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Challenges and trends in telemedicine
In many areas of medicine, telemedicine can provide a valuable complementary service. Its use brings better service quality, enhanced home care, cost reduction and lower disease transmissions. However, the adoption of telemedicine is still relatively low due to its many specificities (e.g. limited physical examinations) and early stage of its development (data quality and security, different levels of digitalization between regions and countries, legal challenges, and reimbursement).
In this blog you will learn:
What are the benefits of telemedicine?
There are quite a few benefits of telemedicine in comparison with the conventional in-person approach at the doctor’s office. Although telemedicine cannot fully replace it, the combination of the two approaches can be highly effective, which helps reduce the number of in-person visits to a significant degree.
Better access to healthcare services
Telemedicine most obviously benefits patients who live in isolated communities or remote regions. The remote approach is also useful in patients with limited mobility and those living in assisted care facilities, saving them the possibly difficult and painful transport to the clinic. An example is patients with Parkinson’s disease (speciality of teleneurology) [1].
Enhanced home care
In a wider sense, telemedicine services can be viewed as medical aspects of home care services. Telemedicine can comprise visits of family doctors and nurses at patients’ homes and sharing the patient’s diagnostic measurements with the remote GP office or a specialist. In this case, it directly supports other benefits of home care: psychological benefits of patients staying at home (e.g. the elderly), better care quality and higher levels of safety. For more on home care, go to this article.
Cost reduction
If telemedicine entails a home visit by the medical professional, there is a reduction in cost associated with travelling to the healthcare provider, the cost of the support staff that receive the patient, administration, etc. According to some studies, the savings may be substantial [2] [3]. Furthermore, home care has proved to be much cheaper than the patient having to go to hospital, especially for basic check-ups [4]: offering diagnostic measurements such as the ECG at the patient’s home or a nursing home facility also reduces the number of unnecessary hospitalisations.
Lower infectious disease transmissions
If inpatient care can be avoided through telemedicine, transmission of infectious diseases cannot take place. Conditions that may be present in healthcare facilities (especially hospitals) include COVID-19 and MRSA. Avoiding these environments reduces the risk of premature death in patients with a weakened immune system [5] [6] [7] [8] [9].
What are the challenges in telemedicine?
A limited number of assessment types is available
If telemedicine is understood as long-distance check-up without personal presence of the medical professional, the most obvious drawback of telemedicine is the inability to perform physical examinations. This includes everything from simple diagnostic modalities like auscultation and palpation to MRI scans, blood testing and biopsies. (The possible limitations of telemedicine depend on the type of medical field.) Some diagnostics can be excellently supported with different wearable and desktop devices for remote monitoring of the patient’s vitals, for example in telecardiology.
Despite advances in video technology and devices for video streaming (e.g. smartphones, tablets, and other devices with built-in cameras), telemedicine without a home visit of the medical professional may lead to medical errors that would be less likely to happen with in-person examinations. An experienced physician can often tell a lot about the patient’s health status by observing the latter’s movement and behaviour [46]. Lacking in-person information, the physicians can run the risk of misdiagnosis or over/underprescribing medications [10] [11]. Particularly at risk are paediatric patients, also because their weight plays an essential role in determining medication levels [12].
In this case, a telemedical concept where the patient is visited at home by a medical professional (e.g. a nurse) who performs an in-person examination and transmits the data from diagnostic tests to the remote doctor’s office can be a good solution. There are medical assessment solutions with in-built electronic patient records (EHR), where the diagnostic results are immediately stored and can be compared with the patient’s previous results. An example is the MESI mTABLET diagnostic system.
Data quality
Modern telecommunication equipment and data transfer protocols can ensure high data quality, but they can be impacted by the quality of the (Internet) infrastructure. For example, some localities have access to reliable broadband Internet and others don’t. Internet reliability can play an important role in certain diagnostics. A study has found that a decrease in internet bandwidth and subsequent reduction in video quality can lead to inaccurate measurements of fine motor coordination (FTT and FNT testing) [13].
Similarly, the quality of data obtained from wearable devices may not be consistent due to the technological variability between devices, even if they are intended for measuring the same vital signs. For this reason, it can be difficult to establish common standards for assessing data quality [14].
Data security concerns
A 2021 study by the Kaspersky Lab cybersecurity company found that the Message Queuing Telemetry Transport (MQTT) protocol, a commonly used protocol for transmitting data from wearable monitoring devices (not just medical ones), contained at least 90 vulnerabilities. [15] Cyberattacks against healthcare in general are on the rise and became prominent during the COVID-19 pandemic, when a significant portion of patients started using telemedicine for the first time [16].
Digital divide
There is a lower likelihood that telemedicine services will be used by the elderly and individuals with certain disabilities [17] [18] [19] [20] [21] [22] [23] [24]. Studies show that people of advanced age (around 80 years on average) are more reluctant to use telemedicine services without in-person contact for a variety of reasons [25] [26]. First and foremost, the elderly may not have sufficient digital literacy to use devices like laptops and smartphones (and often do not have access to them). Consequently, there is a need for assistance in using the telemedicine services, especially in patients with diminished cognitive capacity [27].
Those groups, as well as patients that require a physical examination, would therefore be best served by a “hybrid approach”. A good practice example is the examination at home by a medical professional using a portable diagnostic system with instant data sharing.
Legal and reimbursement challenges
As part of healthcare services, telemedicine is subject to strict regulation; of course, the regulation always takes place much more gradually than technological progress. This makes the adoption and implementation of telemedicine rather slow. Furthermore, there are significant differences between countries and their regulations.
In the United States, for example, it is illegal for medical professionals to practice out-of-state (even via telemedicine) without first obtaining a licence to practice medicine in another state [28] [29] [30]. In other words, a physician cannot treat a patient using telemedicine services if they are not both in the same state. Additionally, physicians must obtain informed consent like they would at in-person consultations, and they should notify the patient about the use of any third-party software or mobile applications during a telemedicine consultation due to cybersecurity risks [31] [32] [33] [34] [35] [36] [37].
In Germany, telemedicine comprises a vast variety of services, from telemedical centres for long-distance consultations with patients to in-person visits by family doctors and nurses, who then transmit the diagnostic measurement results to the remote family doctor’s office. Read more in this article.
Inadequacy and sometimes total absence of reimbursement is another significant obstacle towards greater utilisation and acceptance of telemedicine. This varies between countries [38] [39] [40] [41] [42] [43] [44] [45].
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