#TechTalksWithMelwyn – Tryst With Telemedicine
This week on #TechTalksWithMelwyn lets get into the need of the hour – Telemedicine and how it’s changing our lives in the current scenario.
Have you ever Googled your symptoms when you were sick? Did the internet tell you that you have cancer, even though you just sprained your foot and wanted to know if it was fractured? We’ve all been there I can assure you that. Telemedicine, our topic for the day, has had a not so stellar start both with public and with provider adoption. Across the globe, the experience had been so clunky and fraught with issues, that the German government had banned remote consultations till 2018.
If we learned anything about technology from the 2008 recession, it would be that extreme times push for the adoption of new technologies that change the way we have been doing things for decades. Consider Credit Karma (2008) – managing your finances online; WhatsApp (2009) – free instant messaging; Venmo (2009) – digital payments without banks and fees; Uber (2009) – split a cab with a stranger and the list goes on. Fast-forward to 2020, we have more internet penetration, better internet bandwidth, the highest smartphone ownership numbers yet, and of course social distancing. Doctors around the world are increasingly using audio and video technologies to test & treat patients that they can’t see in person. These technologies range from complex robots to simply using FaceTime or Google Hangout. They benefit patients by saving commute time, avoiding visits to a hospital, and subsequent exposure to COVID-19, accessing specialist consultations in remote areas, and reducing the total spending.
Even though Telemedicine sounds like a no-brainer, there have been several barriers to adoption on a large scale. These issues can be classified into two major buckets: trust and economics
- Trust: The possibility of fraud using a person’s medical and financial information and even the potential leak of protected medical history information has been a major show stopper for most people. Combined with this, the lack of credibility and verification of practitioners online as opposed to what one can find in a hospital has reduced the reach of telemedicine severely.
- Economics: There is a general lack of clarity on what an insurance provider would cover for a patient using telemedicine and how a hospital will be reimbursed for providing these services. Probably the most significant barrier here is that for-profit corporations benefit from higher fees for in-person visits as opposed to short video sessions and they don’t see a value add in disrupting their existing revenue stream.
Despite these barriers, the current pandemic may just provide the necessary impetus for Telemedicine to emerge as a winner for 2020!
Overcoming Barriers: Trust
To solve the trust issue, governments and non-profits are rolling out easy to use applications and mobile apps to residents. Various telemedicine initiatives have been rolled out since the onset of COVID-19 to provide more information on the pandemic, perform at home screenings/tests, and even treatments with robots.
The first initiatives included chatbots on WhatsApp, by WHO, to dispel misinformation that was being shared through social media and by word of mouth. The automated chat allows you to get real-time information on the latest numbers, travel advice, press releases and supports more than 6 languages. However, this may not scale any further for medical advice or diagnostics as end-users may be wary of sharing medical information on an application owned by ad-marketing giant Facebook.
Taking the next step for Telemedicine was the Community of Madrid, which created a self-assessment webpage & mobile app, Asistencia COVID-19, which helps end-users determine if they may have COVID-19 and provided instructions on what next steps they should follow. Based on its success, the Spanish Government rolled it out to 5 more areas and will soon share the source code with other countries to assist in their fight against COVID-19. The government also provides assurances that the data will be anonymized and used for statistical purposes once the pandemic has subsided.
Similarly, the government of Singapore has also launched COVID-19 Symptom Checker for all residents as a one-stop-shop for self-assessment and instructions on what to do next. In India, the state of Goa has launched its own application, Test Yourself Goa, which includes a survey of previous travel history, and informs you of what steps to take next.
In the US, the pandemic has brought about a significant change both from a policy and innovation front. The Centers for Medicare & Medicaid Services (CMS) has lifted rural & site limitations on using telemedicine and relaxed its norms on what qualifies as acceptable audio-video equipment. The CMS has also relaxed its norms for the duration of the pandemic and now allows Nursing Homes & Hospices to use telehealth technologies; the HIPAA violation penalty has also been waived if the practitioner was trying to help a patient in good faith. The only restrictions put in place are on the use of Facebook Live, Twitch, Tik Tok, and other public broadcasting video applications. While some of this may be new to us city-dwellers, telemedicine has been actively used since 2001 for the Inuits in Alaska, where it would otherwise take 30 days to ship medical records by sled dogs to the nearest city of Anchorage.
The topic of trust comes as a choice between anonymity and convenience. In countries like India, where there have recently been tensions between the government and minority groups, personal identifying information may not be entrusted to a government source but may be shared easily with a trusted private sector enterprise like what is being done by DOCYET in Germany. DOCYET, a startup, allows users to cross-check their symptoms and setup up telemedicine appointments with a chosen doctor across the country and soon the EU.
Overcoming Barriers: Economics
The state of Massachusetts has already partnered with Doctor on Demand, one of two telemedicine applications that allows you to perform a free coronavirus risk assessment from the comfort of your home. In addition to this, insurance providers such as Aetna, Cigna, and Blue Cross Blue Shield have recently announced that they will provide free telehealth options to their subscribers.
As for the healthcare businesses/corporations that have resisted change so far, they will have to adopt the new business model of telemedicine consultation. Famed academic and author, Clayton Christensen, developed the theory that a new disruptive business model usually starts with a lower perceived value (low cost and low margin) and grows until it can completely disrupt & nullify an existing business model due to its accessibility. We have seen this theory come true in several cases, e.g. the video streaming industry started with Netflix who had a targeted audience – people who didn’t bother with the latest hits and could wait for their DVDs to come by mail. As Netflix kept improving with faster shipping and newer titles, Blockbuster didn’t pay attention to this new business model until it was too late. Now, most of you probably have more than one streaming subscription, but Gen-Z doesn’t even know what a Blockbuster card is.
What do you think the future of Telemedicine will be? Definite Winner or Not-so-much? Let us know in the comments below.
Fount of wisdom, insufferable know it all, make it go away are just some of the phrases used to define Melwyn. When he is not at his Consulting job, he spends his time reading about technology and current affairs.