Term ‘Telemedicine’ Makes Me Think of Fax Machines and Dial-ups
Yesterday I attended European Health Parliament’s session ‘Rethinking Europe’s Healthcare for tomorrow’. The session introduced a long list of interesting and good ideas on how healthcare should be improved. ‘Agile’ and ‘Artificial Intelligence’ got mentioned several times. The list of things to improve was long and I recognized many of the topics from our discussions at Tepsivo.
Telemedicine today
The most interesting session for me was about telemedicine. The attendants learned that not many have used telemedicine services regularly before or even after COVID-19. Those who had used telemedicine services were for the large parts satisfied with them.
The challenges related to telemedicine could be divided into three categories:
1. Lack of technical skills and knowledge of the patients and the healthcare professionals
2. Lack of processes around the technology: privacy and security, interoperability, infrastructure
3. Lack of legislation, governance, reimbursement mechanism etc. — Bureaucratic barriers
Telemedicine has obvious positive impacts for both the healthcare providers and the patients but also some risks were presented. The list of risks (see below) made me raise my eyebrows, so I asked for additional information about them.
Potential risks of telemedicine:
· Wasteful spending
· Perverse incentives
· Careless / negligent providers
· Compounding inequities
The answer to my question about the risks involved was that “the risks are actually more specifically limitations.” Certain screenings cannot be done via telemedicine. The healthcare provider might miss something if they are not face-to-face with the patient. In an English study it was noticed that telemedicine was used more by urban youth than elders in the rural areas. No surprise there, but it is a real issue.
The term ‘telemedicine’ is dated
Personally, my main issue with telemedicine, is the term ‘Telemedicine’. While the term is accurate, it makes me think of fax machines, dial-up modems and CDs. Internet has been available to basically everyone for 25 years. Smart phones have been around for 15 years. They are used by everyone all the time and you can do pretty much anything with your phone. Still we use term ‘telemedicine’ for medical treatment not done in person.
It is true that language progresses slower than technology. This is especially the case when there is no perfect term available. There is no Uber, Venmo or WhatsApp of medicine yet. In this situation it would be better to just forget the ‘tele’ and talk about medicine.
Using phones and computers for providing healthcare services should not have been “innovative” in 2020 during COVID-19. There have been online doctor services around since mid-90s. Now, post-COVID-19, doing things over the phone is the new normal.
An example
I recently got a prescription for an eye infection by having call with a nurse, logging into my healthcare providers online portal and uploading couple of selfies. The doctor examined the pictures and wrote me an electronic prescription. I got the diagnosis, instructions and information about the prescription in an SMS.
To me this seems like the only sensible way to deal with this kind of situation.
This is how it should be
The technologies used were no more complicated than what I would use daily for fun. Except maybe the uploading part. I would have preferred sending the pictures directly via WhatsApp or Signal.
The picture uploading to the healthcare provider’s system was most likely due to security reasons to ensure the patients privacy. In my opinion this is unnecessary. I think there are no trust issues from the patient side. My guess would be that most patients are already sending pictures of their rashes and red eyes to their family members and friends. Sending the picture to your physician should be no different.
Security issues are real
The biggest scare is that someone hacks the healthcare providers and steals the patient’s information. The data can be embarrassing and hurtful if it is spread around the web. Maybe it will be used for blackmail.
To avoid this kind of situation, there are ongoing billion-dollar projects to create extremely secure computer systems for healthcare providers that cannot be entered by hackers. Unfortunately, usually this means that they can be entered by the healthcare providers only after years of waiting and even after that they are so slow and complicated that they are almost unusable.
What agile really means
Having the data on grass root level, for example in your healthcare providers phone, is actually much safer and easier. In that case one big hack would not reveal your embarrassing rash pictures. Maybe, if the doctor has some common sense, they would even delete the Signal discussions or WhatsApp pictures at the end of the work day.
Of course, in case Facebook gets hacked and all pictures get stolen. But if that would happen, are the rash pictures on the top of the list of things you would wish to keep secret? Have you ever sent or received something worse?
The session included a great example from a patient representative who acts as a spoke person for the usage of patient data in the EU. She told that her original goal for having an European electronic healthcare record available had been by 2010. In my opinion, even 2010 would have been 5 years late.
