• Telemedicine
  • eHealth Group offers a telehealth paradigm shift

    About a third of African countries invest in telehealth, identified by the WHO and Global Observatory for eHealth in their 2015 survey. Since then, eHealth Group, based in South Africa, has leapfrogged telehealth’s technology and its supply side. 

    Its lineage goes back to the Da Vinci Robotic Surgery. This enabled eHealth Group to incorporate the ideas, principles and techniques into its robotic telehealth services. Instead of a link between a patient and a healthcare professional, eHealth Group’s robots and products enable healthcare professionals to deal directly and easily with several patients in wards, ICUs and communities.

    At its core are:

    • Direct access to a wide range of clinical data about patients
    • Explicit, precise and clear images of patients
    • Its own excellent, global telecommunication network. An example is where doctors can have two screens.

    The picture shows a doctor accessing a patient’s view and PACS side by side. It’s an efficient and effective use of his time and benefits patients directly.

    South Africa’s eHealth Group provides services across Africa. It’s part of a global network, operating in over 30 countries, across 20 specialties in over a thousand hospitals and over 4,000 medical specialists available online. About 70% of US telestroke hospitals in the USA use eHealth Group’s services, up from 30% four years ago. 

    There’s a wide product range extending from tablets to sophisticated robots that provide high quality telehealth. Alongside the products, eHealth Group provides a service range including access to advice from a network of medical specialists, specialists who can provide direct patient care, and training. 

    Elliot Sack and some of his robots from eHealth Group will be at eHealthAfro 2017 on 2 to 4 October in Johannesburg. His presentation will reveal the paradigm shift that can make a difference to Africa’s health and healthcare. eHNA has more to report on it.

  • Kenya accesses ConnectMed’s telemedicine services

    Launched in 2015, ConnectMed, a South African eHealth start-up, has now launched operations in Kenya. Its aim’s to provide affordable medical advice to patients outside a healthcare setting. It’s gained recognition after being chosen as five winners in the 2016 DEMO Africa start-up pitching event, then its recent involvement in the Lions@frica Innovation Tour in Silicon Valley.

    ConnectMed’s mainly for middle and upper incomers who have easy access to Internet-enabled devices and use private healthcare. However, it’s been successful in Kenya’s rural areas and big cities. During trials in Kenya, it became evident that elderly patients who found it challenging to travel for sexual and mental health advice had adopted the platform.

    The start-up gives patients a platform to schedule a secure virtual 15 minutes access from 8am to 11pm, seven days a week. Users can set appointments with doctors for the same day over a video for common ailments. These are either directly through ConnectMed Prime or indirectly through clinic partners ConnectMed Care.

    Like most of Africa, Kenya’s healthcare relies on insufficient doctors, is inaccessible to many communities, has high travelling costs and limited available hours. The virtual doctor services aim to deliver scalable healthcare to solve these challenges.

    At least 50 doctors licensed by the Kenya Medical Practitioners and Dentists Board (KMPDU) have signed onto the platform. They can provide ePrescriptions, sick notes or referral letters. ConnectMed patients are given discounts on medication and follow-on services from service partners.

    An article on eHealth news says ConnectMed also offers an enterprise solution suitable for clinics experiencing a shortage of doctors. It enables clinics to treat more patients and improves the medical skills of existing staff. Melissa McCoy, CEO of ConnectMed said to Demo-Africa that the company plans to establish physical hubs in cyber-cafes and pharmacies where the general public can access its health information. It may not be long before its available across most of Africa.

  • Masters in eHealth management applications open now

    Like all health systems, developing eHealth management and leadership skills are essential for Africa. In February this year, Acfee and Rome Business School (RBS) set up an arrangement to support the RBS Masters in eHealth and Telemedicine Management. The next course starts in October 2017. Online applications are already now.

    Part of the arrangement is a discounted price for applicants from Africa. It’s only available to Acfee members. Acfee membership’s free to people working in health and eHealth, health and healthcare organisations, professional bodies and health ICT entities.

    If you’re already a member, you can use your Acfee membership number in your RBS application. To join, email info@acfee.org with details of your current role and employer, and Acfee will send you a membership number and information pack.

  • Telehealth may make no difference to some LTCs

    Enabling patients with Long Term Conditions (LTC) to manage their health’s been one of telehealth’s long-term goals. A research team from Edinburgh has reported in the Journal of Medical Internet research (JMIR) completed a metareview of 53 studies to see if telehealth’s beneficial in managing five LTCs, diabetes, heart failure, asthma, Chronic Obstructive Pulmonary Disease (COPD) and cancer. It aimed to:

    • Assess telehealth’s impact for interventions to support self-management, disease control and health care utilisation
    • Identify telehealth components of support and their impact on disease control and self-management.

    It found that benefits varied between and within diseases. Blood glucose tele-monitoring with feedback and educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes. Telemonitoring and telephone benefits for heart failure patients reduced mortality and hospital admissions, but were not consistent in all reviews. Results for the other conditions were mixed. No reviews showed evidence of harm.

    Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma.

    A firm conclusion is that telehealth-mediated self-management’s not consistently superior to usual care. Telehealth’s a safe option for managing LCTs, especially heart failure and type 2 diabetes, apparently because they have developed evidence. Larger-scale telehealth trials based on theory are needed to have certainty about which telehealth technologies may be harnessed to support LCT management. 

    WHO, in its 2015 eHealth survey, found that just over a fifth of Africa’s health systems are actively investing in various forms of telehealth for remote monitoring, the. The telehealth study indicates that they could gain by linking these investments to expansions of their evidence bases. They could also contribute to the bank of knowledge by evaluating their remote monitoring services and supporting the rest of the continent in achieving better telehealth and eHealth proejcts.

  • Telemedicine is as big a US priority as EHRs

    Telemedicine’s up with inpatient and outpatient EHRs for US eHealth investment priorities. A survey by Reaction Data found 33% of healthcare executive have it as their top priority, alongside 32 % who have EHRS for inpatients and outpatients as top. Nearly half the respondents work in standalone hospitals. About a third are ion Integrated Delivery Networks (IDN).

    About 20% have investment to support a payment initiative. The Medicare Access and CHIP Reauthorization Act 2015 (MACRA) is a new way to pay doctors who treat Medicare patients. CHIP’s the Children's Health Insurance Program.

  • Telemedicine performance can steer Africa’s programmes

    In the right setting, telemedicine’s worth it. For Africa’s remote communities, it can offer access to services and avoid long, and sometime wasted, journeys. A US study by NTCA–The Rural Broadband Association Anticipating Economic Returns of Rural Telehealth, identifies quantifiable and intangible benefits.

    The report identifies intangibles that include access to specialists, timeliness, comfort, transportation, provider benefits and improved outcomes. Its quantifiable benefits are transport cost savings, reduced loss of wages, hospital cost savings and increased revenues to local labs and pharmacies.

    For Africa’s rural communities, telemedicine can bring all these, but there are two big practical challenges. One identified in the report is rural telemedicine’s significant dependency on the future-proof, fibre-based broadband infrastructure. It’s seen as a challenge in the US too. In Africa, it’s a longstanding technical and affordability challenge. Part of the solution may be in using smartphones and their networks for telemedicine.

    Increasing access for rural patients may result in a significant impact on stretched healthcare resources, especially specialists. This can be offset by reducing the unnecessary visits, but still likely to increase workloads. It’s not necessarily an insurmountable problem, but clarity on the implications is important to have in advance.

  • Samsung's launching new telemedicine features

    At the launch of Samsung Galaxy S8 and S8+ phones, the company announced the re-invention of its S Health app as "Samsung Health". An article in mobihealthnews says the upgrade includes tracking and social features already in S Health and  adds new features and a new user interface.

    Ask an Expert’s Samsung's most-popular feature. Users can connect via video to a doctor for US$59 without insurance. It includes real time insurance verification. 

    The app taps into American Well's system so users can see several doctors. The company says its network contains more than 1,200 certified, licensed doctors with an average of 10 to 15 years of clinical experience.

    "This isn’t telemedicine, this is a connected healthcare ecosystem,” American Well CEO and President Dr. Roy Schoenberg told MobiHealthNews. “And we’ve been building up so that it is bigger than anything we have done, and what Samsung is saying is, ‘I’m not going to build healthcare on my product, I’m going to tap into that ecosystem and open the door through technology that touches a lot of people.'”

    In addition to the telemedicine features, Samsung Health includes:

    • Access to lifestyle, food, and fitness trackers
    • A step leaderboard to compete with friends
    • A Discover feature for health content
    • Integration with connected health devices
    • Rewards for signing up with Ask an Expert or Health Insights, a feature that adds analytics and coaching to Samsung's health trackers. 

    The app will be available on all devices that run Android 4.4 and higher. Some older devices and devices in certain countries may not have access to all features. It highlights an important component of Africa’s drive towards Universal Healthcare (UHC).

  • Telemedicine saves time, cuts travel costs and improves air quality

    Telehealth policies continue to grow. Whether it actually reduces healthcare costs and improves outcomes is still a point of some contention. Researchers at University of California Davis (UCD) looked at how telehealth impacts patients at a basic level: driving costs.

    Spanning across two decades, the study, published in Value in Health, examines 18 years of UCD’s clinical records from 1996 to 2013, evaluating inpatient and outpatient interactive video visits for 19,246 patients.  Patients usually still visit their primary care doctor, but they also consult a UC specialist via video consultation. The cost savings were measured based on patient travel to a telemedicine center near their home versus traveling to UC Davis Health in Sacramento for specialty care.

    Telemedicine visits saved patients an aggregate of nearly nine years of travel time, five million miles and US$3 million in costs. For each individual, these numbers are a little more modest. Over the 20 year period, a patient could see an average cost savings of four hours of driving time, 278 miles and US$156 in direct travel costs.

    The UCD team researchers measured environmental impacts from the avoided car trips. Telemedicine helped saved almost 2,000 metric tons of carbon dioxide, 50 metric tons of carbon monoxide, 3.7 metric tons of nitrogen oxides and 5.5 metric tons of volatile organic compounds. It’s a big contributor to cleaner air, a factor often missing from previous evaluations.

    If the study paramaters were expanded to include rural areas that are underserved by medicine and reliable public transportation, the results are very different. The real costs of fuel, mileage and time are all measurable savings from telemedicine to patients. This is the case in many African countries, where people often have to walk long distances to reach a healthcare facility before waiting in queues for hours before being helped. These should combine into encouraging more patients to seek medical care. As telemedicine technology advances costs to patient will drop, reinforcing increasing access.

    African healthcare systems have a way to go before telehealth benefits can be realized and services be implemented on a large scale. Infrastructure, affordability and connectivity remain challenges.

  • Brazil looks set to expand telemedicine

    Market research report on Brazil’s telemedicine shows it’s likely to increase from $495.3 million in 2015 to $743.8 million in 2017. That’s about a 50% increase in two years. Research and Markets published its findings and also found that the country’s mHealth market revenue look set to grow from $446.8 million to $1.43 billion over the two years, more than three times its 2015 spend.

    Brazil’s teleradiology takes a huge market share, 98%. The remaining 2% is for specialist consultations and distance learning and education. mHealth is a different market. Its range’s broad, and includes some apps for telemedicine.

    Despite mHealth’s gigantic growth forecast, there are several investment barriers. Short life-cycles is one. Both wearable and apps, and across vital signs remote monitoring and chronic disease management, mHealth’s rapidly and constantly transforming its ecosystem with new value proposition and solutions. Dealing with these obsolescence costs creates affordability challenges.

    World Bank data shows Brazil’s Gross Domestic Product (GDP) per head as about US$8,539. An average for Africa’s about US$5,666. The extra 50% can make a big difference to eHealth affordability. Even so, Brazil’s forecast expansion’s huge, so Africa’s health systems may be able to see some significant growth.

  • WHO’s telehealth view is optimistic – unpacking the 3rd Global Survey on eHealth

    French and English speaking African countries have long associations with telehealth. Réseau en Afrique Francophone pour la Télémédecine (RAFT) Project involved Geneva University Hospital and Health On the Net Foundation in developing a network for eHealth in Africa. It started in 2000 and is now across four continents.

    Telehealth data from WHO Global Survey 2015 provided insights for Chapter 3 of the WHO and Global Observatory for eHealth (GOe) publication eHealth Report of the third global survey on eHealth Global diffusion of eHealth: Making universal health coverage achievable. The report deals with five telehealth types:

    1. Teleradiology
    2. Teledermatology
    3. Telepathology
    4. Telepsychiatry
    5. Remote patient monitoring.

    A country average was 3.7 telehealth programmes. At about 3.3, Africa had slightly fewer, about 90% of the global average. For the five telehealth types, Africa’s teleradiology in about two-thirds of countries has a score of some 60%, below the global rate of 75%. The other four types are below 45%, with telepsychiatry the lowest, about 20% of teleradiology’s rate.

    Telehealth evaluations are increasing in number. Criteria used to evaluate government-sponsored telehealth programmes were:

    Programme acceptance by providers
    73%
    Quality
    73%
    Access
    68%
    Programme acceptance by target groups
    64%
    Cost-effectiveness for providers
    55%
    Sustainability                    
    55%
    Health outcome
    50%
    Cost-effectiveness target groups
    46%

    Comprehensive evaluation using Cost-Benefit Analysis (CBA) could combine all these perspectives. It could also include efficiency and provide a direct link with telehealth financing. Global perspectives of barriers to telehealth investment may not match Africa’s, especially telehealth finance and infrastructure for connectivity:

    Importance        


    Very      
    Not
    Funding                
    <10%
    >70%
    Infrastructure  
    >10%
    >50%
    Priority                  
    <20%
    >40%
    Legal    
    >10%
    >40%
    Capacity
    >10%
    >40%
    Policy
    >20%
    <40%
    Cost-effectiveness
    >10%
    <40%
    Demand
    <20%    
    <40%
    Effectiveness
    >10%    
    <30%








    Since telehealth emerged on the scene, technology’s changed. The Internet and mHealth have created new and wider opportunities. Initiatives like Figure 1, described in an eHNA post, are changing its scope and range, and offer Africa’s health systems greater participation.