The rise of telemedicine in the age of virtual healthcare

The need for telemedicine has become increasingly clear in a climate of isolation and lockdowns. A particular focus is given to the benefits and drawbacks of telemedicine, and the way in which healthcare is governed through laws and regulations, specifically in Austria and the wider European region. While telemedicine will not solve every challenge associated with healthcare delivery during these unpredictable times, it’s well established to become the most viable option in the treatment of COVID-19.

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The rapid spread of COVID-19 across the globe is transforming the way in which healthcare is delivered. As the virus expands so does the surge in the demand for treatment, with hospitals and wellness centres experiencing an influx in patient numbers. In wake of these difficult times, healthcare facilities and physicians are turning to innovative health-tech solutions to aid in the optimization of life-saving care.

Telemedicine, in particular, is at the forefront of public and global health emergencies (1). Telemedicine is the use of electronic communications to share medical information between sites, for the purpose of improving patient health. It facilitates information sharing between healthcare facilities and patients, allowing doctors to suggest diagnosis based on individuals’ symptoms and medical data (2). It can be delivered through various forms, such as video conferencing and e-health patient portals to remote monitoring, among others (3).

As self-quarantine becomes an essential element in the management of COVID-19 transmission, telemedicine is ensuring that patients everywhere have access to medical care. In these difficult times, healthcare systems should lean on remote testing, e-prescriptions, check-ups, and postal delivery of medicines to tackle the spread of disease. Traditional healthcare tools are no longer an adequate means of care, with the age of telemedicine dawning a new light on virtual healthcare and how people receive and deliver routine medical treatment.

In controlling the rising number of patients seeking treatment, many healthcare facilities are adopting telemedicine to sort through and prioritise patients as they arrive. This is where the virtual health landscape has become more prevalent. The on-demand nature of telemedicine has allowed patients to screen themselves without having to leave their homes and risk being exposed to the virus.

This patient-centric screening approach not only protects the patient but also reduces the chances of physicians and the wider community being exposed themselves. It offers 24/7 patient-physician communication, through the use of smartphones or computers. Health providers are able to easily obtain detailed exposure history, thus allowing automated screening algorithms to be built into the intake process with local epidemiologic information used to standardise screening patterns across providers. This, in particular, is highly beneficial among European regions where an imbalance and shortage of healthcare professionals exists, with the number of clinicians varying from 1.9 in Turkey to 5.2 in Austria per 1000 population (4).

In addition, the structure of the healthcare workforce is in a continual process of change, with nearly one out of three physicians aged older than 55 years (5). Physicians and healthcare professionals are at the frontline of the epidemic and, in addition to their age, are at the highest risk of contracting the virus or developing complications if they do get it. As such, the aging population is more susceptible to getting the virus. Telemedicine can aid in mitigating this risk by minimizing the amount of in-person contact.

Although telemedicine has been on the rise for years, it has not become a mainstream form of patient interaction because it defies the time-honoured tradition of physically visiting a healthcare facility. Furthermore, there are numerous regulatory and commercial hurdles that need to be overcome for the proper embeddedness of digital infrastructure and the securing of the patient-physician relationship. Yet, the need for telemedicine has never been greater with a growing increase in global lockdowns. However, there are a number of concerns when it comes to the implementation of telemedicine that pertain to legal and ethical issues including privacy, fraud and even malpractice liability (6).

In addition, there is the potential to dehumanize the patient-physician relationship; a main attribute in patient care. If providers completely remove the physical aspect of care, and only focus on telemedicine, there is a fear that healthcare empathy will be lost in process. If physical and personal interaction is removed due to virtual care, it can also lead to a loss in communication between medical practitioners that in turn could breakdown professional and collaborative communication due to fewer personal interactions. While these base-level barriers can be managed to a degree, there are other legal barriers that can prove more problematic to the use of telemedicine.

The complexities associated with telemedicine implementation rest in the stringent nature of local laws that govern the way in which healthcare is delivered, as laws and regulations vary from country to country. Here are some examples:

• The Medical Act in Austria regulates that a physician must carry out his or her treatment in a personal and direct manner (7). Remote diagnosis or distance consultation, such as that of telemedicine, is prohibited.
• It is not explicitly regulated under Austrian law, but electronic prescriptions are legally permissible and allow physicians and nurses to write, send and re-fill prescriptions electronically to pharmacies and participating dispensaries (8).
• In addition, drug prescriptions throughout Austria are to be digitised by 2022 (9).
• The Medical Activity Act in Poland, on the other hand, has offered telemedicine since 2015, whereas places such as Bulgaria and the Czech Republic have no explicit regulation regarding online medical check-ups but are still performed as special campaigns (10).

As digital healthcare becomes the norm, the Austrian Medical Chamber has taken the stance that it is the physician’s responsibility to decide when telemedicine is permitted. Given the confusion in terminology, such as that of “personal” and “direct” treatment, many health professionals are uncertain about the kind of remote services they can legally offer, and are hesitant in implementing telemedical services at all (11).

Technological advancement has led to a considerable change in the way healthcare is delivered (3). The COVID-19 pandemic is pushing telemedicine into the mainstream, not only in terms of the way in which healthcare providers keep up with treatment demands but also in terms of forcing innovation among broader health-tech companies. The deployment and perfection of telemedicine has never been as important to the rise of virtual care as it is today.

Though telemedicine will not solve every challenge associated with health care delivery in these times of need, it’s well suited in already established systems, allowing physicians to see patients from their home, thus limiting exposure to the virus and permitting ongoing care. Telemedicine is positioned to become the most viable option in the treatment of COVID-19, and society needs to embrace a future where virtual healthcare is the new normal.

Government laws and regulations across the globe are starting to re-define traditional health diagnosis and treatment delivery, and as we move forward out of this crisis, our lifestyles and our approach to daily living will change not only in relation to health care but also in the way we communicate, educate, and shop. If anything, this pandemic has shown how we, as humans, can thrive together in times of need.

References

1. Lurie, N., & Carr, B. G. (2018). The role of telehealth in the medical response to disasters. JAMA Internal Medicine, 178(6), 745–746.
2. Goodini, A., Torabi, M., Goodarzi, M., Safdari, R., Darayi, M., Tavassoli, M., & Shabani, M. (2015). The simulation model of teleradiology in telemedicine project. The Health Care Manager, 34(1), 69–75.
3. Dowling, R. A. (2015). Telemedicine: Are we reaching a tipping point? Urology Times, 43(2), 27–30.
4. World Health Organisation. (2020). Data and statistics. Retrieved from http://www.euro.who.int/en/health-topics/Health-systems/health-workforce/data-and-statistics
5. World Health Organisation. (2020). Strengthening the health system response to COVID-19: Recommendations for the WHO European Region Policy brief. Retrieved from https://euro.sharefile.com/share/view/s5af6405658d4b0eb
6. Nyeem, H., Boles, W., & Boyd, C. (2013). A review of medical image watermarking requirements for teleradiology. Journal of Digital Imaging, 26(2), 326–343.
7. Medical Act. (n.d.). Retrieved from http://www.ceom-ecmo.eu/sites/default/files/documents/medical_act_-_austria.pdf
8. London School of Economics and Political Science. (2017). Efficiency review of Austria’s social insurance and healthcare system. Retrieved from http://www.lse.ac.uk/business-and-consultancy/consulting/assets/documents/efficiency-review-of-austrias-social-insurance-and-healthcare-system.pdf
9. Hauptverband der österreichischen Sozialversicherungsträger. (2019). e-Rezeptstartet 2020: Digitalisierung in der Sozialversicherung weiter auf Vormarsch. Retrieved from https://www.chipkarte.at/cdscontent/load?contentid=10008.673701&version=1549971412
10. Sirakova, I., Todorova, E., Voldánová, M., Klimek-Woźniak, P., Moga-Paler, M., & Surugiu, A. (2020). E-healthcare and telehealth become vital to tackling COVID-19 in CEE. Retrieved from https://www.schoenherr.eu/publications/publication-detail/e-healthcare-and-telehealth-become-vital-to-tackling-covid-19-in-cee/
11. Khalil, S. (2020). Telemedicine On The Rise In Austria? Retrieved from https://www.mondaq.com/Austria/Food-Drugs-Healthcare-Life-Sciences/889858/Telemedicine-On-The-Rise-In-Austria