Telemedicine: Telehealth and Remote Care Expansion

July 19, 2022

What is Telemedicine?

Telemedicine involves the use of electronic communications and software to provide clinical services to patients without an in-person visit.

Telemedicine can be classified into three broad categories:

Interactive telemedicine - allows doctors and patients to communicate in real-time. These sessions can be conducted at the patient's home or at a designated medical kiosk. Interactions include telephone conversations or the use of HIPAA-compliant video conferencing software.
Remote patient monitoring - also known as telemonitoring, allows patients to be monitored at home using mobile devices that collect temperature, blood glucose, blood pressure, or other data.
Store-and-forward - also known as asynchronous telemedicine, allows a healthcare provider to share patient information, such as lab results, with another healthcare provider.

Benefits of Telemedicine

Internet-based medical practice can speed up diagnosis and treatment, increase the efficiency of care, and reduce patient stress. Some advantages of telemedicine

For patients include:

Convenience: Patients do not have to take work offs for appointments. There is also no travel time, wait time, or associated expenses, such as paying for gas or child care.
Increased access: Patients in rural areas may receive specialized services, such as mental health treatment or post-surgical follow-up, which they may not be able to obtain without having to travel long distances to visit in person. Similarly, patients living in federally designated, low-service areas have increased access to primary, dental, and mental health care.

For Doctors include:

Reduced cancellations or no-shows: Telemedicine can reduce cancellations or absenteeism through patient convenience. If a patient forgets an appointment, providers can reach out before or at the time of the appointment.
Encourage healthy lifestyle choices: Telemedicine allows providers to encourage patients to choose a healthy lifestyle like avoiding smoking.

Telehealth: What’s the Difference?

The intermediate between medicine and technology can be confusing. The terms telehealth and telemedicine are often used interchangeably, but there are differences between the two.

The term telehealth includes a wide range of technologies and services to provide patient care and improve the health care delivery system as a whole.
Telemedicine is a subset of telehealth that refers only to the provision of health care and education services at a distance, through the use of telecommunications technology.
Telehealth refers to a wider range of remote health care services than telemedicine.
While telemedicine specifically refers to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.
According to the World Health Organization, telehealth encompasses “surveillance, health promotion, and public health functions”.
Telehealth is a subset of eHealth, which includes the provision of health information to health professionals and health consumers, the education and training of health workers, and the management of health systems through the Internet and telecommunications.

Telehealth: PreCovid v/s Post Covid

At the beginning of the COVID-19 pandemic, there was an increase in the use of telemedicine services as consumers and providers sought ways to securely access and provide healthcare. In April 2020, the total use of telemedicine for office visits and outpatient care was 78 times higher than in February 2020.

The results include the following information:

The use of telemedicine has stabilized at a level 38 times higher than before the pandemic. After an initial peak of over 32% of doctor visits and outpatient visits via telemedicine in April 2020, utilization has broadly stabilized, ranging from 13% to 17% across all specialties. This usage is more than two-thirds of what we planned for virtualizable visits.
Likewise, consumer and provider attitudes towards telemedicine have improved since the pre-COVID-19 era. Perception and usage have declined slightly since peaking in spring 2020. Some barriers, such as perceptions of technology safety, have yet to be overcome to support consumer and provider adoption of virtual health, and models are likely to evolve to address this Optimize virtual and interior-person hybrid. care delivery.
Some regulatory changes that have facilitated the expanded use of telemedicine have been made permanent, such as the Centers for Medicare & Medicaid Services' expansion of reimbursable telehealth codes for the 2021 physician fee schedule. However, uncertainty remains over the fate of other services that may lose exceptional status when the public health emergency ends.
Investment in virtual care and digital health, in general, has skyrocketed and fueled new innovation, with 2020 doubling the level of venture capital investment in digital health compared to 2017.
Virtual healthcare and business models are evolving and proliferating from purely “virtual emergency care” to a range of services enabling long-term virtual care, integration of telemedicine with other virtual healthcare solutions, and hybrid virtual/in-person care models with the potential for improving consumer experience/convenience, access, Results, and Affordability.

Different Approaches in Telehealth

The Direct-to-Consumer (DTC) approach

In today’s world, this is the most popular & common approach to Telehealth. Most people who know what Telehealth is would think of a DTC telehealth company when they hear about online consultations, telemedicine, or telehealth.

DTC TeleHealth companies usually hire or contract with a team of doctors, and they do business directly with patients. This is also one of the reasons why DTC companies are the most popular in the Telehealth space. To be successful, they must be easily discoverable for patients who need timely online doctor advice.

The EMR integrated approach

Some electronic health record (EMR) and practice management software companies have already added telemedicine capabilities to their products, allowing doctors to provide online consultations to their patients directly from the EMR.

The closed platform approach

This situation is comparable to EMR integration with one difference: EMR operation and integration are missing, however, there's attention on the operation of the telehealth switch. Patients additionally get equivalent expertise once having consultations with doctors victimization completely different EMR solutions, as long as the telehealth platform is the same.

Similar to EMR integrated approach, doctors employing a closed telemedicine platform don’t reach new patients and might offer online consultations to their own patients solely.

The open/closed (hybrid) platform approach

In this approach, it’s up to doctors to determine whether or not they need to produce telehealth consultations with their patients solely or see new patients who discover them via the platform.

The approach you ought to opt for once selecting the correct telemedicine platform depends on several factors, as well as your area of expertise, variety of patients, and placement. However, if attracting new patients is the aim then providing comprehensive online care to existing patients, creating your schedule a lot more versatile, and permitting you to figure remotely is vital, opt for the open hybrid platform.

Essential Components of a Telemedicine Platform

The main purpose of a telemedicine platform is to facilitate communication between patients and doctors or care professionals. It will do this through a mix of technologies that embody knowledge storage, sharing, and analysis.

An effective telemedicine app needs 3 versions for patients, doctors, and health care managers. Each of those varieties of users desires completely different options of the health care platform that are helpful to them.

Patient App Features

The patient’s version of the telemedicine platform is sometimes either a mobile app or an online app. The key options of this platform are:

Authorization method: The patient has to be ready to register and check in to the platform during a secure manner.
Patient profiles: Profiles enable the patient to feature crucial knowledge like age and self-declared health problems.
Medical record storage: Uploading and downloading medical records adds another layer of communication between patients and doctors.
Scheduling: Patients want the power to make, modify or cancel appointments.
Real-time communication channels: The core feature, live chat, video, and/or audio streaming permits the patient to induce effective treatment from their practitioners.
Payment gateways: Patients need a safe and secure way to conduct financial transactions.

Healthcare Provider App Features

The provider’s version of the telemedicine app is most frequently a web app. A mobile app wouldn’t be as simple to use in a workplace setting. The main characteristic of the doctor’s version are:

Doctors profile: A profile permits every doctor to simply share data like job title, education, and a lot with their patients.
Appointment manager: Practitioners should be able to check their list of appointments and modify them as required.
Scheduling: Doctors also should be able to change their schedule and availability.
Access to the EHRs: Electronic Health Records are a digital type of the patient’s medical health record and give important background information for the doctor.
Real-time communication channels: Communication needs to be two-way. Doctors are also required to access the same real-time channels as patients.
Prescriptions: Integration with local pharmacies and prescription software allows the provider to write and fulfill prescriptions when needed.

Admin App Features

Finally, the admin version of the platform provides the most accessibility and functionality and is almost always a web application. This version allows you to control many or more administrative functions in a healthcare facility. The key features are:

User profile: Administrators need profiles to keep track of who has made changes to the system and to set role-based access.
Patient profile management: The admins can want access to a patient’s profile so as to edit data, transfer new medical records, see their monetary standing, etc.
Doctor profile management: Administrators need access to a doctor’s profile in order to see their availability, appointment scheduling, and even to disable the account if needed.
Analytics: Data permits the admins to pull together insights from each patient and doctor. The app will track revenue, the number of virtual visits, and far a lot of.
EHR system integration: Administrators must be able to manage the integration of the telemedicine application with the existing Electronic Health Records system.
Payment management: Again, as with health care providers, administrators need access to view and manage the patient's financial history.
Notification management: Administrators also require the ability to manage the app's notification systems – set up, schedule, and trigger when a patient or doctor needs to be notified.

Latest Technologies Used in Telemedicine Apps

Recent trends in the development of telemedicine applications show that emerging technologies such as machine learning, artificial intelligence, blockchain, and IoT are building paths with the latest telemedicine applications.

The following technologies show great promise or are already in use in telemedicine applications through certain APIs and frameworks:

Artificial Intelligence

AI is increasingly added to telemedicine applications. Language processing, chatbots, voice recognition, and machine learning are making healthcare services more personalized than ever before.

As AI analyzes medical records and patient care knowledge, it will facilitate doctors build predictions concerning the well-being of their patients, develop personalized treatment protocols and enhance preventative care through telehealth.

Sense.ly, a virtual reality nursing app, uses built-in AI technology to monitor patients' vital signs, record the results, and provide them to doctors. Another application that uses AI is the ADA, which asks simple questions to help patients classify their symptoms and help doctors make a diagnosis.

Machine Learning

Data mining and machine learning algorithms are increasingly being used to identify early signs of cancer or other diseases, leading to improved patient outcomes. WebMD also uses machine learning in its popular "symptom checker" feature, as well as drug interactions, conditions, side effects, and getting doctor-reviewed information on demand.

Machine learning can use convolutional neural networks to analyze images such as X-rays, CT scans, and MRIs to quickly diagnose unusual and rare diseases without requiring patients to go through a series of tests.

Big Data/ Data Engineering

Medical records are becoming increasingly difficult to manage. Teladoc uses big data analytics on electronic medical records (EMRs) to improve healthcare systems and reduce errors in medical diagnosis, treatment, and billing. In the long run, this reduces costs for both providers and patients while improving health outcomes.

Blockchain

Blockchain technology is a great tool for storing and securely exchanging medical data as opposed to paper records. Health records using cryptographic hashes as block identifiers, as opposed to personally identifiable information, would be immutable and tamper-proof, providing greater patient protection. One telemedicine app built in France, Blockpharma, uses blockchain to help patients verify that drugs are not counterfeit before they start taking them.

“A large portion of today's telehealth and telemedicine systems are centralized and fall short of providing necessary information security and privacy, operational transparency, health records immutability, and traceability to detect fraud related to patient insurance claims and physician credentials” (NIH, 2021).

However, according to Dr. David Randall of the American Research and Policy Institute, blockchain can facilitate access to information while protecting patient privacy and preventing fraud.

Internet of Things

Internet of Things (IoT) devices for telemedicine devices include wearables, tablets, medical kiosks, digital cameras, smartwatches, etc. Internet of Things technology is the foundation for Remote Patient Monitoring (RPM).

The IoT interacts with the human body and monitors vital signs, helps patients adhere to medications, and allows doctors to monitor treatments. IoT devices such as wearables can be integrated into the development of telemedicine applications for personalized patient care.

In one example, BabyScripts is a mobile app that uses IoT-based remote monitoring tools to reduce the number of in-person prenatal visits while filling gaps in maternal care for at-risk populations.

Technology Stack for Telemedicine App

What tech stack should be used for an application or website for delivering remote healthcare services? There are many different options available and we will cover them in this section.

Frameworks and Programming Languages

We use a variety of telemedicine application development frameworks, programming languages, and third-party tools such as cloud storage platforms. Below is a list of technologies to develop telemedicine applications for different platforms:

Swift
WebKit

Android

Java
Kotlin
Retrofit

Cross-platform

React Native
Flutter
Xamarin

Databases and backend infrastructure

Python
Ruby
Java
SQL or NoSQL Database

Web-based apps

ReactJS
Ruby on Rails
Django (python)

No-code and low-code platforms are ideal for getting your app to market quickly or testing demand. However, low code can be limiting in terms of customization or creating new features.

For maximum customization with extra features, it pays to build an app from the ground up using popular frameworks like Swift for iOS or Java for Android with python for the backend.

APIs and SDKs for Building Telehealth App

There are many telemedicine APIs and SDKs with microservices that serves to the healthcare industry. Below is the list:

APIs

There are innumerable APIs available to help you build a telemedicine application. Most of them are RESTful APIs like Stripe, EC2, S3, SendGrid, and Firebase Cloud Messaging to name a few.

Cloud Platforms

Google Cloud
AWS (Amazon Web Services)
Microsoft Azure

While there are many cloud providers, Google and Amazon are among the most popular and cost-effective, especially if you plan to expand your business usage through your telemedicine application.

Video Conferencing

XMPP
WebRTC
MQTT

Using the WebRTC protocol and TURN servers, telemedicine applications can be used in most medical facilities, even on secure public networks. You can develop it using open source or paid APIs that give you granular control over your application. Telemedicine applications can also use the XMPP chat protocol when an extensible markup language is needed for the chat function, or the MQTT protocol for machine-to-machine telemetry when remote patient monitoring is used.

In-app Chat

CometChat
Socket.io

There are many instances of chat in telemedicine applications. Whether you're developing chat using third-party tools or from scratch, it's critical for telemedicine applications that real-time chat features and automated chatbots are HIPAA compliant.

Compliance and Data Security Regulations

Numerous regulations require your telemedicine application to comply with privacy and data security. These regulations include HIPAA, GDPR, PIPEDA, SOC 2, and ISO to name a few.

HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 to protect personal health information from being shared with others without the patient's permission. HIPAA-compliant application development must ensure that personally identifiable information is not compromised or disclosed when physicians and patients use email, instant messaging, or intra-hospital communications within the application.

ISO

Experts from the International Organization for Standardization agree on ISO standards. They are like formulas or recipes for how to do something, such as manufacturing products, managing processes, providing services, supplying materials, or, you guessed it, developing applications.

More specifically, the standards most relevant to the development of telehealth applications are set out in ISO 27001 and ISO 13131, which were recently updated in 2021. In particular, ISO 27001 provides requirements for a data security management system. This standard enables developers of telemedicine applications to manage the security of financial information, intellectual property, employee details or information entrusted to third parties, including medical information.

GDPR

Enacted into law in 2018, the General Data Protection Regulation (GDPR) protects the privacy and rights of EU citizens by severely penalizing any organization worldwide for non-compliance. If an EU citizen is ever going to use your app, it is vital that it is GDPR compliant.

Conclusion

As always, the exact architecture and system design of your telemedicine platform will largely depend on the specific requirements.

The best way to increase speed to market and reduce costs is to use existing HIPAA-compliant frameworks for each component of the telemedicine system architecture. For example, you can use AWS or an equivalent cloud service to manage your infrastructure, storage, and servers.

REFERENCE

Content Credit: Mohammed Hussain

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