Getting telemedicine off the ground successfully

SINCE the Covid-19 pandemic began, routine doctor visits have become a little unnerving for some people. This has led to a surge in patients leveraging telemedicine services in Asia, with platforms such as MyDoc in Singapore seeing a 60 per cent rise in daily active users even back in February 2020. This figure doubled the next month in March.

It is worth noting that even before the pandemic hit, telemedicine was on the upswing. Driven by a shortage of medical professionals and rising costs, healthcare institutions have started implementing remote services, especially for low-risk, high-volume clinical tasks such as GP consultations for minor ailments and prescription refills.

Telemedicine can not only help manage the sector's talent shortage by freeing up resources, it also can make healthcare more accessible to patients with mobility issues, or those residing in rural areas. Increased accessibility is also important in driving early intervention and diagnosis, which contributes to better long-term patient outcomes and lower public health costs.

While all signs have pointed to telemedicine being a game changer for patient care, discussions around online medical services were muted, and the sector's progress stilted until the pandemic struck.

What has prevented telemedicine from becoming mainstream, and what will be the key drivers of its success beyond Covid-19?

Getting patients to say yes

From the patient's perspective, there are plenty of practical and emotional considerations before turning to remote medical services. First and foremost, patients must be aware of the services offered and feel confident that the quality of care they get will not be compromised. Providers must also educate patients about the services and treatments that are ideally suited for telemedicine versus those where an in-person clinical assessment is crucial.

Secondly, telemedicine services must be easy for patients to use. Once again, the onus is on healthcare providers to offer services that cater to a wide base of users with differing digital ability. This particularly applies to older patients, who have the most to gain from access to remote healthcare services, but who also tend to have the lowest levels of digital literacy.

Thirdly, patients need to know and fully understand the payment and insurance policies surrounding telemedicine. Until now, many insurance providers have been cautious about covering such services, though some have started to include coverage for e-consultations during the pandemic. Moving forward, more insurance providers should follow suit as this will make remote healthcare more financially accessible and viable for patients.

Finally, to ensure greater trust in telemedicine, patients must also be assured that their medical data is being stored and used securely, and in compliance with local privacy legislation. Healthcare institutions must not only look into best practices for safeguarding patient information, but also communicate this data security commitment to patients.

Knowing patients better

In order to get patients onboard with telemedicine and successfully get the sector off the ground, providers will have to reimagine the way they manage basic tasks. One such task is patient registration.

During an in-person appointment, the registration process enables the healthcare provider to pull patient records, medical history, drug allergies and more, and is essential to providing high quality care. A similar process needs to be set up for e-consultations so that doctors can be sure of who they are treating, even though the doctor and patient are not in the same room.

This is where Know Your Patient (KYP) processes come in. Similar to the banking industry's Know Your Customer (KYC) protocol, which enables banks to verify a customer's identity, assess risk and determine appropriate product offers, KYP is essential for the safe and accurate delivery of digital healthcare services.

Traditionally, the approach to verifying patients' identities has been to require them to show their IDs over a video call. This approach is less than ideal since it offers low levels of identity assurance. That is, it may be difficult for a healthcare administrator to discern between a legitimate government-issued ID and a fake one over a video call. Most practitioners are not trained to identify fake documentation especially when those IDs may be from other countries. Assuming that the ID is authentic, doctors may not be able to assess whether the person pictured on the ID matches the person on the call - especially if the photo on the ID is dated.

This is why sophisticated technologies, such as facial biometrics and AI, need to be leveraged for identity verification. This will allow KYP to be the first line of defence against fraudsters who use stolen or fake identities to see a doctor, get access to controlled substances or file unlawful insurance claims.

This approach will also enable telemedicine providers to streamline the online process of telemedicine - from registration to scheduling appointments and filling prescriptions - while complying with existing regulatory guidelines. KYP can also now be conducted securely, allowing doctors to treat patients confidently and confidentially - secure in the knowledge that they have access to the right records. Beyond verifying patients for routine consults and prescription deliveries, KYP can also effectively verify third parties, for example when young children must have a parent or guardian present during consultations or to purchase medication.

Progressive regulation

As with any new industry, governments and market innovators need to work together to better understand the benefits and limitations of telemedicine. This includes establishing best practices and standards of care that prioritise patient welfare and security, but also encourage innovation and ease-of-use.

Singapore is doing well in this regard and published its National Telemedicine Guidelines in 2015, which outline appropriate standards and outcomes, and HR considerations for providers. Subsequently, in 2018, the country established a regulatory sandbox with selected telemedicine players to enable the development of innovative models within well-defined patient safety and welfare parameters.

It is important for the public and private sectors to continue collaborating to reimagine every step within the consultation and treatment process. This will help identify any risks and establish best practices early on, ensuring that telemedicine can flourish and positively impact those who need it most.

However, to keep such a young industry nimble, more must be done. Governments must implement proactive policies and measures to encourage more healthcare institutions - such as hospitals and clinics - to transform digitally and revamp their delivery of medical services. More public education campaigns encouraging the adoption of telemedicine and outlining its safety and benefits must also be undertaken.

A revolution in healthcare has been long overdue - driven by the current pandemic, rising costs, and lack of trained medical professionals. With telemedicine being the new frontier, healthcare providers must take concrete steps to win the confidence and support of patients, while working with everyone in their value chain to ensure the secure, safe and seamless delivery of remote medical services.

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