Treatment, Care Continuity Despite the DistanceBy Rodrigo Brugada | Mon, 07/19/2021 - 18:32
COVID-19 was a game-changer in the healthcare sector. Not only did it expose the cracks in the healthcare systems but it also shifted how public and private care were delivered. For some healthcare workers, the changes were minor; for others, whole paradigms had to change.
Some of the major shifts brought by the current pandemic happened because of three main interacting factors: changes in accessibility to healthcare facilities, public health containment measures and restrictions and changes in patient behavior. When hospitals started overflowing with COVID-19 cases, some of them ceased to provide their regular services, such as consultations and non-urgent surgeries.
Regarding patient behavior, something happened in healthcare akin to other industries previously. As stated by Jorge Camargo of Ecaresoft, “When customers became “digital customers” the old IT support software had to be thrown out and new technology tools had to be created from scratch with the digital customer in mind.” This too happened inn healthcare.
An important part of the population in need of care stopped receiving it, although many healthcare workers tried to adapt to ensure treatment continuation. Face-to-face consultations stopped, which spurred doctors to continue their practice online, many of them trying this for the first time. Digitalization was particularly relevant in those specialties that do not rely as heavily on physical exams. Relevant examples include mental healthcare and the care for chronic conditions. As many physicians delved into a digitalized world, the transition revealed gaps, however. Many healthcare workers started offering consultations through unregulated platforms, such as Zoom or Google Meet. Many more had several problems with health records and turned to Dropbox or Google Drive.
Other specialties did not have it as easy, mainly those that rely more heavily on a physical examination. Surgical specialties, for example, rely heavily on direct interaction with patients and often this component of the consultation may dictate the course of action or treatment. A clear example can be seen in orthopedics; while a patient may present certain symptoms (joint pain, for example), different maneuvers during the physical exam give a sense of what may be wrong. In the absence of these procedures, physicians need to rely more heavily on imaging and lab studies, which may mean higher expenditures for patients and an incomplete clinical panorama for physicians.
Disruption Sparked Innovation, Technology Adoption
These difficulties sparked a new set of technological adaptions that eased the provision of healthcare. A crucial first adoption, as mentioned before, was the use of video conference platforms that enabled patients and physicians to be connected despite the distance. The use of technologies is broad in scope and not limited to consultation services, as stated by the CDC.
As stated by Ricardo Moguel of Doctoralia, “it is key to be able to send prescriptions, otherwise patients cannot purchase their medications. Other improvements have been prescriptions, […] and record-taking function so the doctor can take notes about the patient.”
The adoption of technological innovations helped to provide coaching and support for patients managing chronic health conditions; to foster participation in physical, occupational and other modalities of therapy, to monitor signs of certain chronic medical conditions or to engage in the management of patients who have difficulty accessing care (for example, those who live in very rural settings, older adults and those with limited mobility).
Telehealth is only one of several ways in which technological innovation is helping healthcare systems as they transition to a more rounded and comprehensive future known as Healthcare 4.0. There are many competing definitions for what Healthcare 4.0 is. Nonetheless, many of them converge on what it entails, as new technologies in healthcare are derived from Industry 4.0. As stated in an article published in JSAN, the basis of this revolution is cyber-physical systems or intelligent machines. The main characteristics of Industry 4.0 comprise the integration of IoT, increased automation technology and improved communication and self-counseling methods. Industry 4.0 can leverage technologies to make the healthcare sector more straightforward than before. An example is the improvement and enabling of remote monitoring systems based on IoT. Other key characteristics that these advances provide include KPI metrics, cloud-based record systems and fast communication between users and between systems with almost immediate data transfer. Other critical technologies that are playing more prominent roles every day are IoT, blockchain, cloud computing, and AI.
These technologies provide significant advances in disease prevention, patient management and health literacy. They could also reduce the time required to obtain a diagnosis and initiate treatment, allowing for a close follow-up at home, avoiding over-saturation of medical facilities, reducing travel times and minimizing the risk of intrahospital infections, according to World Scientific.
Technology Requires an Adequate Environment
Many systemic changes must be discussed and put in place for such a significant innovation to take hold, however. Many international organizations have tried to provide a framework to assess the current state of the healthcare system and how mature it is to implement technologies such as telehealth. PAHO enlisted six categories that aim to assess how ready any particular institution is to provide these services. These categories include:
- Organizational readiness to ensure that there is a solid foundation to build upon.
- Adequate processes for everything to run smoothly and safely.
- An appropriate digital environment that includes any relevant technological infrastructure, including electricity and internet access.
- Trained personnel to ensure a proper institutional capacity in IT and its related areas.
- Proper regulation compliance.
- Additional expertise that may benefit the effective implementation of these services.
Applying these criteria to the Mexican healthcare system reveals an unpleasant truth, which mimics other aspects of Mexican society: the capacity to adopt new technologies is present in a highly unequal manner. Only a handful of places have the relevant qualifications and infrastructure to provide these services, while most of the country lags behind. This is by no means a reason not to embrace innovation, but there is a risk that in doing so these gaps are widened.
An essential criterion among those mentioned by PAHO is the regulatory framework, which in Mexico is lagging. The country has done little to keep up with global developments and there are certain legal gaps in the existing regulatory frameworks, for example in the case of electronic prescriptions.
As stated by the Christian López-Silva of Baker McKensie, “the regulatory framework could be greatly improved not only by addressing the aforementioned innovations in the field of digital health, but also by adopting digital transformation in general. For that, we could look at some proposals put forward by key players in the digital health ecosystem.”