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Feb 05, 2020

Seeing your doctor anytime, anywhere – the promise of telehealth

Estimated reading time: 11-13 minutes

Opportunities for telehealth solutions in the shift to value-based care

Already in April 1924, when radio technology had just started to enter American homes, an imaginative cover for the Radio News magazine foreshadowed telemedicine in its depiction of a ‘radio doctor’, linked to a patient not only by sound, but also by a live picture[1].
Radio News

And indeed, wouldn’t it be great if you had access to virtual visits from your doctor, could monitor your chronic symptoms at home, get quick electronic transmission of your medical information, and engage with your doctor with interactive patient self-management tools – just as easy as handling your financial transactions or managing your trips?

 

Today, almost 100 years after this visionary idea was born, with mobility and connectivity permeating our everyday lives, we expect easy access to about everything and everyone — including our healthcare providers. But reality is that in most cases when you make an appointment with your GP or receive a referral to a specialist, you still end up having to travel to a practice or hospital, and you often spend considerable amounts of time in a waiting room, reading through dog-eared, back-dated magazines.

Another remarkable, but rather worrisome fact: while more than half of the world’s population is online[2], at the same time there’s an almost equal number of people who still don’t have full coverage of essential health services[3]. In many geographies, direct access to healthcare is simply not available yet.

The promise of telehealth as an enabler of value-based care

Telehealth – the provision of healthcare remotely through telecommunications networks, both in ambulatory and clinical care settings – can extend the reach of healthcare to places like the home, as well as remote or formerly underserved areas. It is a pivotal technology in the transformation towards value-based care, addressing the Quadruple Aim – it can enhance access by bringing care within the reach of more people; it can boost efficiency by reducing costs and promoting better outcomes through allowing care to be delivered quickly across distances and pooling healthcare infrastructure; and it supports satisfaction by enabling more patients to receive trustworthy care to fit a variety of needs on demand, and by reducing workload for healthcare staff.

 

Our 2019 Future Health Index (FHI) report, based on a survey of 15,000 individuals and more than 3,100 healthcare professionals in 15 countries, showed that healthcare professionals who are embracing the use of digital health technology – such as digital health records and telehealth – are seeing a positive impact on their own experience, as well as that of their patients. At the same time, digitally empowered patients who are sharing their health data are seeing a strengthened relationship with healthcare professionals[4].

 

And we can take it even further – by enhancing telehealth with artificial intelligence (AI) and deep-learning analytics, it is possible to analyze enormous amounts of data faster than humans will ever be capable of, hence being able to identify imminent critical health issues. This opens up great opportunities for tele-radiology, for example, allowing patients in nearly any part of the world to get the expertise that was once limited for patients in metropolitan areas.

 

Let me give an example: in China, the number of radiologists is too small to be able to cope with a vastly growing demand for radiology services. In 2018, together with Digital China Health, the largest provider of cloud-based healthcare services in China, we therefore introduced SHINEFLY[5] – a tele-radiology application and services platform to meet the demands of China’s rapidly expanding healthcare system. It is a customizable cloud-based image management system that allows clinical experts – anywhere in this vast country – to remotely retrieve, view, analyze and report on radiological images and associated patient information. In this way, patients can receive optimum treatment via their local hospital, wherever they are.

Telehealth home
Telehealth – the provision of healthcare remotely through telecommunications networks, both in ambulatory and clinical care settings – can extend the reach of healthcare to places like the home, as well as remote or formerly underserved areas.

Why is the adoption rate of telehealth still slow?

Although telehealth is increasingly being used in both ambulatory and clinical care setting, the rate of adoption worldwide is still relatively slow. Across the countries surveyed in our 2019 FHI, telehealth has yet to become a common part of healthcare professionals’ day-to-day work, with 39% saying that they do not currently use telehealth in their practice or hospital. Furthermore, low proportions of healthcare professionals report telehealth positively impacting the patient experience over the past five years.

 

In our 2018 FHI report[6], we already found a number of complicating factors that may cause this slow adoption. Current reimbursement and payment models may not apply to services delivered remotely, especially across institutional or regional borders. And although there is a mounting body of evidence that telehealth solutions can deliver value by lowering costs and offering high levels of patient satisfaction[7], or promoting equality of care in remote or underserved areas[8], this does not necessarily mean they are embraced by all end-users. Ironically, adoption in the patient side seems to be faster, as they see telehealth as part of the total range of online consumer services that they are already used to in other sectors, such as the banking or travel industry.

 

Another complicating factor: as investments in telehealth are unlikely to produce immediate results, budget-holders, payers and healthcare institutions often don’t see direct financial incentives to make the typically substantial initial investments in telehealth. 

 

And finally, in many cases the regulatory or technological infrastructure needed to support telehealth is not fully in place. According to the World Health Organization, only 22% of countries have national telehealth strategies[9], and in a world where some 3.9 billion people still lack internet access, even the most basic infrastructure can't be taken for granted in many countries – especially in the remote or rural areas that could benefit from telehealth the most.  A 2018 study[10] shows that EU policy makers have already undertaken a number of successful initiatives to facilitate telemedicine adoption, with – among others – Finland and Estonia as ‘guiding’ countries.

Although telehealth is increasingly being used in both ambulatory and clinical care setting, the rate of adoption worldwide is still relatively slow.

Dismantling the barriers to telehealth adoption

I am convinced that we can speed up the adoption rate of telehealth solutions by taking the following actions:
 

  • Build the financial case for telehealth implementation – telehealth can be expensive to set up, run and maintain. Reimbursement models should be updated and connected to the value telehealth can deliver, while healthcare organizations can improve their collection of data that demonstrates return on investment. Be aware that in the US, for example, unprecedented reimbursements for telehealth and other virtual services such as remote patient monitoring and image evaluation are available for the treatment of Medicare patients through Centers for Medicare & Medicaid Services (CMS) policies that began in 2019. And beginning this year, telehealth expansion has also specifically grown to allow in-home visits for all Medicare Advantage (MA) patients enrolling in a mix of the private/public MA insurance program.

  • Ensure telehealth implementations go beyond the technical aspects – deployments should factor in training and education for the end-users to ensure these technologies are understood and successfully integrated into everyday practice. Healthcare professionals need to see how telehealth can make a process more efficient or error-free, while patients must understand how it contributes to a more convenient or cost-effective experience. Indeed the concepts of telehealth should be part of the curriculum of doctors and other healthcare professionals

  • Develop a common language – the proliferation of different solutions and data formats can make it difficult for clinicians to share patient information effectively in some areas of telehealth. Interoperability and standardization of formats – at least at the level of individual practice areas – will be needed to realize the network effects that telehealth promises by seamlessly connecting experts in multiple physical locations.

  • Base telehealth on recognition of local differences – we may need more standardization of data formats, but telehealth will not look the same everywhere. Both infrastructure and solutions need to be tailored to the local environment, particularly in currently underserved parts of the world. 

 

I’d encourage all health systems to get behind pilots to find an effective model – start small and scale up to encourage further investment.

Vitalwatch image
Health First’ VitalWatch eICU, powered by Philips’ acute telehealth platform eCareManager

Let me give an example of long-term, successful collaboration in the context of telehealth in intensive care settings: in 2004, Health First in the US became Florida’s first tele-ICU (intensive care unit) when the organization went live with VitalWatch eICU, powered by Philips’ acute telehealth platform eCareManager. VitalWatch allows Health First's critical care physicians and nurses to monitor real-time vital signs, laboratory results, and patients’ complete electronic medical records from a central location across 102 ICU beds at the four Health First hospitals. 

 

Over the past 15 years, this VitalWatch eICU program – monitoring more than 10,000 patients each year – has demonstrated significant reductions in mortality and lengths of stay for the health system’s sickest patient population: a 23 percent reduction in overall mortality across the four hospitals as a whole; 49 percent reduction in ICU length of stay; and 35 percent reduction in lengths of stay throughout the four hospitals[11].

 

As with other aspects of connected care, success in telehealth will ultimately be based on the involvement of multiple actors – healthcare professionals, the general population, payers, regulators and the private sector – together with the recognition that healthcare is, at heart, a human field that depends on people. By helping to unite the industry and stakeholder community behind a common roadmap, I am convinced we will be much further on the path to delivering more patient-centered, outcome-based telehealth – as already envisioned in 1924: bringing the ‘radio doctor’ to you, wherever you are.

 

References

[1] https://www.ncbi.nlm.nih.gov/books/NBK45445/figure/a20006365mmm00001/?report=objectonl

[2] https://www.statista.com/statistics/617136/digital-population-worldwide/

[3] https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)

[4] 2019 Future Health Index report: Transforming healthcare experiences, https://www.philips.com/content/corporate/en_AA/about/news/future-health-index/reports/2019/transforming-healthcare-experiences.html/

[5] Commercially available in China only

[6] 2018 Future Health Index Report: ‘Telehealth: Delivering value across institutional and geographical borders’, https://www.philips.com/a-w/about/news/future-health-index/reports/2018/telehealth-delivering-value-across-institutional-and-geographical-borders.html

[7] https://www.healthcarefinancenews.com/news/telemedicine-can-lower-costs-health-systems-24-patient-study-finds

[8] https://news.aamc.org/patient-care/article/telehealth-health-care-disparity-gap/

[9] World Health Organization. (2016). ‘Global diffusion of eHealth: making universal health coverage achievable’, https://www.who.int/goe/publications/global_diffusion/en/

[10] ‘Market study on telemedicine’, European Commission report, 2018. https://ec.europa.eu/health/sites/health/files/ehealth/docs/2018_provision_marketstudy_telemedicine_en.pdf

[11] Data and outcomes per quarterly benchmarking reports provided through Philips eCareManager system. https://www.philips.com/a-w/about/news/archive/standard/news/press/2019/20191211-philips-and-health-first-spotlight-results-of-15-year-strategic-collaboration-in-tele-critical-care.html

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Author

Jan Kimpen

Jan Kimpen

Chief Medical Officer, Royal Philips

Before joining Philips in 2016, Jan Kimpen, Professor of Pediatrics, was CEO of the University Medical Center in Utrecht. He leads the global clinical team of Philips, focusing on advocacy, customer partnerships, clinical research and medical consulting, and is responsible for the annual publication of the Philips Future Health Index.

 

He is a strategic advisor for commercial and clinical strategy, market reimbursement, R&D roadmaps and partnerships and M&A, and provides thought leadership on relevant clinical and medical topics. Jan participates in the WEF Global Future Council on Healthcare, the American Heart Association alliance and the Board of Sanara Ventures in Israel. Jan is president of COCIR, the European trade union for imaging, healthcare informatics and radiotherapy.

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