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Challenges and trends in telemedicine

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The current pandemic has shed light on the many vulnerabilities of even the most advanced healthcare systems whose resources have been stretched to breaking point. Of course, this has been to the detriment of not only patients infected with COVID-19, but also those indirectly affected by degradation of the quality of service or access to preventive and even emergency treatment.

The aftermath of these untreated or undertreated patients will undoubtedly be felt even when this pandemic or at least some of the more restrictive preventive measures pass. However, this may also provide the necessary impetus for greater expansion of telemedicine, which can be of significant help in times like these, and development of new technological solutions for mitigating some of the challenges it currently faces and that preclude its wider utilisation.


In this blog you will learn:

What is telemedicine?

The definition of telemedicine is “the use of electronic information and communications technologies to provide and support health care when distance separates the participants” [1]. The word itself was coined in the 1970s by Thomas Bird from the Greek words “tele” and Latin “medicus” which, when combined, literally mean “healing at a distance” [2]. But what is telemedicine in reality, and what forms does it take?

In other words, using modern telecommunication channels like the Internet, medical professionals diagnose diseases using information provided by the patients themselves through the use of a webcam (live video) or by other medical personnel at the patient’s location, follow disease progression and advise on further treatment and even perform remote surgery using robots. Of course, not all specialities are equally well represented or can be viably applied remotely: some of the more successful applications are, for example, teledermatology and telecardiology, the latter being intimately connected with the beginnings of telemedicine itself [3, 4].

Despite the term being half a century old, the history of telemedicine actually goes back more than a century. In 1906, Willem Einthoven, a brilliant physiologist and inventor of the first practical electrocardiogram, published a paper in which he described recording a patient’s electrical cardiac signals at a hospital on his electrocardiogram and transmitting them over a distance of 1.5 km [5]. The advent of modern radio opened a new avenue for long-distance communication and was quickly taken up in the 1920s by Norwegian doctors for providing medical advice to sick ships’ crew members at sea [5].

A more sophisticated application took place in the 1960s in Boston, Massachusetts USA [6]. Researchers set up a two-way microwave audio-visual connection between the Massachusetts General Hospital and the nearby Logan International Airport and even incorporated an electronic stethoscope and other electronic diagnostic tools (connected to the examinee by a nurse-clinician at the location) [6]. They used this arrangement for successfully examining 1000 patients in the period from 1 August 1968 to 27 December 1969 [6]. Rapid technological development soon made cumbersome and expensive microwave communication equipment obsolete and ushered in the era of the World Wide Web, greatly amplifying the reach and benefits of telemedicine.

What are the benefits of telemedicine?

There are several distinct benefits of telemedicine in comparison with the conventional in-person approach. The most obvious one becomes apparent when the patients live in isolated communities, remote regions or are otherwise “geographically challenged” and are unable to easily visit their general practitioner (GP) or other specialists.

The remote approach is also useful in patients with limited mobility and those living in assisted care facilities, like patients with Parkinson’s disease (speciality of teleneurology) [7]. However, looking more broadly, those who (would) reap the most benefits are traditionally underserved demographic groups that, due to their socioeconomic status and geographical remoteness, don’t have access to quality health services [8].

The second benefit frequently touted is a reduction in costs associated with travelling to the healthcare provider (or vice versa), the cost of the support staff that receive the patient, administration, etc. Some studies suggest that cost savings may be substantial, particularly on the side of the patient [9, 10]. However, more robust and comprehensive studies are needed to better elucidate the long-term economic benefits.

The third—and from today’s perspective highly relevant—benefit is the virtual elimination of the possibility of transmission of an infectious disease between the patient and healthcare workers. Besides protecting from COVID-19 infection, another infectious disease that patients could do without is MRSA, which significantly increases the risk of premature death in hospitalised patients with a weakened immune system [11-15]. Yet in spite of this and other benefits, telemedicine is in many respects still far from becoming an integral part of modern healthcare.

What are the challenges in telemedicine?

The challenges preventing the wider use of telemedicine are many and start with the other side of the coin when it comes to the physical distance between the doctor and the patient—the lack of a hands-on approach. There are many medical conditions that cannot be diagnosed or detected through sight (video) alone. Diagnostic devices can mitigate this, but many are expensive, cannot be used outside specialist laboratories or require specially trained personnel, negating many of the benefits of being used remotely. Undoubtedly, future technological progress will mitigate these issues through the introduction and proliferation of accurate and reliable wearable IoT diagnostic devices [16].

Another important point raised by some researchers is reluctance on the part of both healthcare professionals and patients to use modern technology and/or telemedicine-specific working protocols that deviate from the conventional approach. Lastly, complexities and (cyber)security vulnerabilities connected to the efficient management of the large amount of data (colloquially known as big data) collected and processed as a part of remote diagnosis and treatment pose as much a legal as a technological challenge [17, 18].

Fortunately, much progress has been made in rectifying the latter issues, primarily through the development of electronic health records (EHRs). They offer nearly error-free (on the part of the user, like poor penmanship found on physical paper records) representation of data obtained through conventional or telemedical channels and traceability of changes in addition to great ease of sharing through the Internet or local networks and much more [19-25].

Additionally, there are several new technical diagnostic solutions on the market that aim to integrate support for EHRs and their remote sharing in diagnostic devices themselves. They offer healthcare professionals greater work flexibility by empowering them to decide where the patient is examined and who has access to the patient’s data for subsequent treatment or additional diagnostic procedures. However, they are yet to become a staple in the modern healthcare practice.

Telemedicine offers a viable alternative to the conventional approach for selected patients and can provide a valuable complementary service to healthcare users in general. However, several technological, practical, cultural, and legal barriers currently preclude its wider utilisation.

Data saves lives. The rise of predictive medical assessment.