Telemedicine's potential to improve healthcare access in remote regions

Running head: ROLE OF TELEMEDICINE IN ADVANCING HEALTHCARE 1

THE ROLE OF TELEMEDICINE IN ADVANCING HEALTHCARE 10

The Role of Telemedicine in Advancing Healthcare Will telemedicine improve the quality of healthcare and its delivery for remotely located advanced healthcare? Introduction Cost-effectiveness, quality, equity, and access are the central issues facing health care in both advanced and developing nations (L\\\\\\\'Esperance & Perry, 2016). One biggest challenge facing the global healthcare system is providing quality care to the larger part of the population cannot access to quality healthcare due to factors like socioeconomic conditions and geographical limitations (Hurst, 2016). Telemedicine or the utilization of technology to provide healthcare from a distance has been fronted as a viable option of overcoming the barriers to healthcare especially in communities located in remote and rural regions (Combi, Pozzani, & Pozzi, 2016). Furthermore, telemedicine potentially reduces the gaps in delivering critical care to individuals that are underserved, primarily because of insufficiency of sub-specialty providers. The recent wave of ICTs adopting including cell phones, the internet, and computers have revolutionized interaction between individuals and exchange information (Hurst, 2016). These technologies have also shown significant potential in addressing the contemporary health challenges around the globe. Telemedicine, a word invented in the 1970s to mean ‘healing from a distance’ entails the use of technological advances to enhance the patient outcomes by the increase of healthcare and medical information access (Nyamu, De Coster, & Taib, 2015). As a continually evolving concept, telemedicine incorporates the new technological advances as it adapts and responds to the changing societal contexts and health requirements. The History and Origin of Telemedicine Telemedicine can be trailed back to the mid-to-late nineteenth century when there was a publication covering the transmission of electrocardiograph data via the telephone (Hurst, 2016). The concept of telemedicine was initially adopted the 1960s particularly by in space and military technological landscape. During this time, the available communication gadgets were used in alerting doctors to offer help in areas that they could access especially during wars (Nyamu, De Coster, & Taib, 2015; Hurst, 2016). The advances in telemedicine at the time involved the use of television to support consultations between general practitioners and specialists at a state mental hospital. There was also the delivery of expert medical advice to an airport medical Centre from a major teaching hospital. In the previous decade, the increased access and use of ICT around the globe have been the most significant drivers of telemedicine (Combi, Pozzani, & Pozzi, 2016). The biggest winners in the recent developments have been the underserved regions of the industrialized countries and the developing states. There is an upsurge in the healthcare provider’s interest to use telemedicine to cover more ground when providing quality healthcare. After the internet was introduced and popularized, the Web-based applications like teleconferences, teleconsultations, and the email as well as multimedia techniques like digital video and imagery enhanced the telemedicine coverage (Hurst, 2016). Application of Telemedicine The classification of the use of telemedicine is by the interaction between the people involved and the timing of the transmitted information (Hurst, 2016). In the asynchronous or stored-and-forward, telemedicine entails exchanging pre-recorded information between two or more people at different instances (Alvandi, 2017). For example, a referring health practitioner or patient sends an email to an expert with details of the issue and a solution is provided as a response to the message. In contrast, synchronous or real-time telemedicine involves the team involved to be present simultaneously for instant information exchange, for instance, using video conferencing (Alvandi, 2017). In both models, the health information is shared as still images, video, audio, or text. These two fundamental telemedicine approaches are employed in various setting to deliver services including in teleradiology, telepathology, and teledermatology. Telemedicine services focusing on the diagnosis and clinical management of patients is primarily utilized in developed nations like Australia, North America, Scandinavia, Northern Ireland, and the Great Britain (Combi, Pozzani, & Pozzi, 2016). Moreover, patients with acute and chronic conditions can be assisted through remote devices as long as they are addressing the relevant problems such as blood glucose levels and heart rates among others. Predictions indicate the prospects of telemedicine are replacing the current hospital healthcare setting and shifting into homes especially in the industrialized nations. In low-income countries as well as areas with inadequate infrastructure, telemedicine services are utilized to link tertiary-care centers, referral hospitals or specialists with health-care providers (L\\\\\\\'Esperance & Perry, 2016). While telemedicine is sustainable, clinically useful, and feasible in low-income nations and underserved regions, its adoption has not been seamless due to a myriad of barriers. Possible Barriers to the Diffusion of Telemedicine Telemedicine overcomes the barriers of time and distance and supports the delivery of healthcare in remote and rural areas as well as those that are traditionally underserved (Weinstein et al., 2014). Its promise notwithstanding, telemedicine has attained varied success levels in the various pilot studies conducted in both advanced and developed nations. Most of them have proven unsustainable, and the entire telemedicine concept has been marred by several challenges, which undercut its longevity. The complexity of cultural and human factors has been a constant barrier to the success of telemedicine (L\\\\\\\'Esperance & Perry, 2016). For instance, some healthcare providers and patients fight the integration of the service models, which are very different from their indigenous practices or traditional approaches while others do not have the requisite ICT skills to utilize the telemedicine techniques (Weinstein et al., 2014). The most significant challenge would be the cultural and linguistic dissimilarities between the healthcare practitioners and the underserved patients. Diverse literature has covered the economic feasibility of the application of telemedicine. The policy-makers and stakeholders are in pursuit of strong business cases to adopt and allocate resources to the concept of telemedicine. Since it has not been forthcoming, it has led to the underfunding of programs and infrastructural shortcomings in telemedicine (L\\\\\\\'Esperance & Perry, 2016). The unavailability of a universal legal framework that permits healthcare practitioners to provide healthcare services in areas out of their countries or jurisdictions also limits the uptake of telemedicine. Presently, proper policies protecting the confidentiality and privacy of the patient regarding transfer, sharing, and storage of data between healthcare providers and authorities have not been established (Weinstein et al., 2014). Technological challenges are also substantial. Sophisticated systems are utilized, and once they break down, there is an automatic hardware and software failure. Such scenarios result in healthcare providers being held liable while the mortality and morbidity of patients increases. The challenges can be overcome through the establishment of comprehensive and definitive guidelines that are applicable universally (L\\\\\\\'Esperance & Perry, 2016). The institution of the legislation governing the liability, access, privacy, and confidentiality is equally critical. In the recent years, there has been increasing collaborative work between private and public units regarding applications of telemedicine (Weinstein et al., 2014). Therefore, it is rewarding to focus on the common goal, which entails maximizing the provision of health services and improving patients’ outcome and not simply focusing on the potential economic gains. Ethical concerns like the patient’s privacy, dignity, and confidentiality should always be protected during the implementation of telemedicine (Hurst, 2016). Furthermore, the team involved should also find a way of ensuring age, mental and physical ability, geographic location, language, and education do not result in the marginalization of care. Literature Review Clinical Telecommunication Applications Studies have recognized four applications of telemedicine clinically including (1) telephone communication; (2) remote monitoring; (3) store-and-forward mode; and (3) real-time interactive way (Alvandi, 2017). The most basic form of telemedicine that offers remote care delivery and communication relates to the use of phone communication. There is a connection to allow for instantaneous interaction between individuals in real-time telemedicine. Real-time scenarios entail being equipped with the telephones and personal computers like in the case of video conferencing. In store and forward conferencing, the information is captured and stored in the form of data, audio, video, or digital images then sent to an expert to provide his or her input. In remote monitoring, equipment identifies the patient intelligently, and then transmits data on any recorded abnormality (Alvandi, 2017). For instance, devices could monitor issues such as arrhythmia, palpitations, or dyspnea. Once the data is transmitted to the doctor’s phone, he is reminded that an abnormal rhythm needs urgent attention. Advantages of Telemedicine Telemedicine can be utilized to monitor health remotely among the elderly clients by using analytical software or smart surveillance cameras to remind their caregivers about any activity changes, the absence of movement or falls (Alvandi, 2017). It helps healthcare providers to tailor the patients’ therapy availability of services and their preferences and minimizes costs. Telemedicine is particularly important with the increasingly elderly population in-need of healthcare yet the resources allocated for such services remain the same. In the near future, the possibility of the financial well of Social Security and Medicare plan running dry is significantly high, and it is essential that counteractive measures are established. Telemedicine enhances the patient’s autonomy since they are more involved in planning for their healthcare. For instance, a patient in need of a wound care can be managed using the applications of telemedicine while at home (Alvandi, 2017). Telemedicine can support communication between a nurse operating in an outpatient clinic of a particular hospital, a nurse at the home of a patient assessing his or her condition through photographs or wound descriptions located in the database and a doctor in a different facility but exceptionally involved in wound care. The significance of a web-based solution to a coordinated care should also be underscored. Ideally, it involves incorporating information from diagnostic tests and biometric measures then alerting the physician automatically (Alvandi, 2017). One of the in-home communication devices is “Health Buddy” that can be utilized in managing heart failure condition whereby biometric measures like fetal cardiac or breathing rate and blood pressure while patterns are monitored from a different location. The devices provide reminders to the patients when it is time for medication or if they legs should be elevated and monitors increased edema and difficulty in breathing then notifies the nurses. Telemedicine Opportunities in Developing Nations Developing nations will benefit from applications of telemedicine in different sectors of the healthcare system. These nations have limited healthcare resources including insufficient numbers qualified physicians, and there is a significant difference in public expenditure on health when compared to advanced countries (Scott & Mars, 2015). In developing countries like India, Kenya, Nigeria, and South Africa, the healthcare and transport infrastructure is still inferior, and the rural and remote areas are primarily underserved (Scott & Mars, 2015). As such, telemedicine presents a viable and apt alternative of delivering healthcare to the population dwelling in the remotest of regions. In the developing countries, healthcare access is unequal (Qin, Dzombak, Amin, & Mehta, 2013). Although healthcare access may be adequate in the urban areas and cities, the remote areas are hard hit. Individuals who fall sick in such places only receive primary care from local facilities that have limited medicine, are under-equipped and under-staffed (Qin et al., 2013). Some patients have to travel long distances to reach the nearest facility and telemedicine had never been any more essential than today. Mobile health has gained significant traction in some developing countries such as India, and Nigeria where mobile operators have increased their clientele up to the remote areas in the region (Qin et al., 2013). The space of mobile phones regarding telemedicine strategy is well underscored. There are several telemedicine projects underway particularly in the prevention and treatment of malaria. For instance, a telemedicine initiative dubbed Mashavu uses kiosks to offer rural residents ‘e-visits’ to the physician (Holmes, Suffian, Lackey, & Mehta, 2014). These kiosks are managed by trained professional volunteers who give the patients an opportunity to undergo primary diagnostic tests. The tests outcomes are then sent electronically to a doctor who provided feedback regarding the essentiality of a healthcare facility’s consultation. Other telemedicine initiatives in countries such as Kenya include TB Control whereby supervision of adherence is by using mobile telephony and the AMREF’s initiative of monitoring food security and illness episodes occurring to patients in their homes. For example, m-health is assisting in streamlining and improving the national health care efforts (Holmes et al., 2014). When clinics embrace these initiatives, patients are no longer referred to bigger hospitals and the travel costs and time is reduced. It also allows for a better distribution of patient load as the referral hospitals would not have to handle extreme cases (Qin et al., 2013). Furthermore, the delivery of medicine has become more effective and timely resulting in an improved nation healthcare service. However, the telemedicine industry presents numerous opportunities for growth. Advancements in software and mobile technologies accommodate feasibility technologies like video conference that need a stable internet connection (Qin et al., 2013). While telemedicine is currently the new frontier for healthcare in the developing nations, its future success can only be determined by the ability of the states to circumvent the numerous barriers around it. Methodology The researcher interviewed a physician who has the specialty in healthcare informatics named Jose Piovanetti from Healthcare Informatics Group. A semi-structured interview guide with both close-and open-ended questions was used to collect the data. The interview was recorded, transcribed, and thematic coding using Nvivo software with a priori and emergent codes. The participant was asked two central questions with probes to provide more clarity. Question One: Could telemedicine positively improve the quality of healthcare and its delivery for remotely located advanced healthcare? The participant regarded telemedicine quite highly and believed that its possibilities in improving the healthcare quality and delivery in remote and underserved regions are limitless. The physician acknowledges that in remote and underserved regions, the doctor-to-patient ratio is insufficient and the medical specialists are mostly not enough to meet the needs of the population. Therefore, multifaceted strategies should be developed to enhance healthcare delivery in clinically underserved places in both urban and rural areas (Rifat, et al, 2015). When patients receive appropriate health care, acute conditions are locally managed before becoming severe. In most underserved and remote regions, the health care delivery system tussles with the maintenance of sufficient numbers of clinical staff to serve the patient load. Globally, there is a shortage of medical supply, and the situation may not change in the coming few years. The participant recognizes telemedicine as the perfect way to circumvent the current quagmire. For example, Piovanetti says: “Telemedicine is convenient at it enhances patient’s experience when interacting with a physician. Costs are also reduced.” In this regard, a patient receives healthcare while closer to home and do not need to travel long distances in pursuit of a specialist diagnosis. Furthermore, the waiting time, travel and transport costs, and the patient’s healthcare utilization are minimized. These saved costs could be utilized in the implementation of infrastructure-laden telemedicine. Piovanetti states: “Telemedicine connects healthcare providers with specialists in various locations thereby ensuring that the quality of service is enhanced.” Furthermore, telemedicine provides significant learning opportunities for healthcare providers. They no longer need to travel to big cities or towns for information, and it would encourage them to serve in remote regions without feeling left out since they would be informed just like their big city counterparts. The physician maintained that telemedicine presents an opportunity that government officials, community leaders, venture capitalists, and healthcare practitioners cannot afford to sleep on because of its benefits in improving healthcare in remote and underserved areas. Question Two: Is telemedicine sufficient to improve healthcare quality and delivery in remote and underserved areas? The participant also provided that the concept of telemedicine does not function on its own in supporting the delivery of quality care in the remote and underserved region. Professional, organizational, individual, familial, educational, economic, legal, cultural, social, and contextual factors are also significant drivers of the telemedicine success. For instance, Piovanetti says, “The problem is pegged on the unequal allocation of the medical resources which automatically marginalizes some communities.” Once the resources that support telemedicine are not reimbursed, then the initiative is bound to fail. Malpractice issues, the inadequacy of information structure, confidentiality concerns, discomfort with technology, and legal provisions on telemedicine also function as barriers that should not be ignored. It is essential to educate the patients about the entire concept of telemedicine since they have concerns including the involved risks, the procedure, or even the assurance of maintenance of their privacy and confidentiality (Rifat, et al, 2015). The whole concept is also new, and most physicians may also be reluctant to change practice patterns, fear losing patients, prefer transferring sicker patients than observing them remotely or even bare uncomfortable with technology. Conclusion The future of telemedicine in advancing delivery and quality of healthcare in remote and underserved areas is quite promising. The inadequacy of specialist services and healthcare providers and the essentiality of having advanced skills will remain on a significant high in the coming few years. It would be problematic to ensure that the rate of production of healthcare workers is directly proportional to the ever-growing population levels. Therefore, policymakers and stakeholders in the healthcare sector will be forced to adopt healthcare delivery strategies that circumvent these challenges. The findings corroborate the previous outcomes on the efficacy of telemedicine. Telemedicine presents the solution for improving healthcare quality and accessibility since it allows doctors to assess, diagnose, and manage conditions from a distance. It also offers an effective approach for underserved regions to access tertiary care advice. Healthcare sectors should invest in telemedicine to enable patients to look for suitable therapy for acute illnesses, adhere to their therapies religiously, and enhance the quality of life those patients battling with chronic diseases. With telemedicine, patients also get to receive timely medical care without the need for traveling long distances in pursuit of better health. Some of the most significant barriers to the realization of telemedicine in the remote areas include underdeveloped infrastructure, social and cultural concerns, as well as reluctance among patients and physicians especially in developing countries. WHO asks its Member States to support the advancing and utilization of the innovative telemedicine solutions to assist physicians in both rural and urban areas to offer quality healthcare. States should treat telemedicine with the urgency it deserves since the society is evolving and medical revolution is inevitable in the 21st century. Therefore, they should set the momentum to sustain and improve the acceptance of telemedicine as an efficient and viable option for improving the quality and delivery of healthcare in remote and underserved regions.