Digital Health Solutions: Closing the Rural Healthcare Gap

Christina Cardoza: Hello, and welcome to the IoT Chat, where we explore the latest developments in the Internet of Things. I’m your host, Christina Cardoza, Editorial Director of insight.tech. And today we’re going to be talking about advancements in healthcare technology, what that means for patient care, and how it’s being used to improve healthcare access in rural areas with DiagNext, imedtac, and Teladoc Health. But before we jump into this conversation, let’s get to know our guests. First, I want to introduce Moji Ghodoussi from Teladoc Health. Moji, welcome to the show. Please tell us more about yourself and what you do at Teladoc.

Moji Ghodoussi: Thank you. A pleasure to be here. I’m Moji Ghodoussi, as you heard. I’m Vice President of Business Innovation and Partnerships at Teladoc Health. I started my career in healthcare technology after receiving my PhD in Robotics from UC Santa Barbara in the nineties, pioneering the field of surgical robotics, and we actually innovated in the field. And one of the key accomplishments of mine and my team was the historical telesurgery Operation Lindbergh, which took place on September 7^th, 2001, when surgeons in New York operated on a patient in France, 4,000 miles away, which was precursor to telehealth, if you will.

And if you fast forward to the last decade in my current position at InTouch Health, now Teladoc Health, I partner with other innovative medical-device companies to advance healthcare technology, leveraging digital tools. And these are all leading healthcare-technology companies. Many are today’s surgical robotics innovators. And at Teladoc Health our core focus of course is healthcare. And we serve a significant public population—millions of people—with their primary and chronic care, including working with healthcare institutions and hospitals for urgent and related care. And we do so globally.

Christina Cardoza: Great. Yeah, can’t wait to dig into all of that. And that example you gave, you know it used to be something that was very expensive and complicated to do, but recent advancements with digital health, it’s now becoming much easier.

But before we get into that, I want to introduce Leonardo Alves de Melo from DiagNext. Please tell us more about yourself and the company.

Leonardo Alves de Melo: Okay. Thank you a lot for the opportunity. Well, 14 years ago we came together out of curiosity and an interest in offering innovation without physical, technological, and user borders. We are all researchers, and we advise methodology, processes, technology, and tools to increase efficiency in healthcare regardless of its physical location and how difficult, critical, or hostile this activity requires. Our joint knowledge is an extension in development of system and process and in the quality and efficiency of the service provided.

We constitute an important sets of patents, technology, innovations, process, etc., creating a more—turning more efficiently the healthcare for mission critical and hostile environments through IT. We operate exactly where we make a big difference when there’s a strong demand for healthcare, such as a forest, desert, mountains, swamps, cities and small cities, and forest.

Christina Cardoza: Great. And, last but not least, Jason Miao from imedtac. Please tell us more about yourself and the company.

Jason Miao: Thank you, Christina. Hi, everyone. I’m glad to be here. This is Jason Miao from imedtac. Imedtac, our company is a digital-healthcare solution provider from Taiwan. As everybody knows that Taiwan is very good in the semiconductor and ICT technology, so our company basically is using the ICT technology from hardware to software to integrate a turnkey solution to provide the customer like the hospital, like the age-caring institution, even the clinic and the pharmacy. And we cover mostly in Asia market, especially Southeast Asia.

So, I’m in charge of the overseas market. So we are trying to use those technologies to find the local partner, so we’re able to provide like the telehealth or like the smart hospitals solutions for those countries.

Christina Cardoza: Great. So, lots to dive into here with the three of you. I want to start off, we were talking in the introduction, especially with Moji’s introduction, being able to provide healthcare to someone thousands of miles away. And, Leonardo, you said all of these different areas that you guys are providing telehealth or digital-health solutions. So I’m curious, if we could start off the conversation thinking about other areas where healthcare may not be as easily accessible. I mentioned in my introduction rural areas. Can we set the stage a little bit, in certain areas why it has been difficult to get proper access to quality healthcare, what the struggle has been?

Leonardo Alves de Melo: Well, the search for full health in regions, in this kind of region, a constant challenge for these people. There are a variety of problems they had faced given the hostile environments they find themselves in, starting with the lack of basic inputs for healthcare, such as meds and medical equipment, hospital supplies, and mainly qualified professionals whether healthcare or not.

Another point that we know that affects them are different, and have a different impact, than those that affected in urban regions—there are often diseases typical of the places where they live not fully identifiable or treatable with conventional or every medical care. All of this further amplified by the complex logistics: few hospital clinics, lack of reliable energy sources, and few financial resources. I’m talking about the parts of the Latin America that was in the Amazon rainforest, is a big example of that, and we have operations there 12 years. And that’s so difficult to make healthcare to this population.

Christina Cardoza: Yeah, and it’s a difficult challenge just thinking about they’re in, sometimes, these remote areas, they don’t have connectivity and, like you mentioned the diseases could be higher there, but yet they can’t access proper medical resources, supplies, things like that. And I think the last couple of years have maybe extrapolated that a little bit.

Moji, so I’m wondering if you could talk a little bit more about recent evolutions in the healthcare landscape—how have things changed over the last couple years? How has that added to these challenges of getting proper, quality healthcare?

Moji Ghodoussi: Absolutely. Significant change in the last couple of years. Obviously we are all familiar with what happened when Covid hit and the pandemic. But, reality overall, healthcare obviously is not simple and is rather very complex. Complexities are not specific to geographies—rural versus urban—yet specific to the question regarding rural healthcare landscape, it comes down to lack of timely clinical expertise available to those populations. City centers have all these specialties available to their local population, while rural areas by default and, naturally, they do not. And this cannot be addressed through any mechanism but telehealth, which is a key area of our business and focus.

What is amazing is that telecommunications technology platform has been available to do so for over a decade. And we were actually founded over 20 years ago to take advantage of the technology to create the healthcare-specific platform that enables doctors to care for patients regardless of geography and time zone. Today, therefore, any rural area through adoption of telehealth solutions can have access to any specialist they need for their population, as we have done this for over a decade. And over the last decade the adoption of telehealth has significantly increased, and more so in the last three years.

And, through our launch of “whole-person care”, we focus on the whole person and not merely a point solution or episodic care, which means that we focus on the person’s episodic needs considering their chronic conditions and other health attributes. And of course with our focus in leveraging AI we can actually go towards individual care that is relevant to the patient rather than broad-based population healthcare remedies of today.

I can give you actually one example of how telehealth can benefit a rural population, and if you can imagine a person living in rural areas, they have stroke symptoms and they’re presented to the hospital, local hospital, who doesn’t have the stroke neurologist on staff 24/7, which is the case in majority of the geographies. Now, with telehealth, they actually ping the doctor that is on call for that area, and the doctor essentially connects through telehealth to that location and within 15 to 30 minutes of looking at the lab results, CT images, etc. they can quickly determine is it 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 to essentially get them the care that they need, which actually was to keep them in the same local hospital, now this person has to be transported to the wrong place, added costs associated with that, etc., etc. And in case of an actual stroke patient, now they have to wait another two, three hours to get the care. And we know what happens in those situations, unfortunately.

Christina Cardoza: Yeah, and to your point, Covid certainly changed the game in providing telehealth. It’s now more widely accepted for providers and in these different areas. I’d be curious to know how—because when Covid happened everyone was just rushing to be able to provide healthcare—now that we’ve had some time and we’re sort of out of the woods a little bit, I’d be curious to hear how we can be smarter about implementing these types of technologies.

But before we get there, Jason, I just wanted to ask you—you mentioned in the Asian region where you guys are working there are hospitals and other things, so there is that expertise there of being able to get medical access. But I’m curious what challenges do these specific hospitals and medical organizations face in these areas, and how the last couple of years have added to the challenges that we’ve been talking about?

Jason Miao: So I think I want to echo—Moji mentioned about the Covid has definitely changed a lot in Asia. Even now, right now, there are some of the countries in Asia are still not allowed to do the telemedicine by the regulation law. So during the Covid time the government, they are thinking about probably they need to allow in some special conditions they can use this telemedicine. It’s very significantly changed everything.

So I think just like some big cities in Asia, like Taipei, like Bangkok, even Ho Chi Minh City, in the big city they do have the good and the sufficient, the medical resource. However, there are still a lot of the rural areas in the mountain area. So how are we going to use this technology to help? And another thing I think is the ICT and the 5G. Especially like Intel providing some of the good new technology, Asia is very accessible for those new stops. So we are trying to find those technologies to become a ready solution in Asia market.

Just like in Thailand—actually right now I’m on business travel in Thailand. We have joined the treasury right here; we also meet the government right here. They have the program to establish this telehealth system in some of the mountain provinces, and those budgets is coming from the 5G. So I think that’s very, very interesting that we are still facing some of the challenges, but we do see the Covid change a lot and the technology is also helping us to move forward.

Christina Cardoza: Now, Jason, you mentioned Intel technology and 5G. I’m wondering if you can expand a little bit on the types of tools, technology, or network capabilities you need to actually make this happen. Especially when we’re talking about Intel technology and things like that, what are the advanced technologies available today that weren’t available before that are helping us break down these barriers?

Jason Miao: So actually what we are talking about is we use those technologies to help the digital transforming for the healthcare. So the first thing is those things basing on the IoT, Internet of Medical Things, we definitely need, because we already have a lot of the medical devices in the vital collecting, like the ECG, like the endoscoping. However, right now we have the edge computing, the very powerful edge computing. It can be able to connect with those devices, and with the good quality for the video and very stable for the data transforming.

So we are able to pack—it’s just like the highway plus software and the cloud as a ready solution. So you will be able to be very fast to also move to any of the different areas. Another thing is the 5G bandwidth. I think before that we were still facing some difficulty to have the live video teleconference, but right now the 4G, 5G is very popular. The doctor can use a high quality to see exactly the almost real video. So no matter the patient in the rural area, the 5G can overcome those infrastructure problems.

So I think it’s a very significantly help in Asia, especially in those rural area. And I believe in western countries the EMR is very popular, but in Asia, some of the areas, they are starting to build the EMR system. So right now we are trying to help those countries so they will be able to have the very reading from the device, from the edge computing with the bandwidth and bandwidth and the cloud system. So I think those are the new technologies that we can see is happening for the telehealths.

Christina Cardoza: Yeah, absolutely. And you mentioned you have some of these devices already, and I’m sure when you’re looking at a hospital, it has some of the infrastructure already available to make this happen. I’m curious, Leonardo, from your point of view, when you’re not in the hospital or you’re in a rural area, maybe you’re getting care or service in your own home or something like that. What type of infrastructure do you need to really successfully gain access to these types of healthcare?

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 air quality. To exchange information they need computers and telecommunication that are minimally stable and have capacity to support the need in a minimal technology environment. Communication is essential.

However, the financial cost increases greatly with the increase in capacity, security, and stability. Thus it becomes more complex to care for patients and distribute care to more people. I’m talking about the forest of Latin America. With this in mind, we develop and use technologies with reduced implementation operation and low costs, low energy consumption, little air conditioning demands, reduced cost for local equipment, and high process and capacity with reduced physical sites.

In terms of sites here, principally with new technology that open, we spend a lot of development intelligence on process patterns that maximize the use of this kind of technology, make it as optimized as possible. Here we use a lot of this kind of equipment, how gateways of healthcare communications. Then this equipment helps a lot for us to verbalize more than one communications channel to add this capacity and provide this infrastructure to the medical doctors, and then using 4K and telehealth surgery, in 4K or telehealth or whatever else.

Christina Cardoza: Yeah, absolutely. And, Moji, going back to what you were talking about earlier, a lot of the recent struggles we’ve had over the last couple of years has really enabled telehealth, or opened people more up to receiving this type of care. But I’m curious to hear how the implementation of telehealth has changed since you’ve started in in your career. How today it’s being implemented, and what are some of the things that we should be thinking about when we’re implementing this care, this type of care in regards to the infrastructure, the technology. As well as that we’re talking about medical health here, so it’s a lot of personalized and sensitive data. So what should we be thinking about when we’re deploying these today?

Moji Ghodoussi: Absolutely. And, as I mentioned earlier, we got into the field about over 20 years ago. Back then the connectivity was cellular, was 3G, and actually 3G was new, because you just transitioned from 2G to 3G. So bandwidth was not there, although the healthcare needs obviously were still there.

So the challenge back then was on the more technology and connectivity side and ease of use, versus today, as we mentioned already by the other guests, that we have 5G, which gives you significant bandwidth, throughput, and reliability. And also technology has become also easier to use for the population in general, because not everybody has a PhD in telecom. So therefore you’ve got to make sure that it not only gets better and faster, but it’s also easy to adopt and use, as everybody now has a cell phone, etc.

But what’s significant is that of course security is paramount when you’re dealing with any digital tools and cloud-based tools. And the added significance here is that in healthcare and telehealth it’s related to privacy concerns. For telehealth companies security and privacy concerns are significant aspects of the platform, in addition of course to developing workflows, tools that allow clinician, doctor, surgeon, nurse to have access to all the information that they need, and easy and secure mechanisms to deliver their care to their patients.

This is why, for example, at Teladoc Health we go way beyond our own security protocols, encryptions, etc., and we go through significant costly but also necessary third-party certifications to adhere to all key standards—from ISO international standards on InfoSec and to certifications to NIST, and even high trust, the CSF certifications, which all of these allow us to be very secure adhering to global standards, which is very important in healthcare. And that includes of course GDPR as one of those requirements.

Christina Cardoza: I can’t imagine being able to provide all of this type of healthcare today that we are doing on the 3G network. It’s almost like Covid came at a perfect point, where we had the technology available to start doing some of these things.

So I’m curious, because obviously you guys have all been doing this for years, and you’ve worked with many different customers, I’m wondering if you guys can paint a picture for our listeners a little bit more of any success stories or customer examples you can share with us about how they did this—how they successfully provided healthcare to rural areas or overcame some of the challenges that we’ve been talking about, and if there’s any lessons learned from there. So I want to hear from each of you, but, Moji, I’ll start with you again on this one.

Moji Ghodoussi: Okay, great. For Teledoc Health of course delivering healthcare to rural health areas is an everyday, standard business practice for us. I gave an example earlier about a stroke use case when a stroke patient is presented. And of course with our partnerships with major healthcare institutions through hub-spoke models we enable clinicians in urban settings to deliver care to rural areas every day of every week.

But as such, I would like to actually instead provide success stories from our partnership with the nonprofit World Telehealth Initiative, which is a 501(c) entity, where Teladoc Health provides our technology and global platform that enable doctors and surgeons who donate their very valuable time to deliver care to less fortunate parts of the world, from African countries such as Malawi, Togo, Ethiopia; to Haiti and Puerto Rico; to Asian countries like Bangladesh, Bhutan, and Cambodia. And of course since the war in Ukraine, to Ukraine.

These doctors would otherwise need to, and used to, travel to these destinations, which is admirable, but now they can avoid travel and therefore deliver even more healthcare to these parts of the world that would really need such help. And we are very proud of this partnership with doctors and WTI.

Christina Cardoza: Yeah, absolutely. That’s a great example, especially when you think that these doctors had to travel to all of these different locations. They can only go be in one location at once, but now they can visit multiple different locations in one day and start providing access and health to all of these different areas. Jason, I’m wondering from imedtac, do you guys have any customer examples or lessons learned over the last couple of years you can share with us?

Jason Miao: We do have some very interesting cases that we would like to share with you. The first thing is in Southeast Asia, like Thailand. The government is leading this kind of project, because the government realizes that people are a national issue. So they are trying to use government policy and resources to help lead this—what we would say is equal rights for all the citizens, no matter who you are in the big city or in the rural area. So it will be very significantly the issue in the Southeast Asia market right now. Like in Indonesia, there are so many islands. If you don’t use telehealth, if you don’t use the 5G, you will not able to provide the good service, the healthcare service for all the people.

Another thing is even inside the hospital; we do have another case in Taiwan. Even in the hospital they have the different branch areas, but in the emergency room somehow some of the doctors, they don’t have the confidence to take care all of the cases. So even for the hospital in between the branch and also the main hospital, the emergency room, they still can use the telehealths to do the second opinion to do the consultation. So I think there will be a very interesting tool of the different models that we see. The telehealth is really very useful for all the citizens, and also for the hospital systems.

Christina Cardoza: Yeah, absolutely. And that it, just in addition to being able to provide this access to healthcare like you’re mentioning, it just provides better patient care, takes some of the burdens off of the hospital staff, so all around providing a great solution for everyone. Now, Leonardo, anything from DiagNext that you can share with us about any customer examples or use cases?

Leonardo Alves de Melo: Yeah, sure. I think in the Amazon rainforest it became famous for our work and efforts in the early identification of breast cancer, which took months to identify, today manages to take just a few seconds. The same technology helps mobile healthcare units in all Latin America by trucks and vessels. This project is a responsible for solving, with minimal operation and technical costs, more than a hundred thousand patients per year in more than 60 hospital units there. Approximately seven and a half thousand patients at risk of breast cancer identified it, and almost 200 are taken to treatment or surgery. I think that’s an exact example of how our technology can help.

We use that in another state in Brazil, like São Paulo, in the Covid period, that we need to turn it on some emergency hospitals for a true emergency, and eight hospitals in two days. And I began using all the tele-radiology, using mobile phones to communicate the systems 5G, 4G or else. Of course the integration is created by an Intel processor and computer server that our team, our developer team, created so fast.

Christina Cardoza: What’s interesting, as we’re talking about all of these different use cases, is we’re talking about using 4G, 5G video cameras, AI edge computing, and, Leonardo, you just mentioned Intel processors—I assume those are being used for performance and the edge computing that we’re talking about. But it seems like there’s a lot that goes into making all of this successful. And I should mention the IoT Chat and insight.tech as a whole, we are sponsored by Intel.

But I’m curious, how do you collaborate with ecosystem partners to make this happen, especially in rural areas. Jason, if you can expand a little bit—you talked a little bit about using Intel technology earlier in the conversation. So what’s the importance of Intel in making this happen, as well as any other ecosystem partners you’re working with?

Jason Miao: Yeah, I think because we are using the edge computing as the gateway to connecting the different medical devices and uploading to the cloud, so the edge computing is very important for us. And, as you know, that Taiwan is good in the semiconductor, good in the multiple laptop, and also for those computers. So we have actually the whole partner chain in Asia, in Taiwan, and leading by Intel.

So when we go to the different country, like the Vietnam, like the Thailand, so we will be able to find the right partner who already has the local service and the warranty. So it provides a very good flexibility for us. We are very appreciative for Intel support. Intel is always into linking those resources together. So whenever we found there’s an interesting new model or new case, we will be able to get the right resources from Intel, and we can just get the local warranty from the different country, I think it’s very important.

And another thing is we need to also connect with the local partners for us to do the local service, because the different countries, they have the different regulations to have the different reimbursement or insurance and also the different cultures. So we need to have the local partners who help us to adjust our service model to the different country. So once again, Intel is not only providing the technology but also helping us to link those resources together. We also participate several of the Intel RTR projects for the last two, three years. So we win the success cases in Thailand, in Vietnam, in Malaysia, and also in the Middle East. So I will say it will be a very good model that we will create a win-win synergy together with Intel.

Christina Cardoza: Yeah, and I can just imagine, when you’re talking about those new models or new use cases, especially working with a company and partnership like Intel, it’s just being able to get access to the latest technology that’s coming to be able to implement this for your users and continue to improve your solution for the company and the customers that you are serving.

Moji, I’m curious, as evolutions keep happening, what we’re talking about yesterday can completely be different tomorrow. So I’m curious what additional opportunities lie ahead—how do you see us being able to continue to improve and help rural communities and address some of these ongoing healthcare challenges that we face?

Moji Ghodoussi: Absolutely. We have actually been partnering with Intel for a number of years, and we’ve used Intel’s specific hardware like NUC, as part of our offerings. And also, more recently and more significantly, we’re using Intel chipsets as part of our custom-designed and manufactured electronics that are part of our telehealth-device portfolio.

And there’s significant opportunities of course lying ahead in telehealth, and specific to rural communities—further adoption and availability of telehealth in these communities, and enabling and adopting the “whole-person care”—so, versus just episodic care that we have been talking about a little bit. In addition to advances in AI, of course—which will definitely impact healthcare and care diagnostics, and delivery—it can and will have significant impact on healthcare in general, and more so in specific to rural communities. And of course all the advancements in technology are the enablers of what we do and what others do in this space.

Christina Cardoza: Yeah. And, as you mentioned, we’ve been focusing on one very small subset of healthcare—providing telehealth and access to rural areas. But there is still healthcare and all these advancements—it’s still moving and changing, and there’s still so many other things that I think we could talk about in so many different areas that we can take.

Unfortunately we only have a short amount of time on the podcast, and we are nearing the end of our time. So, before we go, I just want to throw it back to each of you all if there’s any key takeaways or anything you’d like to add. So, Leonardo, I’ll start with you. What additional opportunities do you see ahead of us in the next couple of years, and is there anything that you want to leave our listeners with today, as we continue to improve and help with the healthcare in rural communities in the future?

Leonardo Alves de Melo: Well, I think there’s a lot to do. We need to include these populations in the care of everything, particularly in health. The minimum technology makes a lot of difference in our individual care, but it needs to be customized with our expansion integration. With new medical equipment and systems both remote, we will be better able to bring healthcare without physical borders. Today we are bringing technology-enabled, tele-assisted surgery, AI tools to make medical care more efficient. And we are building training tools for remote teams and population, new means of communications and equipment with lower operation and input causes are also important, as are investments in the information technology for hospital and clinics in rural areas.

Christina Cardoza: Yeah, I love that, that thought you have to include the population and everything. It’s not just providing this technology or this solution because we see that there is a problem, but what is the problem that the population or the area is actually facing, and how can we develop customized solutions that work on both ends. So, great, great final thoughts.

Jason, anything from you? Any final thoughts or key takeaways?

Jason Miao: Yeah, I think in the last few years the telehealth is already becoming the reality everywhere. And the next step will be the AI, and it is going to help us to increase the care and the technology. And the next thing we are seeing is the age-care topic. Because in Asia—I think in United States and Western countries—the people are getting older, and we don’t have enough manpower to take care of them. So for our company we are also thinking about the next step, probably will be the age-care issue. So I do think we are using Intel and all the new technology. Including the telecare will definitely can help us to have the better life for our retirement life.

Christina Cardoza: Yeah, absolutely. And I see AI and edge going hand in hand, being able to be able to provide these real-time updates, high performance, low latency with edge, and using the advancements of AI and the capabilities to really provide that extra level of care. Moji, you talked a little bit about AI throughout the conversation, so is there anything you wanted to add there, or anything you want to leave our listeners with today?

Moji Ghodoussi: Absolutely. Telehealth will grow because of the benefits it provides to healthcare, enabling doctors to take care of more patients—especially going out to rural areas that we’ve been discussing as well. But technology keeps advancing, which provides additional tools to the clinicians—from diagnostic aspects, so that it can actually help the doctor before even maybe the doctor shows up as to what they should do for this specific patient specific to that patient’s healthcare and chronic care, etc., in addition to the fact that with advancement in technology—which is where the area of focus for all of us is on this call—is to really enable clinicians to take better care and more care of the patients populations.

I also want to take advantage of this opportunity to thank Intel for their partnership in the last few years and congratulate the vision and goal of enabling platforms and solutions that further advance technology, and therefore telehealth. As telehealth, in my opinion, is the only way that we can have true health equity. I also want to highlight and thank Teladoc Health for its mission and focus on enabling workflow solutions that enable our amazing clinicians to deliver care to their patients regardless of geography. And I would like to also thank you for this opportunity to share my thoughts.

Christina Cardoza: Yeah, of course. And I’d like to thank all of you for the insightful conversation. Like you said, Moji, technology keeps advancing, and I can’t wait to see what else Teladoc Health, DiagNext, and imedtac do in this space. So I encourage all of our listeners to visit their websites, keep up with what they’re doing here, as well as visit insight.tech as we continue to cover these partners and the latest trends and technologies in this space. Until next time, this has been the IoT Chat.

The preceding transcript is provided to ensure accessibility and is intended to accurately capture an informal conversation. The transcript may contain improper uses of trademarked terms and as such should not be used for any other purposes. For more information, please see the Intel^® trademark information.

This transcript was edited by Erin Noble, copy editor