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Paving the way for telehealth first

Interview with Dr Robin Ohannessian, Co-founder and Director, Télémédecine 360, on what's trending in telehealth and how to combat the challenges that lie ahead.

On the sidelines of Arab Health 2021, Omnia Health Magazine sat down with Dr Robin Ohannessian, Co-founder and Director, Télémédecine 360, to discuss telehealth and how it’s transforming the healthcare industry today. Excerpts:

Is telehealth here to stay? Is it going to become a pillar of healthcare?

Telehealth is definitely here to stay. In fact, telehealth has been around for over 10 years now. However, COVID-19 acted as a trigger for telehealth worldwide, causing an increase in uptake. So, today, the questions about telehealth revolve around how do we make it sustainable? How do we increase it, improve it, and make it a regular practice for care and prevention worldwide, not just in a few countries?

There are several different approaches to achieve this. The first point to consider is to reverse the way we think about telehealth. Until now, we mainly thought about it as an addition to standard physical care. Now, with the increase in uptake, telehealth should be considered as potentially the standard itself. This means that to improve and make it sustainable, the future we see is telehealth first because it is more convenient for everyone.

At each point of the patient pathway, whether for an initial consultation, follow up or remote monitoring, all of this can be potentially done first with telehealth. This would require scaling telehealth. During the past year, we have seen countries such as France, India, UAE, the U.S., countries in Africa, China and most parts of the world witnessing an increase in the volume of telehealth activity. But then we also saw that progressively it went down a little bit. So, the question that arises now is that how do we scale and sustain it? Two main points need to be considered here. The first being to have regulations that allow this activity to grow without any gaps. And the second one is for countries to define their national strategy. This is one of the main priorities that governments and health authorities should consider for the coming months and years.

What can be done to ensure telehealth is the first preference for patients?

Before the pandemic, telehealth was driven mainly by doctors and other healthcare professionals. But we have also seen some resistance from their side. However, in scientific literature and from the majority of the studies that have been published, we’ve seen that the patient most of the time prefers to have some telehealth component within the patient care. Because it’s convenient for them and has several advantages. Now, the question is, what if a patient wants to have a telehealth service or have a health service, and there is no telehealth service for that? How do we offer that going forward? My advice for companies, start-ups and healthcare providers is to think not from their perspective but keep patient preferences in mind. Additionally, it’s important to measure patient satisfaction on different models because telehealth encompasses various models and activities. Finally, it’s essential to measure what is actually preferred because most of the time, what we thought was the preferred way was not necessarily so in reality.

What can doctors do today to incorporate telehealth into their practice?

An important consideration here is training. A clinical approach to telehealth needs to be integrated within the healthcare training curriculum for all healthcare professionals. For example, in France, for several years now, telehealth training is offered where questions such as what telehealth is, how to use it, and how to do a clinical exam have all been integrated within the initial curriculum. But this is not only for medical doctors, and there has been a push to include it for all healthcare professionals. The training should also focus on how to use telehealth and when would it be necessary to use it. For example, the training should address how to do a throat exam through a smartphone in a video consultation and assess the heart rhythm remotely.

What are the challenges that telehealth poses, and what can be done to improve it?

Today, all around the world, due to the pandemic, doctors, nurses, physiotherapists, psychologists are doing some of their work online. Therefore, we must consider how to promote quality, research, and evaluation. It’s not just can we do it but is it actually better and how can provide the best experience to users. Several start-ups are working on how to have the best user interface and user experience.

The growth of telehealth will impact how healthcare is being funded. Today, there is a fee-for-service model around the world – we go to the doctor, the patient pays out of pocket, or the insurance pays. But we don’t necessarily need to go to the doctor all the time. In the past, this system was built because it was the only choice we had. But when we think about it today, maybe we need to ask a small question and don’t want to wait one week to get an answer. This means that perhaps the funding model will shift to a subscription-based model instead of a fee for service one. Some start-ups have already started work on this. There is a lot of work involved in this in different areas, be it regulations, policy, research and evaluation, training, data management, user-friendliness etc. These topics need to be tackled to make such a model a reality so that everyone across the world can access it. This needs to be an equal right to health and a strong point for universal healthcare. Universal healthcare cannot happen without telemedicine.

What impact has telehealth had on mental health?

The topic of telehealth and mental health is an interesting one, firstly, because it was one of the first cases where telehealth was used. This is because the need for clinical physical exams is less in the medical specialty of psychiatry and psychology. In recent times, there has been a sharp increase and a shift in the way the service is provided. For example, we have video consultations and online appointments. But for mental health, we also see that video consultation may not be enough. We need broader support from a psychologist and automated or AI services that can coach patients on how to decrease their mental burden.

How is artificial intelligence driving telehealth?

While telehealth and artificial intelligence are two different topics, they are related and impact each other. For example, in telehealth, once we have established the distance between the patient and doctor or between different healthcare professionals, then we can input artificial intelligence (AI) components in between. We are seeing this today in the field of Radiology. There are also standalone AI activities, which drive the push towards telehealth activities. So, both should be considered as two facets with the same goal of driving healthcare efficiency and improving patient care. They both need the same digital infrastructure and regulation infrastructure to be able to collect, share, analyse and use the data. While these two areas will continue to grow separately, they will start to be integrated with each other, whether it’s patient questionnaires, algorithm and remote patient monitoring, automated alerts, etc.

What, in your opinion, does the future of telehealth look like?

It’s a very bright future. However, today, even in North America, Western Europe, and China, the level of implemented activities is still not where it can bring a drastic change in the system. So, we can only envision what will happen next. There will be new activities, start-ups, services, and ideas that will emerge. When these are introduced, we must encourage and promote the new services. The development of telehealth services within healthcare systems may be in parallel to the overall healthcare system, but providers need to always think about patient needs first. This movement will only keep going forward, and we need to act upon this collectively.

TAGS: Telemedicine
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