KEY POINTS IN THE ANALYSIS
· Despite tele-care or tele-health methods having been present in our society for the last few years, these have been strengthened with the COVID-19 crisis. Increasing numbers of people favour the use of virtual healthcare models, for services ranging from routine consultations to the issue of electronic prescriptions for transmission to other professionals. Numerous studies confirm this rising trend which many professionals view as a 'paradigm shift'.
· Additionally, telemedicine not only benefits patients, facilitating the consultation process or access to relevant medical information; it also greatly benefits professionals and the medical system in general. Among these, the most significant is the optimisation of resources, since thanks to methods available on the Internet, consultations are quicker, delays shorter and the need for large infrastructures reduced.
· These seemingly innovative methods are possible thanks to a series of disruptive technologies that support the implementation and development of new telemedicine tools. A good example might be the use of artificial intelligence applied to the early detection of diseases, in the chatbots offering personalised assistance or, even, robots supporting surgery performed from a remote location. However, given that our world is permanently evolving, new virtual healthcare technologies are sure to emerge.
· There is an abundance of successful cases, especially among insurance companies and private firms that have integrated tele-health methods in their services. The public sector has always been slower in this aspect, but today there are several public hospitals and governments offering telemedicine to users, as is recently the case in the Community of Madrid.
PARADIGM SHIFT
While it is true that telemedicine is no longer a novelty and has existed for some years now, it is only since the COVID-19 pandemic that it has become more firmly consolidated in Western society, whether out of necessity or voluntarily. We should mention that numerous studies confirm this rising trend and many professionals view this as a 'paradigm shift'. It is therefore convenient to consider some of the data obtained in said studies on the expansion of this type of healthcare methods.
According to the results of a worldwide survey conducted by PwC in January 2021 (1), a large proportion of users, who during the pandemic (especially throughout 2020) were obliged to opt for tele-healthcare methods, state that they will continue to do so voluntarily even after the disappearance of the pandemic. In addition, as shown in the study, the most popular online or virtual tele-healthcare method is the video call: “of those opting for consultation by video call, 91% prefer this method to face-to-face consultation”.
Data such as the above confirm the telemedicine implementation trend, understood as a preferential option; increasing numbers of people choose virtual rather than face-to-face methods, as endorsed by the following evidence.
The results obtained in a survey of 2000 adults in the United states by Sykes in March 2021 (2) indicate that the number of participants in the survey having had a virtual medical consultation had almost doubled in comparison with previous periods. These results support the thesis that the pandemic has been instrumental in consolidating telemedicine, owing to its impact on the rate of use regarding this option.
Source: Vecdis, from data by Sykes (2)
Taking as valid that COVID-19 has been a catalyst in this new panorama in the health sector, the Sykes survey went on to compare users' opinions on the use of telemedicine from 2020 to 2021:
· On the one hand, we observe a considerable increase in acceptance levels.
· And on the other hand, a majority of participants are convinced that they will continue to use tele-care services after the pandemic.
Source: Vecdis, from data by Sykes (2)
Other studies report the same trend. In Europe, Spaniards evince the highest acceptance rate of virtual healthcare systems. In the report "Stada Health Report 2021" (3) in which 30,000 persons from 15 EU countries were surveyed, close to 82% of Spanish participants stated that, in the event of suffering mild or non-severe illness, they would agree to receive healthcare via virtual methods.
Likewise, in the case of Spain, it is evident that the pandemic necessarily boosted the paradigm shift. While in February 2020, before the irruption of the health crisis, "9 out of 10 visits to the doctor were face-to-face, and of the remainder only 10% were online and 90% were by telephone", by September 2020 only "one-third of patients visited the doctor face-to-face and more than 30% reported using telemedicine methods" (4).
Moreover, the report "Digital Patient Experience 2021" (5) led by Instituto para el Desarrollo e Integración de la Sanidad (IDIS) [Institute for the development and integration of healthcare] comprising 1908 answers given both by patients with severe diseases and by healthy individuals, evidences a clear interest in the use of tele-health and tele-care. In concrete terms, "89% of private health users support the use of telemedicine" (5). Of this 89%, 42% of the participants in the survey are strongly in favour of this type of tools, and 46% accept their use at certain moments, combining both telemedicine and face-to-face methods.
According to Juan Abarca, president of Fundación IDIS, "thanks to the pandemic, the health system has learned to change its focus. Up until now, this was geared toward supply, but we are currently learning to focus on demand, that is to say, we are striving to adapt to patients' needs and, in this sense, private healthcare is well in the lead" (6).
With regard to telemedicine market volume, the report by Deloitte "Predictions, Technologies, Means and Telecommunications (TMT)" (4) indicates that, in 2021, a target of "400 million online medical consultations worldwide" was reached or even surpassed, which multiplies 2019 values by five and translates as a turnover of 25,000 millions.
As can be seen from the data shown below, it is envisaged that by 2030 the market volume of telemedicine will reach close to $460,000 million (7).
Source: Vecdis, from data by Statista (7)
ADVANTAGES:
Telemedicine has fostered better levels of communication between health professionals and patients. At the same time, this method creates a far more secure virtual space than face-to-face consultations, for all parties involved.
This modality of medicine is also advantageous for a broad spectrum of users in a wide range of environments: persons with reduced mobility or other motor difficulties are able to receive the same healthcare as in face-to-face conditions. Additionally, thanks to the implementation of new disruptive technologies such as artificial intelligence (AI), the Internet of Things (IoT) or virtual reality (VR), explained below, telemedicine allows for frequent monitoring of patients and the compilation of large quantities of data. As a consequence, it boosts "better self-care practices and provides relevant information for diagnosis, thus assisting healthcare professionals to give a rapid response" (13).
Moreover, this type of medical care allows professionals to offer healthcare services to a larger number of patients and to simplify the consultation process, which in turn leads to optimising resources since, having reduced consultation times, more appointments can be made, and thanks to online methods no great infrastructures are required which further reduces fixed costs.
Similarly, thanks to advances in this field users may also opt for 'emergency tele-healthcare’. Consequently, should the number of patients using this service increase, visits to the Emergency units would decrease, resulting in the decongestion of critical areas within hospitals and clinics.
Lastly, this method promotes a more aseptic and secure environment for all parties. On the one hand, patients who are ill are not obliged to travel to a medical centre where measures must be taken to avoid contact with other patients and the healthcare professionals. On the other hand, professionals are safer, not being exposed to infectious diseases and can exercise constant control over their patients without being in their physical presence.
The table below shows the advantages of telemedicine for patients, health professionals and for the healthcare system overall.
Source: Vecdis, from data by Intel (13) and Esade (16)
Likewise, we may mention again the Sykes (2) survey in the light of a study conducted by SingleCare (8), in which 1700 adults were interviewed in the United States in January 2021, as findings in both cases consist of interviewees' opinions on the benefits of telemedicine as perceived by users.
Of the eight benefits described, shown below, users categorically state that thanks to this method medical processes have become simpler and easier. What is more, a high percentage (74%) find that telemedicine has helped them save time, having reduced the time spent in travelling to hospitals and clinics as well as waiting to receive attention at such centres.
Source: Vecdis, from data by Sykes (2) and SingleCare (8)
In a nutshell, telemedicine not only benefits patients, facilitating the consultation process or access to relevant medical information; it also brings great advantages to professionals and the medical system in general.
We should, however, mention certain potential challenges to the development of telemedicine.
It is a fact that the private sector is ahead in this field, and that the vast majority of companies pertaining to the healthcare sector have added or intend to incorporate tele-health services to their portfolio.
Governments and public institutions are developing their own telemedicine services, so that access to these alternatives becomes increasingly available to citizens. Nevertheless, each different country's financial or regulatory barriers are still a hindrance to this process. As this method is widely accepted by individuals as soon as it becomes available, authorities should not only further promote its implementation (in view of its positive outcome), but also rise to the challenge of developing the appropriate legislation regarding both restrictions and the protection of patients.
TELEMEDICINE USE CASES
As mentioned above, telemedicine has many applications, ranging from establishing a routine consultation with a general practitioner, to accessing clinical histories and transferring information to specialists.
The above-mentioned study by SingleCare (8) in the United States in January 2021 allows us to observe that the most frequently used services are the communication of common diseases, follow-up consultations and psychological therapy (in strong demand as a consequence of the pandemic).
It is verified that, despite users being more likely to choose tele-healthcare for common ailments and mild or non-severe diseases, in the event of more severe health problems patients still prefer visiting the hospital and/or clinic face-to-face.
Therefore, users' confidence in telemedicine is evidently subject to some precaution in the event of more severe ailments.
Source: Vecdis, from data by SingleCare (8)
Moreover, a telling feature in the increased perception of value in telemedicine among consumers and users is linked to the surge in technological health-related solutions, especially noticeable after the health crisis broke out, and which have become a natural part of the healthcare structure.
In what follows we shall discuss some successful cases and figures supporting this statement.
TELEMEDICINE TECHNOLOGIES
Considering telemedicine as a growing trend, professionals are seeking innovative tools and technologies enabling them to offer higher quality services that are adapted to patients' needs.
There exists a wide variety of disruptive technologies that enable or further facilitate the provision of tele-healthcare. Although new tools are currently being developed, many of which are not yet widely available on the market, we may point out those most commonly used or sought after in telemedicine.
The Internet of Things
To begin with, we have the Internet of Things (IoT). This technology allows myriad medical devices to connect simultaneously to a server. It also "allows real-time use of data, allowing the provision of remote healthcare to a high standard" (13). In other words, the use of this tool not only facilitates the connection among all the parties involved, but also the transfer of relevant information in real time.
Cases of implementing IoT in telemedicine services include, for example, the possibility of measuring medical parameters and these being instantly available to healthcare professionals, who are thus permanently updated and unnecessary situations of risk are avoided. Another example is professionals being able to enter medical prescriptions in their patients' clinical histories that can be instantly accessed by pharmacies and other specialist services.
Regarding its application in emergency services, the IoT allows “transmitting EEG, ECG and other data to the hospital staff while travelling to the hospital” (13). In other words, health professionals avail of relevant information in advance of receiving a patient in a critical condition, which means that the hospital staff are better prepared and make better decisions for caring for the patient on arrival at the Emergency Unit.
Artificial Intelligence and Big Data
Artificial Intelligence (AI) has many beneficial applications in telemedicine. Most telemedicine apps use algorithms based on AI to offer patients more highly personalised services, taking into account their needs and in some cases foreseeing them.
This enables an enhanced user experience and greater satisfaction levels overall. In addition, AI makes it possible to add new capacities to traditional medicine, such as the dynamic medical history of patients on the basis of their responses, or the automated generation of reminders for taking medication or conducting patient check-ups, through the personal monitoring data gathered (13).
A further major advantage of AI in healthcare is its implementation jointly with Big Data tools, thus "generating value for health" (13). As mentioned above in the case of IoT, it is already possible to transfer large quantities of data among different devices. These data need to be processed, classified, organised and used intelligently. And the capacity for administering them is provided by Big Data tools; facilitating actions such as fine-tuning diagnoses through data analysis and predictive methods.
Telehealth robots
Though robots have existed in our society for years, their application to telemedicine is an outright challenge. Robots have numerous use cases in this field, whether in remote patient monitoring or support to remote surgery procedures. We should bear in mind that robotics are often combined with technologies such as AI to build robots that are able to take decisions on their own initiative and that are fully autonomous and independent.
Nevertheless, 'autonomous' robots such as these are usually given tasks that do not involve complex patient-related processes. At present, while robots perform repetitive and easily optimised tasks, professionals may dedicate their time to activities of greater importance and necessity.
Another application is the creation of different nodes attached to a mother station, with which several 24-hour care units at different locations can be reconciled.
These robots also play a valuable supporting role in rural or hard-to-access areas, facilitating the work of healthcare professionals and, in some cases, relieving them and enabling remote interaction between doctors and patients.
Virtual Reality and Augmented Reality
These tools may be combined with the objective of easing healthcare professionals’ work and patients’ lives. A frequent application of augmented reality (AR) is in patient diagnosis and evaluation, since AR enables doctors to see specific parts of the patient's body more clearly and make a better diagnosis, thus avoiding errors and unnecessary tests.
Moreover, these technologies are clearly suited for training purposes. Thanks to virtual reality (VR) simulations can be conducted of complex operations or experimental treatments free from risk to professionals or patients. Similarly, healthcare professionals undergoing training can use VR-based applications to put in practice their knowledge, with as many repetitions as necessary. Other use cases of VR and AR are "in rehabilitation and the creation of stress-reducing environments and to distract patients from pain and discomfort" (14).
These tools have unlimited applications, from 3D models for surgical operations, to virtual reality glasses for remote consultations.
An example of this application has been conducted in the United Kingdom, where NHS hospitals use the Virti platform to assist patients with their mental health (14). This application submerges users in specific environments and subsequently assesses how they respond to stress, with the objective of reducing their anxiety.
TRADITIONAL SUCCESS CASES
We find many success cases among traditional insurers, healthcare companies or technological firms that, alone or through alliances, have developed their own platforms for tele-healthcare or telemedicine-related services.
Fundación Hospital General Santísima Trinidad and Upmédica
The platform Upmédica, developed by BHD Consulting, has been incorporated to the services provided by Fundación Hospital General Santísima Trinidad in Salamanca (20). Thus, thanks to the SaaS service based on Microsoft Azure and to the support given by BHD Consulting and Plain Concepts, the Fundación is able to offer an attractive and suitable environment for all age segments. This platform guarantees data security and has a solid legal and technological grounding, in line with the regulation embodied in the RGPD, LOPDGDD and LSSI legislation.
Upmédica is a tool for rendering tele-care and telemedicine services, in which users not only avail of the opportunity to arrange virtual appointments with their doctor, but also to access their clinical history at any time, from any location, and to share their data with other centres.
The pandemic acted as a catalyst to this initiative, and allowed the Fundación to activate more than 16 medical specialities, involving over 60 professionals, giving continuity to outpatients through online consultations. It also allowed a free service for resolving queries regarding COVID-19 to be launched.
This platform is available for all user types and, as claimed by the Fundación, through Upmédica, in two years the number of patients signed up increased by 1000%, with over 20,000 users registered by September 2021.
AXA and the tool Doctor Clinic
The insurance company AXA has developed a platform to enhance its customer services and offer personalised telemedicine services. This tool, Doctor Clinic, is participated by a group of professionals highly qualified in medicine and technology.
Doctor Clinic offers a wide range of services, such as tele-care, patient monitoring, virtual follow-up and access to clinical histories from any locations. Users can access this platform around the clock, as Doctor Clinic offers comprehensive care with the overriding aim of enhancing clients' level of satisfaction.
Furthermore, AXA has recently added to its platform the possibility of delivering electronic prescriptions through a QR code, that "links to over 22,000 pharmacies all over Spain" (17).
DKV and their platform Quiero Cuidarme Más
DKV has integrated its online medical consultation app, Digital Doctor, on the platform Quiero Cuidarme Más. With this change, all their telemedicine services will be available to clients from a single application.
In September last year, this insurance firm announced that funeral expenses insurees with the DKV "Serviplus" package will have free access to the AI-based medical chat on the telemedicine platform Quiero Cuidarme Más "for the time being, until September 2022" (18).
Through Digital Doctor patients may access all types of medical consultations including requesting the evaluation or interpretation of medical documents such as analyses or other diagnostic tests.
The platform is constantly developing new services to further enhance user experience. Among these we may mention "Mi Diario", which provides a summary of recent activity and the most relevant information regarding users’ health issues (16).
In 2020, however, the platform Quiero Cuidarme Más incorporated new services such as 'Cuida tu mente', a tool offering "a psychological orientation chatroom, application for clinical analyses during consultations and an extended timetable for many of its services" (19).
The insurer shows a clear tendency toward placing the client or patient at the centre of its services, creating an optimal environment and enabling the maximum functionalities.
Autonomous Regions of Madrid and Virtual Health Card
The government of the Autonomous Region of Madrid has presented a new initiative regarding the implementation of the Virtual Health Card. As mentioned by the Regional President, Isabel Díaz Ayuso, this project will be introduced initially at "two public hospitals: El Escorial and Del Henares” (21). Nevertheless, it is envisaged that its use will be extended to the remainder of the hospital network by the end of 2022.
It is foreseen that through the use of the Virtual Health Card, users will access their clinical histories through the app, share medical data, and make virtual medical appointments, all of which are services not previously available from the public healthcare system.
We should point out that this service is supported by an extensive network of technologies to ensure patients' data protection and the secure transmission of information.
We have included this example under 'success cases' because it illustrates the public health systems' recent advances in tele-consultation services. In this aspect, we must remember that private healthcare has always developed ahead of public health systems. All this may be the beginning of major steps forward in telemedicine and more competitiveness vis-à-vis private institutions.
EMERGING SUCCESS CASES
Moreover, as suggested above, different innovation hubs have registered an increase in the number of HealthTech start-ups and have highlighted the possibility of new use cases through telemedicine, that were beyond the reach of -or otherwise infeasible- for traditional medicine.
These would include, for instance, Fintech/Insurtech Galaxy, the financial and insurance startups radar in Spain, created by Innsomnia, which indicates that 20% of the technological solutions monitored have become pilot projects related to health (9); or data on investment in eHealth and Wellness projects up until 2020, with an accumulated investment of over €100,000 million, received for a group of 400 companies (10).
Among these Spanish cutting-edge enterprises in the field of telemedicine the following stand out:
Trak
This company offers a solution for enhancing patients' rehabilitation processes through artificial intelligence, assisting their recovery, correcting therapeutic exercises and recording metrics during patients' recovery allowing comprehensive monitoring by hospital centres, doctors and physiotherapists.
Since 2021, Trak works with the group Rivera Salud, through the programme Lanzadera Corporate, and with Hospital Asunción, through Kunsen.
Koa Health
This company offers digital solutions for mental wellbeing based on scientific evidence gathered in the field of conductive-behavioural therapy. It offers a product designed for companies, to help employees fight against stress, increase their positive thinking and self-confidence, and sleep better, alongside other solutions for developing mental wellbeing and digital therapies allowing user access to mental health services at any time and place.
Koa Health is associated with Janssen for research in the use of digital cognitive-behavioural therapies for patients who do not respond to conventional treatment, and collaborates with Massachusetts General Hospital, the British National Health Service, London School of Economics and Universitat Pompeu Fabra Center for Brain and Cognition.
MediQuo
Designed for physicians at private clinics and practices, this application allows them to contact patients through an app offering chat, video call and payment gateway on a single platform, and also delivering electronic prescriptions. By the middle of last year this company claimed over 2000 professionals across Spain, supporting a daily average of 4000 consultations, and aimed to close 2021 having reached a target of 10,000 healthcare professionals.
Predictheon
Predictheon is an enterprise specialised in developing software solutions for real-time prediction of changes in patients' condition and clinically significant adverse events.
Its aim is to raise prediction capabilities: to the clinical data gathered from a large number of patients using high-resolution systems, this company applies mathematical methods to generate predictive models to support doctors and personalise treatment.
These models take individual characteristics of each patient to anticipate their possible behaviour toward specific situations, both in the perioperative period and in other clinical situations.
Nubentos
Nubentos boosts digital health by means of its innovative platform SaaS that simplifies the efficient integration of any HealthTech innovation in any healthcare software.
This platform integrates the digital healthcare services of over 50 companies on its marketplace, and is embedded in clients such as DKV, Solutia Digital Health, Softtek, GMV Innovations, Nueva Mutua Sanitaria, Didoc.cl and Universal Doctor, reaching a total of 40 companies, all thanks to its apified service through the use of its tool Apiens.
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