Telemedicine and the challenge of access
Dr Jorge C Stanham MBE
Access to the appropriate provider and the type of care needed defines one of the six dimensions of quality: timeliness. (The other dimensions are patient safety, patient-centredness, effectiveness, efficiency and equity.) Poor access may lead to late diagnosis, poorer prognosis, more tests and consultations and potentially, a bad outcome and eventually, a preventable fatality. Access is made worse by the mismatch of increased demands being met by insufficient or diminishing resources (human, material, organisational, etc).
Increased demands are to be expected by the health care needs of our ageing Baby Boomer generation (born 1946-1964), who are more than 15% of our Uruguayan population at present and will approach 20% by the end of the next decade. Although the number of physicians who graduate in our country still exceeds 1 per day (more than 400 per year), there is no guarantee that the specialty mix of the new doctors will keep pace with those skills that are most needed: primary care (family medicine, internal medicine, paediatrics), geriatrics, physical medicine and rehabilitation, not counting the number of other health providers who’ll be in most demand: home care nurses, physical therapists, nutritionists, pharmacists, social workers and mental health professionals.
Sometimes, access initially evokes problems with long distances, like the ones faced by those living in rural or remote areas. However, it is more a problem for those living in urban centres, where transportation is complex due to traffic congestion, lack of parking and poorly designed public transport systems. For the younger generations (GenX, born 1965-1979 and GenY, born 1980-1999) who at present are the major part of the workforce in many countries, access is made complex by the mismatch between their work schedules and those of the available services and the previously mentioned displacement constraints within cities.
This year, as I have mentioned in recent prior posts, has been ushered by the 2-digit predicted annual expansion of telemedicine (or telehealth) services in the next half decade. This has been made possible by five trends, as published recently by MDLive,[i] a telehealth/telemedicine provider in FierceMarkets Custom Publishing:
1. Engaged patients/consumers with cloud-based technology in their smartphones.
2. Artificial intelligence, refined data analytics and a personalised patient experience.
3. Reduced reliance on present reimbursement models.
4. Consumer satisfaction, greater demand and reduced costs, with consumers progressively onboarded by removing barriers to telemedicine.
5. A disciplined focus on data security will drive consumer trust and vendor oversight.
Relying on the traditional one-on-one, face-to-face, in-person care, will fall short of being able to cope with the increased demands of an ageing population and a time-strapped young workforce. The technology at present is ubiquitous: smartphones are everywhere; software is in the cloud, sensors to monitor patients at a distance are a reality and providers can cover a larger population with 24/7/365 accessibility.
Telemedicine is not the future. It’s already seeded within our system and will start sprouting – as I write and as we speak.