Telemedicine – the practice of caring for patients remotely when the provider and patient are not physically in the same room – has been around for at least the last 20 years. In South Africa, however, it took Covid-19 for this delivery mechanism to come into its own.
Telemedicine in its simplest form is a telephone call between a doctor and patient, says Dilip Naran, Strategic Business Development Manager at Altron HealthTech. “It does not necessarily require a high-tech solution. Telemedicine is simply the use of information exchanged by electronic communication to improve a patient’s health status.”
This simplicity belies the value attached to telemedicine worldwide. According to the Global Telemedicine Market Outlook 2020 research report, the market for telemedicine was valued at USD29.6 billion in 2017. It is anticipated to grow at approximately 19% per annum from 2017 to 2022.
The global adoption of this type of healthcare delivery is driven by rising incidences of chronic diseases, a growing geriatric population, government initiatives and a shortage of physicians. Through the use of technology, remote consultations are done, medical images are transferred, and patients’ vital signs are monitored. Patient portals aimed at medical education are growing in popularity, as are call centres manned by medical staff to respond to patient queries.
South Africa has been slow on the telemedicine uptake, largely due to the reluctance of the HPCSA to allow practitioners to use it. In 2011, for instance, the Hello Doctor website that was created as a portal for patient support was declared illegal and compelled to shut down.
The arrival of Covid-19, however, changed the game and on 26 March 2020, the HPCSA issued guidelines that allow local practitioners to use telemedicine for the duration of the pandemic.
An important caveat to this permission is that telemedicine is only permissible where there is already an established patient-practice relationship; it can therefore not be used to treat new patients. “The limitation makes sense,” says Naran, “given the in-depth examination and engagement that is necessary when a patient is seen for the first time.”
Following the issuing of the HPCSA guidelines, many local doctors are now conducting remote consultations, some using telephone calls, others adding a visual element through applications such as Zoom or Skype.
Regardless of the technology interface, the onus is on the practitioner to ensure the security of any information transmitted in order to protect doctor-patient confidentiality. “The core tenets of telemedicine are efficiency, privacy and information security,” says Naran.
These requirements bring tech companies into the telemedicine picture. While sophisticated technology is not a telemedicine requirement, purpose-built solutions have the advantage of ensuring a secure channel – be it voice, video or live chat – between practitioner and patient, which definitely is a requirement. Discovery Health, for instance, has brought in an American platform for its Doctor Connect network.
“Altron HealthTech’s approach has also been to ensure secure practice workflow with our practice management applications,” says Naran. “We have also anticipated the advent of telemedicine in South Africa, hence our applications have the necessary capabilities and requirements built-in already.”
The great advantage of the Altron HealthTech systems lies in their high level of integration. From an appointment diary to billing and e-scripting, the patient workflow is seamless. The fact that all the applications are cloud-based is particularly relevant for telemedicine. The doctor can access the patient’s full health record remotely, and update the clinical notes based on the teleconsultation.
“It is, however, up to the practice to ensure it complies with the HPCSA guidelines, notably the treatment of new patients,” highlights Naran.
Telemedicine’s benefits for patients are legion, including cost savings as teleconsultations are less costly than face-to-face engagements, and time savings, especially for routine check-ups or the issuing of repeat scripts. Most importantly, however, is patient health, particularly vulnerable persons with comorbidities who benefit greatly from not being exposed to the high pathogen levels common in medical practices. “There is no denying that a well-controlled diabetic, for instance, is best managed remotely,” says Naran. “The doctor has the full patient record available and vital statistics can be submitted electronically. There is little need for face-to-face check-ups.”
Medical schemes also save money with telemedicine, while practices have more flexibility in allocating resources, which improves efficiency and quality of care.
“The above-mentioned benefits apply equally to public healthcare facilities”, says Naran, citing the example of an interface Altron HealthTech is developing for one of South Africa’s foremost cardiologists who teaches at the University of Pretoria. “The product we are working on will allow the professor to remotely assist provincial hospitals with complicated cases,” he explains.
In fact, sophisticated technologies aimed at supporting specialisations such as cardiology and dermatology are an exciting and highly value-adding application of telemedicine. As the cameras in smart devices keep improving, it is now possible for a patient to send a high-resolution image of a lesion to a dermatologist, enabling a remote diagnosis. “The next step involves the application of artificial intelligence to such images to inform treatment,” says Naran.
While Covid-19 has fast-tracked the adoption of telemedicine in South Africa, it is difficult to imagine that it can be abandoned again once the pandemic is under control. As in many other areas of life, Covid-19 has changed the medical delivery landscape in South Africa, and given the benefits, it is a change that should be embraced and cemented.