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Some situations can test anyone’s patience, like waking up with a fever and body aches in the middle of winter and needing to schlep over to the doctor’s office for treatment. Who knows how long it will be for you to be seen by a doctor once you get there? Minor inconveniences can feel major in the digital age, and it’s easy to forget that in some parts of the world, access to healthcare in and of itself is a hurdle.
Luckily, recent groundbreaking advancements in telehealth solutions help transform rural healthcare by bringing medical expertise to places where geography or sparse population previously made permanent medical infrastructure impractical or prohibitively expensive.
Experts Leonardo Melo, Co-Owner of Diagnext, a telemedicine solution provider; Jason Miao, Sales Director of imedtac, an Internet of Medical Things technology provider; and Moji Ghodoussi, Vice President of Business Innovation and Partnerships at Teladoc Health, a leader in virtual care, convene to discuss advances in telehealth solutions, the challenges of bringing healthcare to rural residents and remote areas, and the means for equity of patient care (Video 1).
Why is it difficult for rural or remote areas to get access to quality healthcare?
Leonardo Alves de Melo: It’s a variety of problems. Hostile environments and the lack of basic inputs for healthcare such as medications and medical equipment are two of them. But it’s mainly the lack of qualified professionals. All of this is further amplified by the complex logistics: There are few hospital clinics, and a lack of financial resources and reliable energy sources. At Diagnext we have had operations in parts of Latin America and in the Amazon rainforest for 12 years, and it’s very difficult to bring healthcare to these populations.
Moji Ghodoussi: There have also been significant changes in the last couple of years; obviously we are all familiar with what happened when Covid hit. But healthcare is always very complex, and the complexities are not specific to geography. Regarding the rural healthcare landscape, it comes down to the lack of timely clinical expertise available to these populations. City centers have all these specialists available to their populations, while rural areas by default do not. And this cannot be addressed through any mechanism but telehealth.
What is amazing is that telecommunications-technology platforms have been available to do this for over a decade. Teladoc Health was founded over 20 years ago to take advantage of the technology to create a healthcare-specific platform that enables doctors to care for patients regardless of geography or time zone. Today, any rural area can have access to any specialist it needs for its population through the adoption of telehealth solutions. And over the last three years, the adoption has significantly increased.
Jason Miao: Even right now some of the countries in Asia are still not allowed to do telemedicine by the regulations and laws. But during Covid time, the governments thought that they probably needed to allow in some special conditions so they could use telemedicine at that time.
Some big cities in Asia—Taipei, Bangkok, Ho Chi Minh City—do have good and sufficient medical resources. But there are still a lot of rural areas, mountain areas. So how are we going to use this technology to help? Covid changed a lot, and the technology is helping us to move forward.
“In the last few years, #telehealth has already become the reality everywhere, and #AI is going to help us increase the care” – Jason Miao, imedtac via @insightdottech
What infrastructure is necessary to provide quality healthcare services in remote locations?
Leonardo Alves de Melo: Any kind of infrastructure, even the most common, can be a challenge in these regions. In rural regions, for example, for medical-equipment computers to function, they require energy, air conditioning, and good air quality. To exchange information, they need computers and the capacity to support even a minimal technology environment. They also need telecommunications that are minimally stable, because communication is essential.
But the financial cost increases greatly when you want to increase capacity, security, and stability to distribute more complex care to more people. With this in mind, at DiagNext we develop technologies with reduced implementation and operation costs; low energy consumption and air-conditioning demands; a reduced cost for local equipment; and high process and capacity with reduced physical sites.
Tell us about the evolution of telehealth over the past couple of decades.
Moji Ghodoussi: The challenge 20 years ago was on the connectivity side, as well as with ease of use. Back then the connectivity was cellular, was 3G—and actually 3G was new. So the bandwidth was not there. And technology has become easier for the population in general to use since then. You’ve got to make sure that it not only gets better and faster but that it’s also easy to adopt, because not everybody has a PhD in telecom.
Of course, security is paramount when you’re dealing with any digital tools, cloud-based tools. And in healthcare and telehealth that’s now related to privacy concerns, too. At Teladoc Health we go way beyond our own security protocols, encryptions, etc., to third-party certifications to adhere to all key standards—from ISO international standards on InfoSec to NIST certifications and even high-trust CSF certifications.
What technological advancements are at the forefront of digital healthcare transformation?
Jason Miao: The first thing is the Internet of Medical Things. We already have a lot of the medical devices for vital data collecting—like the ECG, like the endoscopy devices. But very powerful edge computing can connect with those devices, and with good quality for video and very stable data transformation.
Another thing is 5G bandwidth. Doctors can use that high quality to see almost exactly the real video. Even if the patient is in a rural area, 5G can overcome those infrastructure problems. And imedtac can pack the hardware plus the software and the cloud as a ready solution.
Can you share some use cases of successfully providing telemedicine solutions in rural areas?
Moji Ghodoussi: We have partnerships with major healthcare institutions through a hub-spoke model, and we enable clinicians in urban settings to deliver care to rural areas every day of every week. Here’s one example of how telehealth can benefit a rural population.
Imagine a person living in a rural area: They have stroke symptoms, and they’re brought to a local hospital that doesn’t have a stroke neurologist on staff 24/7, which is the case in a majority of geographies. Now with telehealth they can ping the doctor who is on call for that area; the doctor connects through telehealth to that location; and within 15 to 30 minutes of looking at the lab results, CT images, etc., they can determine if it is a stroke or not. And 80%-85% of these patients do not have a stroke. So instead of transporting this person for two, three hours—with the added costs associated with that—they can actually get the care they need in the same local hospital.
Leonardo Alves de Melo: DiagNext became famous for its work in the early identification of breast cancer in the Amazon rainforest. It used to take months to identify there; today it takes just a few minutes. Tens of thousands of patients can be screened in a year, with several thousand at-risk patients identified, and over a hundred surgeries.
Jason Miao: Another thing is that even in the hospitals in Taiwan—in the branch hospitals and in the emergency rooms—some of the doctors don’t have the confidence to take care of all cases. So even in the hospital they can still use telehealth to get a second opinion or a consultation.
How do you collaborate with ecosystem partners to make healthcare in rural areas a reality?
Jason Miao: Because we are using edge computing as the gateway to connect the different medical devices and upload to the cloud, edge computing is very important for us. So when we go to different countries in Asia we find the right local partner that already has local service. Different countries have different regulations, different reimbursement or insurance, and also different cultures.
Intel is always linking those resources together. We have a whole partner chain in Asia led by Intel. Whenever we have found there’s an interesting new model or new case, we will be able to get the right resources from Intel. So we are very appreciative of that support.
Moji Ghodoussi: We have also been partnering with Intel for a number of years, and we’ve used specific Intel hardware as part of our offerings. More recently, and more significantly, we’re using Intel chipsets as part of the custom-designed and custom-manufactured electronics that are part of our telehealth-device portfolio.
How do we keep improving healthcare in rural communities?
Leonardo Alves de Melo: We need to include the populations of rural communities in their healthcare. Having minimum technology makes a lot of difference in individual care, but it needs to be customized. New means of communications and equipment with lower operation and input costs are also important, as are investments in information technology for hospitals and clinics in rural areas.
With our expansion integration, with new medical equipment and systems, we will be better able to bring healthcare without physical borders. We are bringing technology-enabled, tele-assisted surgery, we are bringing AI tools—all to make medical care more efficient. We are also building training tools for remote teams.
Jason Miao: In the last few years, telehealth has already become the reality everywhere, and AI is going to help us increase the care. The next issue we are seeing is age related. People are getting older, and we don’t have enough manpower to take care of them. At imedtac we are also thinking about this next step, and including telehealth can definitely help us to have a better retirement life.
Moji Ghodoussi: Technology keeps advancing, which provides additional tools to the clinicians. Diagnostic aspects can actually help the doctor maybe even before they see the patient. These advancements in technology really enable clinicians to take better care—and more care—of the patient population.
We have a partnership with the nonprofit World Telehealth Initiative, which enables doctors and surgeons who donate their very valuable time to deliver care to countries such as Malawi, Togo, Ethiopia; Haiti and Puerto Rico; Bangladesh, Bhutan, and Cambodia. These doctors would otherwise need to—and used to—travel to these destinations. This is admirable, but now they can avoid travel and therefore deliver even more healthcare to these parts of the world.
I do want to take advantage of this opportunity to thank Intel for its partnership in the last few years, and to congratulate the vision of enabling platforms and solutions that further advance technology, and therefore telehealth. Because telehealth, in my opinion, is the only way that we can have true health equity.
To learn more about virtual care and digital health solutions, listen to our podcast on Digital Health Solutions: Closing the Rural Healthcare Gap and read Telemedicine Solutions: Closing Healthcare’s Digital Divide, IoMT Technology Automates Vital Signs Measurement, and Teladoc Charts the Future of Telehealth.
For the latest innovations from Diagnext, imedtac, and Teladoc Health, follow them on:
This article was edited by Erin Noble, copy editor.