Telemedicine can be defined as evaluation, diagnosis, and treatment of patients from a distance using telecommunications technology. This could be possible due to a striking evolution in the last decade and has now become an increasingly important part of the healthcare infrastructure, the world over.
Background
Telemedicine started in the 1950’s in America when a few hospital systems and university medical centres tried to share information and images via telephone. Finally, two health centres in Pennsylvania succeeded in transmitting radiologic images over the phone. Then, telemedicine was used mostly to connect doctors working with a patient in one location to specialists somewhere else. It proved to be of great benefit to rural or hard-to-reach populations since specialists were not readily available. However, this approach remained limited because the equipment necessary to conduct remote visits remained expensive and complex.
It was after the proliferation of small devices, capable of high-quality video transmission, that telemedicine got a boost. It opened up the possibility of delivering remote healthcare to patients as an alternative to in-person visits.
Telemedicine and Telehealth: Difference
Both these terms can be distinguished in spite of often being used interchangeably.
The use of electronic communications and software to provide clinical services to patients without an in-person visit for follow-up visits, management of chronic conditions, medication management, specialist consultation and so on can be termed telemedicine, provided remotely via secure video and audio connections. On the other hand, the term telehealth includes a broad range of technologies and services to provide patient care and improve the healthcare delivery system as a whole.
According to the World Health Organization, telehealth includes, ‘surveillance, health promotion, and public health functions.’ It refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.
Significance of Telemedicine
Using telemedicine as an alternative to in-person visits has many benefits for patients as well as service providers. On the one hand, patients enjoy less time away from work, no travel expenses or time, less interference with child or elder care responsibilities, privacy, no exposure to other potentially contagious patients. On the other hand, service providers get the benefit of increased revenue, improved office efficiency, an answer to the competitive threat of retail health clinics and on-line only providers, better patient follow-up and improved health outcomes, fewer missed appointments and cancellations, and payment by private payers.
Scope of Tele-medical Services
Today, these services are being used for the following purposes:
- Follow-up Visits The health software used is not only more efficient for providers and patients, but it also increases the likelihood of follow-up, which reduces missed appointments and improves patient outcomes.
- Remote Chronic Disease Management Chronic diseases are increasing and pose a major challenge for our health system. For chronic patients, the use of telemedicine software is particularly important as it makes health control maintenance easier and less expensive.
- School-based Telehealth If children become ill at school, they generally visit a school nurse or are carried to an emergency care centre. With this innovative system, doctors can assess the urgency of the case and provide instructions or reassurance to patients or their parents.
- Assisted Living Centre Support At night or on weekends, making hospitalisation is the only option even for less urgent problems. With telemedicine, on-call doctors can conduct a remote visit to determine whether to hospitalise a patient or not.
Payment to Providers
As for payment to service providers, the amount varies, depending on a state’s legislation. At some places, private payers pay the same amount for telemedicine as if the service was provided in-person. Some states leave this determination up to the payers. However, the majority of private payers pay at levels equivalent to in-person visits.
As the system is an emerging one, it suffers from certain drawbacks which need urgent regulatory measures. There are several online telemedicine and telehealth platforms, such as Medlife, Practo, Pharmeasy, Netmeds, 1MG, etc. There have been instances where doctors at these sites insist patients to consult them and sometimes use admonishing language.
One such platform know as Practo, which claims of being ‘India’s No.1 Doctor Consultation app’, presents itself merely as a technology service provider and is not liable for the advice given or drugs prescribed by the doctors on its platform. It is a doctor consultation app, which does not create a licensed medical professional-patient relationship. Such concerns need to be taken care of.
Some Other Concerns
Certain basic principles remain central in healthcare like data privacy, doctor-patient relationship, negligence, liability, and so on. However, the dynamics of e-health are very different from offline healthcare be it the process of doctor discovery, ordering medicines, or evaluation of doctor services and patient outcomes.
As for privacy, patient data is subject to HIPPA regulations. Consumer video services like Skype and Facetime do not meet this standard. Therefore, providers must choose technology solutions that use data encryption to protect patient data.
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HIPAA Regulations
The Health Insurance Portability and Accountability Act (HIPAA) privacy regulations talk of national standards to protect individuals’ medical records and other personal health information. The regulations apply to health plans, healthcare clearing houses, and healthcare providers, who conduct certain healthcare transactions electronically. As per the rule, appropriate safeguards must be adopted to protect the privacy of personal health information, and limits and conditions be set on the uses and disclosures that may be made of such information without patient authorisation. The regulations authorise patients over their health information, including rights to examine and obtain a copy of their health records, and to request corrections.
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The integration of various health businesses under one roof is another concern. Because of the ease, e-health platforms have set themselves up as comprehensive healthcare services providers that offer doctor consultations across specialisations, medicines, tests, and health content. But this integration should recognise and disclose conflicts of interest and patients should be made aware of.
Teleconsultation, for instance, is linked to diagnosis and treatment, but pharmacy deals with sale of medicines, and there may be ties between them. Similarly, what if there are links between a platform and an insurance company, which buys patient data?
Therefore, these conflicts should be identified along with regulations and firewalls. Large hospitals, too, of course offer various services under one roof, but these are regulated. Despite India’s push to digitise healthcare, the regulatory framework has not yet been made clear. The National Health Authority (NHA) is using a combination of present laws like the IT Act, the draft Personal Data Protection Bill, and various Supreme Court judgements on ‘data privacy and data security’ to determine a data policy framework under the mission. Even if e-health platforms are made to comply with present regulations, these laws would need considerable additions.
To conclude, tests and medicines are not at the core of healthcare, it is people-centric care. If that focus is lost, both the versions of the Hippocratic Oath (Oath written by Hippocrates) and the medical profession will degenerate. This oath is still held sacred by physicians to treat the ill to the best of one’s ability; to preserve a patient’s privacy; to teach the secrets of medicine to the next generation; and so on.
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The classical version of the Hipprocratic oath is from Ludwig Edelstein, 1943; and the ‘modern’ version was written in 1964 by Louis Lasagna, Dean of the School of Medicine at Tufts University.