On Telehealth

Dr. J. R. Barr & Dr. F. Persia & Dr. D. D’Auria

1. Introduction

The Covid-19 pandemic has had a tremendous impact on the entire world. Virtually every society has faced a dramatic health emergency bringing many health systems to the verge of collapse. As a result of the pandemic we are facing a major global economic crisis which has affected (to the point of decimation) many sectors of our economy, especially tourism, hospitality, airlines, live entertainment. Perhaps paradoxically, the healthcare sector is also negatively impacted. The postponement of routine medical checkups, and [sic] elective medical procedures like dermatology, cosmetic, dental, etc.

Evidently, focus has been shifted to finding vaccine and effective treatments of the Covid-19. Beyond that, the Covid-19 prompted the search of innovative healthcare solutions to problems either caused by, or impacted by the epidemic. Researchers around the world are working on developing novel solutions to meet those challenges which include:

1. Practical emergency response solutions: Developing solutions to cope with the expansion of the pandemic.
2. The management of public health.
3. The reorganization of:
a. social activities;
b. workplace;
c. improving public safety to control spread of the virus;
d. developing solutions to phase out of quarantining “social distancing”;
e. risk management; the development of solutions to counter and contain the effects of a future pandemic.

Telehealth technology offers a cost-effective solution to managing healthcare, to facilitate the delivery of services to patients “anytime & anywhere,” and to promote public safety. For instance, telemedicine makes it possible to activate a hospital medical network to monitor and interact with patients, to help manage chronic diseases, help control episodic occurrences, and promote prevention & good healthy habits.

2. Motivation

The cost of the Covid-19 pandemic made it increasingly clear that a modern healthcare system must recognize telemedicine and digital health as an imperative to improving experience, outcomes, to manage limited resources to control “out of control” cost. In fact, the sheer numbers of people affected by the pandemic in various countries demonstrate that effectiveness of containment measures are closely related to the response capacity and efficacy of overall healthcare services. The correlation is not coincidental; arguably, it rather demonstrates a cause-and-effect relation. Societies with highly developed healthcare systems tend to better follow expert advice and directives from providers.

Furthermore, the differences between fatality and spread rates in different countries and demographic strata, can be explained by variations in capacity and efficiency of health services, as well as by the variations in efficacy of emergency response.

In recent decades hospital and large medical facilities have replaced the family general practitioner. Arguably, hospitals and large medical facilities enjoy the benefits of economy of scale. However, as a result of the pandemic hospitals and large medical facilities became a generator of contagion! One might see how tele-health may be just the solution for the above mentioned problem.

3. Telehealth and chronic disease management

Telematics as enabler of distance diagnoses and therapeutics is increasingly becoming an economic imperative. A case in point is chronic diseases. According to the World Health Organization (WHO) the most common chronic diseases are cardiovascular diseases (of several various types), responsible for (approximately) 17.5 million deaths per year, cancer, 7.6 million, chronic obstructive pulmonary diseases (COPD), 4.1 million, and diabetes culls 1.1 million lives per year. In addition, untreated condition like hypertension is one of the main risk factors for atherosclerosis in coronary arteries, carotids, renal and lower limb arteries, but the condition could be kept under control remotely with relative simplicity with Telehealth.

According to WHO, around 1 billion people worldwide have suffered hypertension in 2,000. This number is staggering consisting of upward of 25% of the world’s population over the age of 20. And the number of those suffering hypertension is estimated to reach 1.5 billion in 2025. This is almost 30% of the population of over-20! Hypertension alone is estimated to be the cause of about 14% of all deaths worldwide. In addition, hypertension is also one of the most common causes of disability. It has been shown that the proportion of patients with hypertension increases with the age of the population – foretelling an impending problem of aging population. As a result, telemedicine help following patients, helping them make optimal decisions as quickly as possible, and help facilitate self-management and promote self-sufficiency in one’s own home. This will transform hospitals from solution of ‘first resort’ to solution of ‘last resort’.

We see telemedicine integrating all the pieces which makes modern medicine, including doctors, specialists, pharmacists, physical therapists, mental health counselors, social workers, and all the services one associated with healthcare and doing so better at and more efficiently, i.e., reducing cost of care. Technology is the answer and the following comparison is apt to making a point. In 1972 one would have spent 6 months’ salary to buy an unsafe car that consumes 14 miles per gallon, while producing 130 HP and rusting away after 5 years. Today, evidently, technology has given the consumer a choice to buy a safe car, spending a mere 2 months’ salary, consuming 35 miles per gallon, producing 210 HP and never rusting. The same trends are happening presently in healthcare with telemedicine and remote patient monitoring. With Telehealth, the consumer gets much more for a lot less.

4. How to develop Telehealth?

For sake of readability we’ll itemize key elements.

– Standardization of common elements:
– Components
– Data & Analytics
– Protocols
– Regulatory NDA

Leverage relationship with providers of all stripes:

– Primary care physicians and specialists
– Nurses
– Physical therapists & nutritionists
– Pharmacists
– Mental health specialists

Engineer scalable platform:

– Distributed architecture & data processing
– Privacy & security.
– Cybersecurity, policies & tools.

Convenience and user experience:
– Utility
– Ease of use
– Accessibility (anywhere/anytime)

Media:
– Spread the word
– Education and training

Upfront investments entail

– Training of all sorts; training material, online content, video, etc.
– The dissemination of guidelines, standard-of-care, and evidence-based medicine specific to tele-health. This is
“media-heavy” endeavor involving broad dissemination of newsletters, scientific journals, meetings, face-to-face
and online events.
– Information and education campaigns to educated patients, their families and caregivers as to the benefits,
convenience, and utility of tele medicine.

Utilization of tele-health will create significant saving, better healthcare management, will increase traffic (boost business to providers) and will reduce risk. This may not have been the case twenty years ago, but today technology is ripened to the point that everybody has a smartphone (either an iPhone or an Android,) and virtually all portable medical sensors “bio-sensors,” often wearable, are fully-integrated, i.e., connected via Bluetooth to a smartphone and with cloud solutions, have become practical solutions to real medical problems, and equally important, consumer-friendly. Today, consume-grade sensors include wearable/portable thermometers, blood pressure monitors, blood glucose meters, blood oxygen meters, or “pulse-oximeters,” and heart monitoring “EKG” systems are all non-invasive devices that are now readily-available, and made for home use by the average consumer.

This is an ever-evolving trend. Devices are being created with increased accuracy, ever-expanding features and often equipped with advanced algorithms to enable diagnostic and treatment functions to increase efficiency in healthcare.

Thanks to cellular technology (soon to be universal 5G) and capable hand-sets, the Internet of Things (IoT) enable seamless integration of services and helps bring real intelligence to real-time monitoring. This is achieved by enabling devices to connect or “talk” to each other. Thus, such devices are capable of intercommunicating and adapting their behavior to the data and information they receive. The devices have full-duplex capabilities and behave like sensors, capable of remote controlled through the network.

In addition, with the spread of e-Health solutions and sensors connected to the Internet, new issues have risen regarding privacy and patient safety. Arguably, to ensure safety, quality & functionality, it will be necessary to certify (e.g., but the USA Federal Drug Administration,) sensors and applications, especially those involving diagnosis and treatment. With populations growing grayer, to help aging population maintain health services, tele-health seems to be an imperative, not a luxury without which this large cohort will surely suffer from diminishment of needed healthcare.

From that perspective, it is critically important to decentralize treatments, shifting healthcare from a hospital to a home care, while improving the quality and effectiveness of patients’ medical care while controlling costs.

5. Telehealth and artificial intelligence

Evidence-based medicine (EBM) is as old as the fourth century BC physician Hippocrates of Kos, the “father of medicine”. EBM is the process of research, evaluation and systematic use of contemporary research as a basis for clinical decisions. More than a century ago statistics has become the standard method to evaluating efficacy and risk, and, more recently, “big data” and artificial intelligence (AI) have augmented statistics to help “automate” cause-and-effect discovery.

With the use of big data and AI, medical evidence may also be based on information not necessarily evident to a human (say, physician), rather, evidence is based on the aggregate using sophisticated mathematical and computing techniques.

Machine learning is the process where machines are programed to self-learn from the faintest of signals from a large amount of data. In fact, a new machine-learning-based medicine is able to process far much more information than is possible for humans and in a tiny fraction of the time.

Nowadays, with the use of big data in healthcare and “deep learning” techniques, we are able to make effective predictions about all sorts of cause-and-effect relationships between many different kinds of inputs, their interactions and net outcomes.

All this gives birth to what is known as preventive medicine which estimate patient conditions long before an onset of any symptoms. Additionally, AI is used to help with medical diagnoses, issue an early-warning for health risks and episodic events (e.g., seizures), and detect diseases in a timely manner. All this has a considerable advantage for chronic- and obesity-related diseases. Access to the entirety of medical databases allows for making better assessments of risks, better diagnoses, better medical decisions, and all those at a far lower cost to the consumer and an overall increase in efficiency.

Electronic health records (EMR) take a centerfield because access to health records (from anywhere and anytime,) is critical in helping to make diagnoses and to optimize treatments to ensure optimal outcomes. Moreover, continuous patient monitoring with bio-sensors allows for pushing diagnoses to an earlier stage in the progression of a disease, even before symptoms appear whereby reducing risk of escalation. As a result, a massive use of EMR is convenient for all the involved entities. On-demand EMR will democratize healthcare by enabling patients an easily access their data, while physicians be able to correlate the patients’ data in a broader context.

The amalgamation of artificial intelligence, machine learning, wearable body sensors, electronic medical records, tele-medicine, and the “multiplicative effect” offers tremendous opportunities for streamlining healthcare and for automation. It’s not a question of if, rather, it’s a question of who will seize upon this transformative opportunity. The opportunity is a complete transformation of healthcare and “flattening the curve” of less health at escalated costs. We have no choice but to act if we wish to avert a looming healthcare crisis.

6. Summary

In summary, we highlight a few points why the time to act is now.

1. Aging population
2. Limited capacity
3. Government initiatives to combat cost escalation & to reduce risks through large-scale preventative actions
4. An increase in the number of chronically ill patients permanently residing at home
5. A reduction in the number of health professionals
6. Improved access to specialists
7. New & novel treatment technologies
8. An endless crisis-mode & game changing Covid19 reality.
9. User-based ready to adapt.

Savings:

– Intervene at an early stage of the disease through monitoring, thus reducing the rate of aggravation and
mortality.
– Reduce the number of days in hospital.
– Streamline decisions through remote consultation with specialists.
– Reduce the costs of patient care.

Technology is here:

– Wearable devices and hand-held computing (e.g., iPhones).
– Cloud computing and distributed data & processing.
– Near universal 5G networks & fiber-capacity & bandwidth.

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