How technology has transformed telemedicine. Consumer benefits of telehealth.

How technology has transformed telemedicine. Consumer benefits of telehealth.

Sebastian Boëthius

Digital Health Business Strategy and Development

Michał Grela

Relationship Manager at Future Processing

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The technology side and the human part are the most important aspects of today’s telehealth, essential to bring the necessary effects and provide healthcare to those in need.

Medicine 20 years ago and medicine today is not the same science in terms of technological acceleration it has faced throughout the years. It seems that 2020 made it even more advanced and technology-oriented considering the ongoing pandemics and the need to limit in-person appointment but maintain the same level, or at least close level, of access for the patients.

In 2019, less than 10% of consumers had a telehealth visit within the past year. In 2020 such visits became a must-have and one month into the lockdown, about 80% of our visits were happening virtually. This shows the huge acceleration we had to face, both in the terms of technological background as well as patient-doctor interactions.

Together with my guest, Sebastian Boëthius, we will touch upon exactly those two aspects of telemedicine: the technology side and the human part. Both approaches are essential for telemedicine to bring the necessary effects and provide healthcare to those in need, especially now.

Michał Grela (MG): Hello, and welcome to another episode of IT Insights by Future Processing. Today, my guest is Sebastian Boëthius, and we’re going to discuss how technology has transformed telemedicine and what are the consumer benefits of the telehealth. In a short introduction to the topic, medicine 20 years ago and medicine today is definitely not the same science, in terms of tech acceleration and what happened throughout the years. It seems that 2020, in the pandemic, made it even more advanced and technology-oriented, considering the ongoing situation and the need to limit in-person appointments, at the same time, maintaining the same level, or at least a close level of access for the patients.
In 2019, less than 10% of customers had a telehealth visit within the last year and in 2020, such business became a must have. One month into the lockdown, about 80% of our visits were happening virtually. Just shows how huge acceleration we had to face, both in terms of tech background, as well as patient to doctor interactions. And together, with my guests, we will touch upon exactly these two aspects of telemedicine; the technology side and the human part of it. Both approaches are essential for telemedicine to bring the necessary to effects and provide healthcare to those in need, especially now. Thanks for joining me, Sebastian. I’m really happy to have you here with me. Can you give some sort of an introduction to our guests?

Sebastian Boëthius (SB): Yeah, sure, hi, Michal. Yes, my name is Sebastian Blasius and I am a serial CTO for several companies. I work largely within the health tech/med tech sector, and I lead online projects, application development and mobile application development, together with teams and agencies around the world, actually. In the past few years, the topic of remote patient monitoring or telemedicine has become very, very interesting, and especially now with COVID and the pandemic, extremely relevant. Yeah, I’m so excited to work in this field, because part of me, when I grew up I either wanted to become a doctor or then actually what happened was computers grabbed my interest and I did that instead. This is a double vocation for me almost.

MG: All right, so very relevant conversation then, indeed. From your perspective, starting with the jump we had to make as humanity, let’s say, do you think that we were prepared to go straight into telemedicine when COVID knocked at our door, or as in many areas of life, we were caught off guard?

SB: Yeah, well, as you said basically, in many years of life, I think everyone got caught off guard with COVID-19. You look at the news and the reports and you see many experts with their, “I told you so,” look on their faces, especially when they were reporting about that this could happen at any time and we were just… There were programs dedicated to this and we were just not ready for it. But I think, especially working with a lot of EHRs, electronic health records systems, and EMRs, I’ve noticed that even there we’re caught off guard with telemedicine. A lot of these systems are conceptualized within a doctor-patient model and a visit or an encounter relationship, and that’s just not reflected in today’s standards.
We have wonderful systems, such as EPIC, Athena Health, but all of them, they implement the fire standard and there’s space for it, but when you ask them and try to implement telemedicine in the way it’s supposed to be done, it just does not exist. They haven’t built out the APIs for it. We find that the objects that are needed, the models that are needed to embody these types of encounters just don’t exist.

MG: That’s both good and bad, I guess. Indeed, we were caught off guard, but I believe that from the tech perspective, the tools were already there. It’s just, we didn’t have this… We needed a friendly nudge to move towards some sort of solutions, I guess, and bearing in these tech solutions, which ones do you believe are most critical in the development of telemedicine, when it comes to tech tools?

SB: Yeah, before we get into that, I just want to say also, just looking at the way it’s gone here in Switzerland, our telemedicine booking tools have been completely overwhelmed. We were trying to start the vaccine program in January and it completely failed. Old people traveled from all over the country and only got their first vaccination time in, which meant that they couldn’t even start the program and so it was a complete disaster. And then you look at also how they were exchanging information, there were just no real tools that were there and necessary to do that. Ultimately, they ended up sending Excel sheets to one another, and that’s how they keep records of who’s been vaccinated or not.

MG: Okay. That’s not a very robust way.

SB: It isn’t. It’s kind of a knee jerk reaction to being caught off guard. Oh wait, we had this great tool, we spent a lot of money on it, but it failed. Now we’re basically back to Excel and that’s what we have to use right now just to get through the day.

MG: If I understand correctly, you mean that the backbone or the building block of the current state of art telemedicine is still Excel?

SB: Yeah. If people are caught off guard, that’s their regular or normal reaction, is just to use something that they can feel that they can control and isn’t complicated. I think that’s something that’s really, really important to remember, that we’re still people, there’s human error, there’s so many parts of this that can go wrong. When you’re in a panic situation, when you’re in a new situation, you just default to… Even if they’re absolutely horrible tools. I’m not saying Excel is bad, it’s just being misused in this case and it’s causing a lot of administrative issues and stress. There’s no way to quantify, especially, for example, if you look at Excel as a tool, this is going to segue into our next question.
If you look at Excel as a tool, there’s no way to aggregate this data. It’s so important to know, for example, right now where we are in the vaccination status. How many people have been vaccinated? When can we expect herd immunity? And there’s just no way to see that from Excel, unless you have to prepare all this data and you have to continuously do that as well, because not everyone’s going to be enforced to the same standard. I think that’s actually one of the most important tools that we have and that we’re developing, and this is where I see EPIC and FHIR being extremely important, and HL7, of course, standards. In terms of what tools are really important, as I just mentioned, standards are really important in making sure that that we don’t cause too much administrative issues with the data. As we saw in the Excel example, you can of course try to enforce a standard within Excel, but it’s easily broken.
What all these other standards, such as FHIR and HL7 have done are basically to standardize the communication and make sure that data models and procedures are held. The problem is, of course, this in turn then also causes these standards to be part of a huge organization, which then also take time to develop these standards and to change them to the dynamic-ness of smaller corporations and a smaller team. It becomes less malleable. Yeah, and when you have such knee-jerk reactions as COVID-19, you end up with, “Yes, it could do that, but we’re still not ready or still hasn’t really been proven or it hasn’t really been implemented.”;

MG: If I understand correctly, you referred to enforcing solutions in a, let’s say, an environment that was not there yet when it comes to preparations, but at the end of the day, it’s all about that person, a human being, that is forced to use telemedicine and society or the situation is actually not giving them a lot of alternatives to choose from. It turns out that surveys say that more than a half or around half of respondents said that they thought telehealth is, from their expectations, inferior to care delivery in person. Well, no wonder. If there’s anything we could do from a tech perspective to convince them otherwise, which areas you deem we should go in? Which areas should we explore, avenues should we explore to make this telehealth experience better?

SB: We all know from the pandemic and having lived through this and work at home, that setting up a video call, even though in many cases it’s just joining a link, there’s always an issue with people being muted. There’s always an issue with people not finding the link. The UX is still not there, even after a year of development, of course. That’s where we’re also caught off guard, is that all these tools, Zoom and so on, that have gained popularity during the pandemic, they work the same as they did a year ago. Nothing has fundamentally changed. They’ve been rewritten to be improved and so on, but really, the UX is still the same. It’s still the classic of trying to unmute calls and so on. And if you want to actually build in, for example, video calls into your telemedicine, that needs to work even better than Zoom does. Let’s say a patient is sick or is depressed or whatever, they’re not going to be bothered to figure out how to use a camera, how to turn on the camera, or they maybe can’t. Maybe they’re too… They would need assistance and then the whole issue is moot, because then you need extra help just to get going. But other than that, I think we have tools such as… We’re improving the UX and video calls and so on, but also, patient surveys. For example, if you use AI for screening or diagnostic assistance, I’m not saying you should use AI for diagnostics per se, but for example, if you use AI to screen, for example if these people have diabetes, there’s so many questions that need to be answered and I think someone, a doctor in a telemedicine setting might not ask them correctly or the user might become flustered or something and might not answer them correctly either. A pre-screening or a combined process could be done, because it’s all within the same interface. But in terms of telemedicine, it has a lot of benefits. For example, you have the benefit of discretion. You don’t have to leave your home and I think that that can, for a lot of issues that people might have, just leaving the home might be embarrassing for that. Also, during a pandemic, you have the benefit of the reason why telehealth is increased now, is because of safety. Risk for exposure or infecting someone else is, of course, a lot lower and you have convenience. Convenience in itself that you don’t need to leave your home. You don’t have to travel anywhere, obviously, and I think, in a lot of cases, especially when it comes to mental health, being in the comfort of your own home is a lot better than having to travel to a new place, even though you’re still meeting another person, meeting a new person in real life has a lot of more sensory aspects to it that might disturb you or might cause you not to be comfortable. There might be smells, there might be the way people look at you. After an appointment, you might hear some news that you don’t want to hear, and then of course, then you’re forced to travel home and there’s no space for that. In that sense, telehealth has a huge benefit, which is patient comfort.

MG: I do agree with you on the bit that it is just convenient not to be forced to go outside, especially if it’s not safe to go outside, and to limit the amount of social interactions, should that be a desired outcome, but on the other hand side, you also mentioned that telehealth is more effective, or maybe more comfortable when it comes to diagnosing or treating those mental health issues, like depression, for example. Let’s face the truth, the pandemic accelerated the… Or the effect of the pandemic is that there’s more and more people, ever more people that do have those mental issues. Here, I’m a bit torn apart when it comes to my opinion, what actually telemedicine is better, because on the one hand is, of course, you just stay at your cozy place and it’s easier for you to get treatment.
But on the other hand side, perhaps this human aspect is what, for many, is the most beneficial, what does them the best when it comes to treating mental issues. But I appreciate that you have this opinion, but there’s definitely more limits to telemedicine. I wonder whether we will be ever able to overcome hurdles such as diagnosing other issues, because mental health is definitely something you would list us as a top thing to tackle virtually, but when it comes to seeing your teeth hurt or you have other diseases to diagnose, the convenience aspect kind of disappears here. I don’t think we’re ever going to have overcome that. What’s your thought?

SB: Yeah, I see, for example, let’s say we do have to differentiate between mental health telehealth, in that sense, and classical medicine where, for example, you have limitations, such as odor, such as real color presentation. You still have to direct the patient to show you whatever is wrong with them, or things like that, that might cause some difficulties. But on the other hand, you have amazing screening tools or imaging tools today that you can do with your phone already, and that’s a whole category by itself and it can be done asynchronously. You don’t have to be in a call with your doctor. You can just upload the images later, for example. But however, what I think with mental health, for example, is I find it’s, arguably yes, it’s a lot better to meet your psychiatrist or psychologist beforehand, or in person, because it creates a more real experience.
But one of the cornerstones of psychology is that you have to create as neutral an environment as possible. I think as much as people want to create that by having a separate practice and keeping it, refraining from putting too many personal objects in there, there’s still things that… You still have taste, not just in clothing, but also furniture that give you an impression of their style, but also I think odors is something that we’re forgetting about completely, and also, of course, the path to that practice and then back. It’s a path filled with issues or potential-

MG: Uncomfortableness.

SB: Yeah, it’s an uncomfortable setting. And the other thing is, of course, that it may not be… In our culture, it’s not so bad to go to a psychologist, for example, but, for example, in countries such as Japan, mental health is extremely taboo. It’s a country where if it’s found out that you’re seeking mental health, it’s almost a disgrace to that point. I think that brings back to my point of discretion, is that you’re able to do this without meeting with anyone finding out, really, that you’re doing it. Lastly, I think one of the things that having gone through these…
I have experience from both aspects, both as a patient and as a facilitator for these systems, so for me, it makes sense to say, “Well, you know this person. You’re able to interact with them via video. You can infer a lot of the sentiments that you would have had otherwise that were in person.” I think you can connect with a lot of issues in a much deeper level, rather than you would where you would be in a distracting environment. I think the comfort and distraction is a huge benefit to telehealth in that sense.

MG: That’s an interesting point of view and a very convincing one. The arguments you presented are putting very interesting aspects in the spotlight. Last but not least, were we to take a look at the future from your perspective, a two-fold question, biggest challenges to overcome for telehealth and the biggest trends that you think will disrupt the environment?

SB: Yeah, I think telemedicine itself is just at the very beginning. The challenges that we’ve always had are, of course, trust. To be able to make a diagnosis of someone remote that you’ve never met in person, it doesn’t sit well with a lot of people. The pandemic has, of course, thrust us into the situation where we’re reliant on that and that’s actually forced us to digitalize to that point, but I still think there are benefits to meeting in person, as well as there are benefits to meeting over remotely. And the same thing goes for the standards. We’re still there yet with policy standards and regulation that… When telemedicine started in the US, or when COVID started in the US, doctors were not allowed to use telemedicine to diagnose, but that actually was changed very quickly, and now doctors are allowed to use remote diagnostics and those are then valid. But I see the trends going towards home solutions. I see users are way more interested in self quantification, self-help in that sense. More and more devices for personal diagnostics are being bought.
People are interested in… It starts starts with the Fitbit, which turns into a full-blown glucometer and a heart monitor, in that sense, that you basically carry with you all the time. I think we will see more and more of those devices come out, the companion devices, if you will. And I also see that there’s a huge room for improvement, in terms of actual video conversations and the usability of that. Yes, you can use your laptop for that and you can use your phone, but they’re not optimal. If you have ever tried using your phone in a more serious environment, you’ll see that there’s a lot of pictures moving around and it’s hard to get a good look in that sense and it’s a very shaky experience for the one who’s on the receiving end of the phone video, or the handheld video. Yeah, I see there’s a lot that can be done. I also see there’s a huge room for improvement, in terms of AI and screening and basically diagnostics, also not just from patient history, but also imaging and other areas where AI is extremely good at.

MG: Definitely a very interesting aspect I look forward to. On the other hand side, I have this uncomfortable feeling that it might go into the direction of, let’s call it more of a Black Mirror scenario. Instead of wearing wearable, you would have a chip under your skin that would constantly monitor your health and send that directly to a doctor or looking at, for example, Neuralink, the mask when they already connected the ape’s brain to a computer and the ape was able to use the computer with brain power only. That’s kind of outside my comfort zone, I feel.

SB: Yeah, no, absolutely. And given it’s actually a similar topic to vaccines, for example. I think if everyone was asked a year ago, “Would you take a COVID vaccine?” I think most people would agree that they would be probably on the, “Yeah, I’ll wait and see,” side.

MG: That’s still a big chunk of society.

SB: I think so as well. Yeah, yeah, definitely. I’d say about 30 to 40% are still on that side, and it’s still not quite solved, but now, you see how many people are actually going for the vaccine and see the benefits in it. I am not saying that this is a scenario where the vaccine is bad or having a chip in your wrist is a bad thing. Inherently, it’s just, is it tested enough? Is our privacy somehow affected? And that’s what I mean by trust, in that sense. The more this technology comes comes out and the more it’s being used, the more risks there are for data breaches, and also that data being harvested into something that you might not want or even be sold on to third parties.

MG: That definitely makes me think that, or the conclusion I reached is that every major development costs some level, a certain level, of sacrifice of the comfort. The question is whether we can find a soft pass between the sacrifice and the benefits introduced by the specific development in this context.

SB: Yeah, exactly. Intuitively, it could be understand that everything changes. Does it get better or worse? It depends on how you apply it. Every situation’s different and might require a different tool. Right now, everything… We’ve created this hammer with telemedicine-

MG: And everything is a nail.

SB: And everything is a nail. Especially now, where it has to be that way, but I think it’s another really good tool in our tool belt and I think we should see it that, way rather than as the panacea of health and medicine.

MG: That’s a really interesting summary of the conversation. I really enjoyed it. Thank you, Sebastian, for sharing your thoughts on the aspect. It was nice to have this discussion.

SB: Thank you, Michal, yeah, likewise.

MG: And thank you, our listeners, for being with us on this another episode. If you liked it, don’t hesitate to leave thumbs up and to let us know if you’d like to have another topic covered in one of the future episodes. Thanks.