10 Things you wanted to know about Telemedicine
By now we are well accustomed to various digital tools that have assisted transformation into the ’new normal’. Zoom meetings, food delivery, e-commerce and webinars are now a daily part of our lives. All due to the daily lifestyle requirements of the global lockdown and social distancing norms.
Higher forms of digital technology have become widely used to provide coronavirus screening kits, contact tracing apps and mass media communications. They have enabled the public health sector and other departments to know how people access healthcare services for various health-related needs.
Telehealth has been available and in use for the past 30 years or so, their popularity has increased due to the requirements of the patient population and of course the democratisation of technology, especially wireless Internet and smartphones.
Telehealth is actually an umbrella term that covers digital health solutions such as electronic health records, medical IoT (internet of things) and telemedicine. The ability to safely communicate with the healthcare professional while in the comfort of your home is a monumental advantage of decentralised digital health – truly a dream come true for healthcare entrepreneurs and healthcare providers.
However, there are still some obstacles to affordable and sustainable access through telemedicine, either within provider networks or healthcare systems coverage in most countries.
What is telemedicine | Why now?
Telemedicine is a connectivity solution to help people connect with a healthcare professional using digital tools, such as video conferencing mobile apps.
This method allows people to choose their health care provider, make appointments, have a Conversation/consultation, check diagnostic reports, receive electronic prescriptions and many other health-related counselling. All this is possible even if both parties are not even in the same city or country.
Telemedicine allows safe, secure and convenient communication without the hassle of arranging a doctor's appointment, spending a lot of time and resources to and from the hospital, and of course the ability to save money in the long run.
All these benefits have been realised a long time ago when patients used to communicate by telephone, and recently through various digital communication platforms such as FaceTime, Skype, and many other mobile apps.
Why did telemedicine become so popular since the beginning of the global crisis?
The simple answer is – all technologies are possible and affordable, their popularity was governed by mass consumer demand i.e. when a critical mass of people in the community begin to understand their benefits, these early adopters will actively be promoted within their social circles. Sooner or later this spirals outwards into greater acceptance.
The Coronavirus pandemic has shown the importance of social distance connectivity – it was inevitable that the future technology of Health2.0 of 2030 is now mainstream since March 2020.
Benefits to patients | Is it safe?
The greatest advantage of digital health is that it increases access to health care services, that would otherwise be a significant obstacle in many cases. Patients often have issues with healthcare access in terms of not being able to afford standard quality care, inadequate insurance coverage, knowledge deficiency in figuring out what type of doctor is required, the geographic distance that needs to be covered to reach the nearest health centre and of course there are issues with follow-up care.
Telemedicine is unique in that it democratises healthcare communication to the masses – at least those with access to internet telecommunications and smartphone devices.
Telemedicine provides the following advantages to most patients:
1 | Convenient communication regardless of distance
2 | Affordable access to certified healthcare providers
3 | Transparency of providers’ skills
4 | Ability to store a vast amount of patient data for easy transfer and updates
5 | Social distancing can be maintained by both parties, therefore, decreasing exposure risk to themselves and others (especially from crowded waiting rooms)
6 | Patients can easily manage telemedicine appointments without taking a day off work or arranging childcare i.e. an entire working day does not have to be sacrificed for a doctor's appointment
7 | Compliance increases when doctors can establish a good rapport and patients can easily contact for follow-up counselling – this is especially useful for chronic disease management
Other additional benefits to patients can be found in a previous publication related to the essentials of telemedicine.
Click on the following link to download the e-book;
Why would doctors join telemedicine?
In a global health crisis, the healthcare community will overcome the challenges and provide much-needed services in our times of need.
Telemedicine also provides unique benefits to certain specialities related or not to coronavirus care management.
To be a telemedicine specialist a doctor must have the appropriate licensing to practice, a smartphone or computer device and a stable internet connection.
It is ironic that doctors not directly related to coronavirus management (emergency physicians, ICU, radiology and other related fields), are facing some employment issues.
Medical institutions that are financed by public funds or private reimbursements require a steady patient turnover with consistent numbers of elective procedures and patient admissions.
There are reports of various specialist clinics and hospitals closing down and firing their medical staff due to a sudden decrease inpatient flows - quite simply there are fewer people coming to the institutions for their usual healthcare needs.
Additionally, there are doctors who are concerned, perhaps due to their own existing comorbidities and advanced age, that they may succumb to Covid-19 infections as well.
Therefore a solution is required to maintain safety for all parties and still be able to practice clinical medicine safely.
Telemedicine has seen unprecedented adoption by healthcare specialists, who are traditionally resistant to technological innovation in the past, have now realised that this will help them ensure and even enhance their clinical practice.
Health care providers have noticed the following benefits to including telemedicine in their usual practice, either exclusively or alongside their clinic hours:
1 | Telemedicine allows social distanced communication so as to decrease unnecessary exposure to infected persons
2 | Many doctors are able to build up their patient rapport to improve on their history taking abilities
3 | Many insurance companies are increasing their coverage and reimbursements to doctors who not only practice telemedicine but are able to provide preventative care management for patients with chronic diseases
4 | Specialist and consultants are able to oversee difficult cases in many locations while supervising junior staff without the need to physically travel between locations
5 | Theoretically, providers who may not be willing or able to carry out procedures by hand can at least take on a teaching role to upgrade the skills of junior doctors
6 | Telemedicine provided by private organisations or startups may provide sustainable revenue to some specialists who are otherwise not in great demand due to the decrease in patient turnover
Additional benefits to doctors can be discussed in previous literature by clicking on the following link for a direct download.
Link to e-book – https://www.viosapp.com/ebook8
How do you choose the right online doctor?
Patients often have great challenges in finding the right health care provider for their own health issues or for their families. Around the world there is a severe shortage of skilled doctors and nurses, this shortage is worsened by the COVID crisis as well.
Usually, people judge doctor's skills and capacity by the following criteria:
1 | Word-of-mouth referrals from social circles
2 | Online searches related to their health issues
3 | Crowd-sourced recommendation through social media groups
4 | Specialist referral from a doctor in the family
To actually take a conscious decision to select an appointment with that person, people have a deeper consideration when making that choice, often that referred doctor will be further scrutinised according to:
1 | Affiliation to trusted medical institutions such as a reputation medical university, a teaching hospital or a well-known specialised clinic
2 | Adequate certification and skills training such as postgraduate courses related to that speciality
3 | Sometimes speaking a common language or belonging to a common ethnic minority group can be a deciding factor, especially in metropolitan cities
4 | The ease of access in securing a convenient appointment
5 | Very rarely the consultation fees may put off certain patients in out-of-pocket systems, if the patient's pain is severe enough, people have been known to take extreme measures to raise the necessary funds
The real question now is how would you choose an online doctor, and will that person have the right qualifications?
Digital health allows users to assess the key qualities of a product, provider or service before purchasing – much like the description and ratings system in e-commerce.
Telemedicine allows you to be connected with registered and certified professionals who must complete a thorough registration process in the system. Such intense effort in verifying their credentials is important due to the sensitive nature of dealing with someone's health – especially from far away using mobile applications.
Most platforms follow a simple user interface where you can click and select a health care provider from a grid, you can view their credentials and perhaps their training (some platforms even have a rating or patient recommendation section as well) and then you can take the decision to book an appointment for later or to initiate video session through the app.
Often people have to take a large leap of faith to entrust their health and well-being to a complete stranger, whether offline or online.
At the end of the day, it all depends on how the telemedicine platform has positioned itself as a beacon of safety and convenience, and how it upholds strong diligence by only allowing the good doctors to be a part of its platform.
Is Telemedicine really going to help you?
The real impact of telemedicine can only be measured according to the severity of the patient’s problems. Rarely do users compliment a solution based on its aesthetic or hype, as with all things in the marketplace, the true value of an innovation is measured by how effective it solves a user's problems
People who have had difficulties in the past to connect with a qualified healthcare provider due to knowledge deficiencies, geographic distance to the nearest health centre, affordability or as is most commonly the case, the inconvenience of the entire process of reaching a doctor and following the instructions – such issues are efficiently managed using digital health.
Digital media communication allows real-time connection with people from any location at the same time, therefore guaranteeing healthcare access quickly, easily and in an affordable manner, is an obvious win-win situation.
Will a video call with the doctor really solve your health issues?
The cumulative value of telemedicine is the sum of the total experience during a difficult conversation; its contents, the way the provider speaks to you, the ability of the patient to fully understand the recommended management and the most important aspect of any business organisation is customer retention.
Would you come back to the platform and follow up with your assigned provider for regular health visits in the long run?
Honestly speaking, as yet there is still not enough research data to prove that telemedicine visits actually impact positive behaviour modification, management and compliance, patient satisfaction, provider satisfaction and a wider impact on the overall health data outputs (any change in the incidence of a disease, medication consumption, any decreases in morbidity and mortality).
Preliminary data points to an overall positive feedback experience from doctors and patients alike, however individual satisfaction is still something to consider in a case-by-case situation.
Ultimately you have to decide whether a virtual clinic visit solved a particularly distressing health issue for you, which you could not have done physically like in the pre-Coronavirus period.
How would telemedicine help your parents or your children?
Chronic diseases such as high blood pressure, diabetes, cancer, mental health disorders and other complex health illnesses require long-term specialised management by empathic and practical health care providers.
The pandemic crisis has unfortunately shifted attention away from these global killers. Research funding, skills training, medication delivery, insurance reimbursements and timely healthcare access have taken a severe hit.
The Coronavirus outbreak has indeed caused a great deal of suffering and death undoubtedly. But one thing you must realise is that chronic diseases are still a major cause of severe mortality and loss of life quality amongst a larger population.
One day the Covid-19 crisis will be under control by proper public health management and vaccines, however the number of chronic disease patients will still be very high and increasing due to global changes in lifestyle habits and impact of climate change.
Complex diseases usually affect the extremes of age, the very young and the very old. Health care access is still a major issue for the elderly, people with pre-existing health issues and other marginal populations.
There is great potential in using telemedicine to provide easier, cheaper and safer methods in healthcare management for the elderly. Evidence suggests more positive well-being when there is enhanced health management in the form of collaborative relationships offered by both providers and patient caregivers.
There is a negative perception that the older generation are reluctant to accept technology in their lives, actually in many cases people of all ages have realised and are willing to use whatever is at their disposal to impact their problems.
The pandemic has streamlined various behaviours that we would have been common in 2025 – eg. automated food delivery, virtual conferences, digital mass media communication and of course digital health, all within the space of a few weeks since the lockdown.
It is of no surprise that the older generations have become accustomed to smartphone communication and a basic level of tech-savviness to maintain some form of independence. Undoubtedly being able to communicate with a trusted healthcare provider without leaving the home will be widely accepted, regardless of age.
Remote health monitoring by medical IoT devices, easily accessible electronic health records and affordable telemedicine are the key components of any Telehealth infrastructure.
Whatever initial hesitancy may have occurred in the previous decade, is now removed to mass adoption. The real value to elderly care will be based on actual health outcomes and measurement of patient compliance.
What about a full physical checkup?
A comprehensive health checkup is incomplete without a thorough physical examination, diagnostic workup and some basic laboratory tests. In combination with all these procedures, an experienced clinician will ask a series of questions as part of the patient history - to come to a differential diagnosis as to what the patient may be suffering from, and the appropriate clinical management thereafter.
Given the present situation and the inherent deficiency of remote digital health, obviously the doctor is unable to place their hands on you for the physical examination part. This is a common query by both providers and patients with regards to the diagnostic value and its medicolegal consideration with telemedicine, or digital health as a whole.
Back in residency and during my former practising years, I am reminded of the wisdom of my senior practitioners, as they continuously narrate the importance of comprehensive history taking as the cornerstone in clinical diagnosis for most diseases.
The Royal College of Surgeons have carried out extensive research into the importance of standardised history taking. It has been found that asking the patient the right questions can actually produce a 90% accurate probability of coming to the correct diagnosis, the remainder is confirmatory as per physical examination and diagnostic test.
Telemedicine does not claim to replace the clinical examination in any way, nor does it attempt to replace the intimate doctor-patient relationship. It is merely a practical answer to a difficult situation.
An experienced clinician who has spent decades perfecting the art of clinical history taking, fine-tuned soft skills (communication skills, empathy and practical emotional intelligence) and professional bedside manners - will be able to translate his mannerisms into the digital platform.
One of the most common complaints with modern medicine is that the doctors are always in a hurry, they don't give enough time to hear the patient or some may appear indifferent to the patient’s suffering.
On a personal note, I believe telemedicine specialists can finally revert back to their professional era (before the days of patient quota systems), by taking the time to have an empathic conversation via videoconference.
Telemedicine is not perfect. It will never replace the doctor-patient relationship that we had on a physical level.
It is hoped that this form of digital conversation will act as a triage, an initial conversation that will help decide the next step in clinical response; whether or not the patient should actually come to the clinic, do they require any laboratory investigations or maybe just a friendly conversation with a caring doctor can often heal many wounds.
How will you get your prescriptions?
Many diseases can be managed by conservative treatments at home, but there are some ailments which require prescription medication to be taken.
E-prescriptions and pharmaceutical deliveries are supplementary innovations that have become streamlined due to the pandemic. Such services were already present in various forms decades before, only now have people realised their value.
Some telemedicine providers may have an existing vertical whereby the online doctor may provide you a digital prescription, which you may forward to an affiliated pharmacy delivery company. In some countries, an integrated platform exists with medical insurance coverage such that the telemedicine specialist can directly communicate with the local pharmacy for home delivery.
In most cases the online doctor may email you a list of recommended medications (with their digital signature and doctor's seal) and you may have to communicate with your local pharmacy either in person or through their digital contacts.
Can you afford telemedicine?
The ability to afford quality healthcare is perhaps the most essential concern on everyone's minds right now. Healthcare financing is a complex issue faced by doctors who need to earn a living, patients who need to raise funds for procedures or the check if their insurance providers will cover that claim and medical insurers will need to plan for provider reimbursement.
In most developed countries, your healthcare needs would be supported by universal health coverage. Or if you do have medical insurance, your coverage package would reimburse you completely or as part of a deductible.
In the rest of the world, people access healthcare by out-of-pocket means, purchasing appointment time slots, medications, procedures and other services from their own funds.
Until now telemedicine reimbursement is a complicated issue. Many insurers and public sector bodies are unsure as to how to bill a telemedicine session. Many doctors are also not sure how much to charge for a digital consult.
Some would argue that the consultation fees should remain the same whether offline or online since the patient is purchasing the unique skills of a healthcare provider i.e. value-based pricing method is often used and patients pay by digital payment options.
The real question to you is can you afford not to use telemedicine?
Good health management is an ongoing process for people with complex chronic diseases. Lifestyle management, behaviour modification and incentivising positive health choices in the community are dependent on empathic communication with health experts.
Given the circumstances, a minor investment in forming a professional relationship with an online doctor, who is equally skilled and trained (and motivated) to provide a patient with customised practical tips may be a necessary choice to make.
Many public health practitioners are concerned about a much bigger pandemic after the Coronavirus is under control. The unresolved global burden of chronic diseases is a much greater danger.
It is possible that many people have not followed up with her medications and other treatments in the past few months. Stuck with long delay in adequate healthcare management may give rise to a large pandemic of adverse health outcomes due to uncontrolled diabetes, asthma, hypertension and others.
Many telemedicine startups may charge a wide variety of fees for the services – ranging from a package deal, a monthly membership fee or an affordable fee for access to healthcare providers in their team.
It is understandable that most people are reluctant to pay for health services, preferring the public sector to cover the cost or as part of a larger medical insurance package. There has been some collaboration between telemedicine providers and medical insurance companies in this regard.
Unfortunately, a sustainable revenue model for both parties is still under consideration. Regulatory oversight is another issue to contend with before such a partnership can be realised.
Nonetheless, it is still recommended that certain patients take the initiative to use telemedicine to at least follow up with their existing clinical care plans, via telemedicine.
As the saying goes…...something is better than nothing.
Digital care is better than no care at all
How do you prepare for a telehealth visit?
To take full advantage of your telehealth visit and to help the provider evaluate your condition, there are several steps you can take to prepare:
1 | Make a list of your current symptoms, when they started and how severe they are.
For instance, do you have difficulty breathing or pain in your chest?
Do you have fatigue? If so, how severe and for how long?
Do you have stomach pain or diarrhoea?
2 | Keep track of your health records.
3 | Do you have a fever? If so, what is it, and has it changed?
4 | Do you have a blood pressure monitor? If so, what is your blood pressure today?
5 | Are others in your home ill? If so, for how long?
6 | Make a list of any chronic conditions you have and a list of medication you are on.
7 | Have you been tested for COVID-19? If so, what were the results?
8 | In case you are asked to go to the Emergency Room or clinic, make sure you know the location of the closest one.
Also in preparation, make sure your technology is ready:
1 | Are you going to use your phone, tablet or computer for the visit?
2 | Is the device fully charged or plugged in? Do you have headphones?
3 | Do you have a stable internet connection?
4 | Does your health system use an app for telehealth visits? If so, download and register in advance.
5 | Make sure you have a comfortable place to sit for the visit and that your camera gives a clear view of you for the provider.
6 | Have paper and a pen ready to take notes during the call.
During the call:
1 | Be aware that there may be a high volume of calls, so you may have to wait to be connected.
2 | Talk clearly, making sure the provider can hear you.
3 | Make sure they can see you through your camera.
4 | Give identifying information about yourself or your family member.
5 | Clearly present your symptoms.
6 | Answer the provider’s questions as clearly and to the point as possible. There may be a time limit to the session.
7 | Make notes of the provider’s recommendations and ask questions if something is unclear.
Overall, a virtual visit is similar to visiting a doctor’s office, but in these unusual times, more meticulous preparation is helpful. You may or may not receive notes from your call through your patient portal. If you have a portal for this provider, check it after the call to review any recommendations.
Possibilities for telemedicine will evolve and become clear as the technology and policies change. Due to the long term benefits and convenience of digital health, it is likely that even more people will be able to have improved access to more meaningful, helpful, and convenient healthcare.
The future looks bright for telemedicine and nearly limitless possibilities for how it may reshape the global healthcare system by 2021.
"Right now, as much routine care as possible is being transitioned out of in-person settings to remote platforms to reduce the risk of infection. And it seems likely that some of these more routine visits will continue to be offered remotely even after the pandemic subsides.
Now that we know that doctors can easily do electronic health calls, what will we expect in the future?
It’s an exciting time for telehealth and good that we have the technology to do this."
- Dr William England, PhD, JD
Director of the Office for the Advancement of Telehealth in the Federal Office of Rural Health Policy at Health Resources & Services Administration.
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