free up more time for empathy with patients, deliver overall better standard of care and generate new revenues.

• Integrated cancer patient pathways (Hosted by MSD): Provide cancer patients with a more convenient and connected patient care experience by offering a personalized, integrated care pathway including off-the-shelf telemedicine solutions, especially tele-consultations.

If you want to tackle the challenges that hospitals and care providers are facing, come to Hack Healthcare 2021.

Why is telemedicine relevant now? What is enabling the accelerating trend of telemedicine? 

Well, my short answer is Covid and the corona crisis.

The technology was already available. If you look at the tools that were available, let’s say 10 years ago, the technology was there to enable video calling and to have a call with your doctor. There was a startup in San Francisco (Sherpaa) which was fully digitized. They had the technology to monitor, to fire sensors, smart watches… It was probably not 100% ready, but it was available in the market. Why is technology enabled telemedicine not widespread? Why isn’t everyone using it?

It is because of a legion of stakeholders that is less interested in those solutions for various reasons; it is because the legacy infrastructure is not up to date, which makes it difficult for external devices and sensors to get that data into electronic health records. Sometimes it is because of reimbursements, as a telemedicine consultation isn’t reimbursed by the national or regional healthcare system.

Another reason is fear: fear of the unknown, fear of cybersecurity threats, privacy, and – the elephant in the room – of the liability.

What happens if my client asks for an interview or a teleconsultation? We see each other, but we may be telling something wrong to each other, or the doctor may be giving the wrong diagnosis. The patient may have recorded the call and could end up suing the doctor because he or she thinks that there was a misdiagnosis.

The COVID-19 epidemic has advanced innovation by 10 years. What we foresaw that would happen within 10 years has happened in a couple of weeks. And this is something I keep seeing again, and again, and again. Because this is a prolonged crisis, a prolonged pandemic situation, the healthcare ecosystem and particularly healthcare practitioners have been forced to use those solutions for a longer period. Out of pure necessity they’ve seen that telemedicine has its benefits, and they got feedback and reimbursements.

Secondly, they see that their clients are applauding this new way of doing things, certainly people with chronic diseases who previously needed to go to a hospital multiple times per week and had to plan their lives around that. Now they can get the help they need from their homes, without a cumbersome commute.

Right now, healthcare practitioners are seeing that people with chronic diseases – who make up about 70% of the cost of healthcare – find this service much more easy to use, and it doesn’t interfere with their daily lives so much. They see the benefit.

There’s an explosion of telemedicine tools now, of care paths and digital tools that can help patients also in their recovery and rehabilitation paths, being used in a widespread manner.

Today there are a lot more technology and startups, there’s more choice. Today’s tools are more accurate. Today, for example, you can have your 6-lead electrocardiogram (EKG), in your home with a device that costs only $190. This kind of evolution helps tremendously in the rollout of telemedicine.

What is needed for telemedicine to be fully adopted? 

Trust.

People need to trust that the data is safe, that medical devices function properly, that an algorithm is going to augment them instead of replacing them, that legislation will help them (certainly from a from a health care practitioner perspective, that they aren’t going to be sued), that practitioners won’t be liable for that algorithm’s mistakes, that the technology is trustworthy and won’t be used for other purposes… We need this kind of fundamental trust in the system to enable the healthcare solution provided by telemedicine.

People and governments are weary of trusting Big Tech with medical data. Some people think that this will be similar in healthcare.

If you have a hammer (technology), you can use it to build a shelter for the homeless, but you can also use it as a weapon. We need an agreement, a fundamental protection for everyone involved, a set of guidelines and rules about the use of technology for the short and the long term, so that everyone can trust the system.

Maybe tools like blockchain or distributed ledger technology could be used for building trust, for example with non-fungible tokens (NFT) or time-stamped smart contracts that can make a process like medication prescription nearly frictionless, secure, transparent and safe.

If there is no trust, there’s no deal. There’s no innovation. There’s no patient-driven healthcare that is going to be enabled.

People should really think through what happens once that trust is enabled. Once we all receive our data, there will be an explosion of new businesses. Once we have our data, and someone can do something with it, we will have more personalized medicine. We should own our data, and it should be enriched with data from medical professionals, companies, and health services. It should help me live a better life.

Who do you think should be accelerating telemedicine? Will they do it?

I don’t think this is a single organization, it is an entire ecosystem that needs to take one step at a time. You can’t change an ecosystem with only one player. It needs the industry participants and the legislators (as in the creation of the European General Data Protection Regulation GDPR).

When Covid happened here in Europe, we suddenly realized that we needed to adapt, to take all kinds of measures, and to change policies. This is when change happened because we humans tend to delay things until the last minute.

The response to Covid is a joint effort of all stakeholders: hospitals, legislators, insurers, practitioners, patients… We’ve all needed to change our habits, and this does not come without friction. Some patients prefer to go to the hospital when asked not to, when asked to use telemedicine. Some are digitally illiterate, some don’t have the device needed for the call, some don’t have internet access… Everyone needs to be on the same bus, and these people should be helped too.

Do you think the spread of telemedicine will keep on accelerating? 

Absolutely. More people are getting accustomed to it, and more people will use it and deploy it. Imagine you were the manager of a hospital, and you would give me as a patient a health companion application (app). It is just an app on my smartphone, which enables me to ask questions and to aggregate my data, because my smartphone knows everything about me when I move or sleep. You also provide me, the patient, with information about my medical examinations, my lab results, and so on. And there’s also a telemedicine component in there for a regular checkup, or maybe just to reach out.

When I need to reach out to the hospital to see a physiotherapist because I have a sore shoulder, I can just use the app to talk with the therapist and show where it hurts. The physiotherapist may be able to give me some exercises, and, if it doesn’t help, tell me to come by your hospital and make an appointment with the app. This would increase the hospital’s turnover (fees and services), which could be five to six times higher than a hospital that did not use those technologies.

From a healthcare organization perspective it makes sense to have more interactions through a health companion app with patients, even when they are traveling.

Increasingly, healthcare organizations will invest in telemedicine because they know that if they don’t people will flock to other healthcare organizations that offer this convenience.

And what about the business model of healthcare providers? 

I think the hammer analogy is once again useful here. Hospitals may have a magnetic resonance imaging device (MRI) that has cost you 15 to 20 million euros. Some administrators may be tempted to do the unethical thing and send as many people as possible to get an MRI so they can have a return on their investment, sometimes out of fear of going bankrupt.

If you turn the model around by looking at how a patient can receive the most convenient treatment and at the same time enhancing your turnover, this could be done with new services which could be geared more towards prevention and its benefits.

So your model is going to turn to preventive care, which may seem very odd. As a hospital owner or healthcare organization founder, your focus should be to keep people out of your organization and still earn money with it. Your current infrastructure will change, but you will still have an emergency room and you will still have that very expensive equipment, because they are necessary to do your job the right way. On the other hand, you will have many more patients and income from service fees. Right now it is sometimes difficult to help your patients because of the lack of available resources and space. If you can keep them healthy, I think it will turn the profession into something more magic, by helping your customers (patients or not) lead a healthy life, exercise more, take the correct treatment before they get a severe illness.

I’m 100% convinced that if I can choose between an insurer coupled to a healthcare organization, or a standalone health organization that will ask me for a fee to keep me healthy,  I would pay it, even if it is not reimbursed. This would be a great outcome for everybody, not only for the patients and non-patients. Also for healthcare practitioners, because it will make their job more enticing, with less stress and more focus on special cases and building insights into the human being as a whole. If I was a healthcare practitioner, I would prefer to talk to people and try to coach them instead of doing administrative tasks.

Will technology and telemedicine replace humans with robots?

No, it’s the other way around. Technology is taking the robot out of the individual. Technology will augment the work of healthcare practitioners and turn them into super healthcare practitioners.

Think of chess grandmasters. They didn’t want to use chess computers, right now they have a chess computer sitting next to them, and it helps them avoid errors. The computer also helps them think about strategies, and not wasting time on boring stuff.

Technology is helping healthcare practitioners to avoid errors, and it will also help in the liability department. It frees more time for them to think. Right now they have about 15 minutes per patient, which starts with the healthcare practitioner reading your file and asking the same questions over and over again, which takes five to six minutes. Then there’s a quick examination and usually you are given a diagnosis. Telemedicine will improve that situation, and allow for more time, which will be also more centered in the patient-doctor relationship thanks to the help of great dashboards, with more time for coaching and for understanding the problem. For the patient this is much better, because there’s much more empathy from the healthcare practitioner and the whole ordeal is much more relaxed. The healthcare professional is more satisfied because he or she knows that patient much better, which helps him or her avoid errors.

There will also be speech-to-text recognition tools, so that the professional does not have to type the findings after a consultation, which also frees up time to work better and to give better service to patients.

It is about augmentation, not about replacement or cost cutting. And it is a good investment, because employee and patient satisfaction will improve dramatically.

About in4care

in4care is a dynamic and creative membership organization that originated from the care institutions themselves. Driven by the needs of healthcare, in4care today brings healthcare institutions, startups, companies and other healthcare innovation partners together to realize innovations in healthcare and welfare. in4care stands for creativity, speed, future thinking, and can-do mentality.

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