Digital health, incorporating telemedicine, is now front and centre of how we deliver care
Most of us cannot imagine a world without our smart phones or mobile technology device. EU research shows that in 2019, 73% of the adult population used a mobile device.1 The corresponding share among 16-29 year olds stood at 93%.1 We are all well used to streaming from our TV, shopping online and scrolling through our social media accounts. Despite our comfort living our lives in a digital and virtual world, one area that has been slower to adapt is healthcare. This fact has always surprised me. Healthcare is a science that moves fast and changes rapidly. Doctors constantly have to adapt their care and protocols to incorporate new treatments based on evidence coming from academia and large-scale trials. Despite most medics using technology in our daily lives, many have been slow to adopt it in daily practice. Thankfully times are changing and strangely we may have the Covid pandemic to thank for that.
Telemedicine is the delivery of healthcare through information technology and virtual means. Telehealth is a broader term which encompasses healthcare as a whole rather than just focusing on medical consultations. Recent years have seen the launch of many telehealth services. Medical insurance companies started offering remote doctor, nurse and physio consultations. When the Covid pandemic hit, healthcare workers were trying to limit face-to-face consultations and keep social distance measures in place. Telemedicine experienced exponential growth. At the height of each pandemic wave, virtual doctor consultations exceeded face-to-face visits in many settings. While this level of virtual consultation isn’t being maintained as Covid numbers have fallen, there is no doubt that telemedicine is here to stay.
There are three arms of telemedicine.2,3 We are all familiar with the interactive type; this is the simple virtual consultation between healthcare provider and their client. It is commonly conducted over a video link allowing real time interaction between the two. The downside of this consult is it doesn’t allow for a physical examination of the patient. This is the part of telemedicine which makes some medics anxious. The art of medicine to date has required being in the same room using examination and investigative tools to reach a diagnosis. It is no surprise then that as telemedicine has advanced so too has the world of remote patient monitoring; the second arm. Most frontline healthcare workers see this as essential if we are to fully trust virtual consultations. We now use apps and home monitoring devices to check patients’ body systems without stepping outside our homes and offices. Reliable remote patient monitoring allows the examination to also become virtual.
The third arm of telemedicine is the healthcare information and data that this field generates. We don’t need to look too far to see how valuable this form of healthcare data is. The recent cyberattack on our HSE database had us all wondering who holds what, and where it might end up. Decades ago, the only data held might be on paper in your doctor’s office, yet now it can be around the world in seconds. It is unfortunate that data sharing often makes the news for all the wrong reasons. Recently, the FutureProofing Personalised Health Index revealed that the Irish public’s willingness to share data for medical research and care improvements was low with a score of 4 out of 10.4 I firmly believe that normalising sharing medical data securely is one of the most important steps forward we can take.
The way we plan healthcare is evolving. Providing the right medicine, the right dose, at the right time to the right patient hasn’t changed but the way we select that treatment is being disrupted. Historically we relied on evidence from clinical trials published in medical journals, however we now recognise that a ‘one size fits all’ approach is less than ideal. Humans are a very diverse species. Personalised medicine, where treatments are tailored to our own unique DNA, is becoming more and more common. The more data we can gather about disease, treatment and response, the better medicine can be. This is especially true in the case of rare disease. Using telemedicine would allow cross-border and cross-continent collaboration in real time, creating a virtual pool of patients with similar disease features. There may be diseases out there that the gathering of large data will discover. If we manage the data gathered through telemedicine correctly, we can safely collate national and international databases of symptoms, disease, treatment and outcomes. This evidence will be core to future health planning, development and roll-out of personalised healthcare.
Healthcare is changing and while it may have lagged behind in recent years, digital health incorporating telemedicine is now front and centre of the way we deliver care. Healthcare workers are finally embracing this change. Now we need our national healthcare providers and management to accelerate and fund it, making digital health truly accessible to all.