• Telemedicine
  • Telemedicine market set to expand further

    The global market for telemedicine is expected to be worth more than $34 billion by the end of 2020. An article in Healthcare IT News looks at a new market research report, Global Telemedicine Market - Growth, Trends & Forecasts (2015-2020), published by Mordor Intelligence.

    As could be expected, North America is leading the charge as the largest market globally, accounting for more than 40%. Driving growth is an increasing aging population, increasing incidences of chronic diseases and a rapid rise in the software market.

    Many healthcare systems are also trying to reduce the number of hospital visits and the length of stay in hospital. In response, there’s a growing trend for patients to be monitored in their homes paving, the way for more telemedicine.

    While tremendous growth is forecast, the market still has some obstacles to overcome. A lack of physician support, poor cases of implementation, high technology costs, and legal and reimbursement concerns are all hindering the growth of the market, and will have to be addressed to reach its expected growth by 2020. These are challenge that Africa’s healthcare has to address too. 

  • Smartphones can do telemedicine

    As photos on smartphones become better, they can replace images provided by telemedicine. Figure 1’s already using images in the same way, as eHNA posted earlier. A study by a team from South Africa’s Stellenbosch and Pretoria Universities and Sweden’s Karolinska Institut has shown that smartphone photos are as good as telemedicine photos.

    In Liebert’s Telemedicine and e-Health, the report says the team hired a professional photographer to photograph a series of three types of objects, none of which were clinical, with three smartphones; an Apple iPhone, a Samsung Galaxy S2, and a BlackBerry. Photos were also taken with Canon Mark II digital camera as a comparator.

    Sixty lay people were shown them in a blind review to assess the quality from the four devices. There were wide variations between and within categories.  The iPhone had the highest proportion of images evaluated as good. It was also best for more objects. Results for the Samsung, Blackberry and Canon were similar.

    The team says its results provide good indications that smartphones from the three mobile platforms can provide doctors with a working tool that can help with photographic documentation and image-based communication. Tele-experts weren’t included in the study, so their views are needed before a switchover. Before this happens, the team are confident that there’ll be an increasing volume of tele-advice provided using smartphones or tablets. Figure 1’s experience confirms it. Doctors’ practices may make the switch in real time, so Africa’s healthcare has an opportunity.

  • Telemedicine will grow by 18% a year

    An assessment of the global telemedicine market by Research and Markets says spending will grow at a compound rate of more than 18% a year up to 2020. It says the shortage of physicians in rural and remote areas provides the opportunity for telemedicine to reach millions of patients, leading to a rapid and widespread deployment. The study, Global Telemedicine Market Outlook 2020, reviewed telemedicine technologies, including hardware, software and services. Total spending in 2014 was an estimated US$ 17.8 billion.

    The estimated growth is attributed to the high prevalence of chronic diseases, the increasing number of smartphone users, the need for better quality services and increasing elderly populations.

    But, reimbursement challenges, uneven telecom network distributions in remote areas, and high operating cost hinder implementation. This may tip Africa away below the average growth. It may also be constrained by affordability.

    The dominant suppliers included in the report include McKesson, Philips Healthcare, GE Healthcare, and Cerner. Will they see an average growth in African countries?

  • Telemedicine helps type 2 diabetics

    As the cases of diabetes type 2 increase, a systematic review by Dr Rashid Bashur from the E-Health Center, University of Michigan Health System, and his colleagues, published by Liebert, says telemedicine can help. Its findings are “The major contributions point to telemedicine’s potential for changing behaviors important to diabetes control and prevention, especially type 2 and gestational diabetes. Similarly, screening and monitoring for retinopathy can detect symptoms early that may be controlled or treated … Overall, there is strong and consistent evidence of improved glycemic control among persons with type 2 and gestational diabetes as well as effective screening and monitoring of diabetic retinopathy.”

    The study reviewed 73 research articles on the outcomes of telehealth use for diabetes control. It analysed different patient populations, technologies, resources and research protocols. Other findings were:

    Telemedicine for diabetes can be effective for rural patients A 29% increase in adherence to prescribed glycemic tests by patients when nurses called patients to remind them Decreases in A1c levels and cardiovascular risk factors with an electronic disease management system and a home care link to send messages for Type 1 or Type 2 diabetes.

    The study provides evidence for African countries to use in assigning priorities to their telemedicine initiatives. It could overlap as good practices for some mHealth projects too.

  • More mHealth services for Kenya

    Airtel Kenya has partnered with Medanta Africare to launch a new mHealth service that will allow customers access to quality health advice from doctors through their mobile phones by calling 1525 at normal calling rates. BIZTECH Africa says the service will be available daily from 8am to 8pm.         

    The mHealth services to be piloted in Nairobi will allow Airtel customers to access health services at pre-defined rates and get second opinion on diagnosis from specialists in Medanta India through Medanta’ s Telemedicine Centre in Nairobi. Additionally, the following benefits will be extended to all Airtel Premier customers when they visit Medanta Africare:

    Pathology: 20% discount for customers who pay on cash basis Radiology services: 20% discount for customers who pay cash Dental Consultation: Kshs.1,200 discount for customers who pay cash Doctor’s consultation: 1 free consultation a year for subsequent reviews 1 health check at 10% discount per year  Telemedicine consultation with Medicity: 50% Discount  Home collection of samples if within 5km radius from main facility Pharmacy Medicine: 10% discount on all medicine purchased from the premises Specialist consultation at main facility: 20% discount.

    To ensure that the service delivers accurate medical diagnosis, Medanta Africare has stationed trained staff to attend to customer calls and recommend solutions to respective doctors in the hospital for appropriate action to be taken. Additionally, all medical consultants will be supported by a world-class technology solution that will help them examine customers’ medical cases in the most effective way possible.   

    Medanta Africare President & CEO Anil K. Maini said, “This is an innovative and a first of its kind service in Kenya, to a large section of Kenya’s population, wherein they will be able to access healthcare information on their handsets & also avail home healthcare services provided by Medanta Africare, in the comfort of their homes.”

  • ICUs need telemedicine too

    Traditionally, telemedicine is associated with consultations over considerable distances and often with the equivalent of a preliminary to an outpatient appointment.  There’s a growing case for telemedicine driven from ICU. A research study, by Marshall University in West Virginia, USA, published by Telemedicine and e-Health.

    ICU telemedicine needs are different. They have higher implementation costs than outpatient versions, but hospitals could benefit more, both for healthcare quality gains and financially, the research says. Quality benefits included better patient safety and patient satisfaction. Teamwork, supervision and communications between health workers improved too.

    Affordability of ICU telemedicine may be a challenge, but the costs and benefits are worth exploring, especially for large tertiary hospitals. As they realise benefits, they provide evidence for the case for further expansion, or no expansion.

  • Why should telemedicine regulations differ from conventional services?

    Some anxieties are creeping into the excessive requirements for telemedicine services compared to the regulations for conventional healthcare. The American Telemedicine Association (ATA) guidelines propose a principle that provides for “a standard of care for telemedicine equal to that of in-person care in order to promote patient safety, increase the quality of care and expand access and patient choice in health services.”

    FierceHealthIT has a report on the ATA’s application of its principles in its submission to the Federation of State Medical Boards’ (FSMB) proposed telemedicine regulations, its Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine. They include:

    Allows patients to choose the physician providing telemedicine, rather than be assigned one at random Define telemedicine as videoconferencing or store-forward technology, not telephone or email consultations Allow physicians to treat Medicare patients across state lines, not just in patients’ jurisdictions Don’t require physicians to reveal their details or her credentials before treatment because it sets a higher bar in-person visits.

    As African countries expand their telemedicine services, there are some good principles in both the ATA and FSMB documents worthy of consideration.

  • Telemedicine uptake on the rise

    Technological advances continue to revolutionize healthcare. Infinity Medical Equipment Services, a healthcare consulting group, is using its innovative technologies for an entirely new medical purpose. The company recently conducted and completed a service call, with doctors in the USA speaking to workers in Senegal. A doctor in Camberen, Senegal, reportedly needed help understanding a new part for his catheter lab. The physician received support and guidance via a live video feed from 25 experts who specialized in the technology. The experts connected to the doctor’s remote cardiovascular surgical facility, extending its ability to treat patient problems.

    Given the potential benefits of telemedicine and its ability to make healthcare more efficient and cost-effective, it’s no surprise that the market is expected to expand. A recent Markets and Markets report predicted that potential growth could rise as high as a compound adjusted growth rate of 7.31% over the next five years, with the overall market increasing to US$103.42 billion. This is largely because cloud-based services and interoperability are growing in popularity world-wide.

  • Is telemedicine a dying duck or an ugly duckling?

    Two famous Danish authors have links to Africa. Baroness Karen von Blixen-Finecke wrote Out of Africa using her pen name Isak Dinesen. Hans Christian Andersen wrote The Ugly Duckling about a bird born as a misfit into a community of ducks, to find he was a beautiful swan, a bit like telemedicine’s waiting. Both books have become films. Only the Ugly Duckling has become a hip-hop band.

    Unlike ducks and swans, telemedicine hasn’t taken off in Africa in a way that matches its promise. It’s the same for many countries on other continents. Software Advice has asked a few USA citizen what they think about it. Its report, Patient Interest in Adopting Telemedicine, might show how far it still has to go.

    The sample revealed a low use rate. About 73% haven’t used telemedicine. About 18% had in the previous year, with 6% using it more than a year before. Asked how interested they were, people said:

    15% extremely 24% very 37% moderately 18% minimally 6% not at all.

    The report interprets this as 75% of “patients are at least “moderately interested.”” Put alongside the take up rate of about 24%, a more relevant interpretation might be 61% of people aren’t very attracted by telemedicine, 39% are. It’s an improvement on the current rate, but doesn’t seem likely to stimulate a massive telemedicine uptake.

    Does it mean that telemedicine’s a dead duck or an ugly duckling or something more promising we haven’t seen yet?

  • Telementoring works in Africa and on Mars

    A mission to Mars and a remote rural village in Africa may have more in common than initially meets the eye. While they can be separated by as much as 400 million km, they share the characteristic of physical separation between a patient and the medical care they may require. While both may have someone able to deliver basic medical interventions, that person is often not trained to manage complex medical emergencies.

    Telementoring is a technique used by physicians and surgeons, where a specialist can guide a less experienced colleague performing a complex procedure in real-time. This guidance is best provided through a two-way video link with real-time data transfer, although in some cases only voice or one-way video may be sufficient.

    In its first virtual Mars mission simulation called V-ERAS 1, the Italian Mars Society conducted a telementoring experiment, where four of its virtual astronauts were faced with a simulated medical emergency. The exercise consisted of two other virtual astronauts involved in an accident on a simulated spacewalk on the virtual surface of Mars, and arrived at the base seeking medical attention. The injuries encountered were above the virtual astronauts’ level of training, so they established a telemedicine link with the African Centre for eHealth Excellence (Acfee) with Dr. Sean Broomhead, playing the role of a physician at another surface base on the Martian surface. The simulation took place in Madonna di Campiglio, Italy, while Dr. Broomhead was located in Kimberley, South Africa; a separation of over 8,400 km.

    In the simulation, Dr. Broomhead successfully guided the virtual astronauts through the execution of complex medical procedures, including reducing an anterior shoulder dislocation and decompressing a tension pneumothorax, saving the lives of the simulated patients. Of course, such a link could hardly be established between Earth and Mars, due to the communications delay introduced by the great distance between the two. This was rather a simulation of communications between two Mars surface bases.  Where near-real time communications are impossible, video mentoring may play an important role.

    While this type of communication exists in many places world-wide, this was a powerful demonstration of its effectiveness. Not all rural communities in Africa can physically have a slew of experts in all medical disciplines, but they can benefit from their virtual presences. Telementoring can be valuable in many settings and infrastructures.

    Telementoring can make use of:

    Landlines Mobile phones Video links Data links.

    At the most basic level, it can consist of a voice connection facilitating a telementoring consultation between two experts in different medical centres. With increasing infrastructure, video and data streams can be integrated to provide a better telementoring experience.

    The implementation of telementoring in African healthcare centres is an example of an organizational change that can be implemented with or without any additional infrastructure. It is a solution whose simple implementation can have big impacts; and this type of low-hanging fruit should be a starting point in African nations’ eHealth strategies. It is low-budget, high-impact, rapid implementation, and low risk, and would enable medical experts from one centre to assist local healthcare providers with a wide range of their clinical needs.

    Photo courtesy of the Acfee - Dr Sean Broomhead performing a teleconsultation.