Telemedicine: the challenges and opportunities

Telemedicine is an emerging industry which many health professionals say is changing – and will continue to change – the way we access healthcare in decades to come. Such technological advances present a range of opportunities and challenges to the present and future practice of eye care.

Telemedicine is defined as the remote diagnosis and treatment of a patient using telecoms technology. The very first telemedicine project was funded by NASA in the 1970s, facilitated using voice, video and data communications.

Though deemed unsuccessful, this early project sowed the seeds for modern day telemedicine, now advancing due to the accessibility of powerful computers, tablets and smartphones. It is estimated that the US telemedicine industry will attract 7 million patients by 2018 as more and more healthcare providers find ways to help patients access care.

What types of telemedicine are on offer?

  • Consultations. Subscription-based healthcare apps like Babylon and DoctoronDemand offer GP appointments by video. In these consultations, the ‘online doctor’ can usually offer medical advice, authorise prescriptions or arrange a referral.
  • Testing. Simple tests can be undertaken by patients on their smartphone, for example, to test their hearing or eyesight. Currently, these health apps offer basic testing online – a simplified version of a sight test or basic testing for early signs of AMD. If the results are of concern the app will usually recommend that the patient sees a professional.
  • Monitoring apps offer peace of mind and convenience for those managing long-term conditions, and also for medical professionals tracking the progress of a patient. One example is the app Diabetik, which helps those with diabetes log and monitor their insulin levels, medication and diet. The app then uses this data to help people manage their condition and predict triggers for blood sugar spikes and drops.
  • Information. We are often warned of the dangers of googling our symptoms but despite that, there are a number of apps that offer medical advice in an easy-to-digest format. There are apps like which offer users an easy way to look up drug information – offering guidance on dosages and side effects.

The opportunities for telemedicine

The key advantage of telemedicine is the convenience it offers to the patient. A GP appointment can be accessed without the need for time off work or extra travel.

This accessibility can also be an advantage in rural areas or developing countries. A clinician may just need a handful of apps to diagnose and treat patients in remote areas, providing a basic diagnosis without the need for lots of equipment.

The Peek app and adaptor is one such example of a portable examination kit that is improving healthcare. The Peek app combines with a clip-on camera which allows health workers to see inside the eye and capture images for diagnosis. Conditions like cataracts, diabetes and high blood pressure can be diagnosed on site, or sent to be examined by an eye health professional.

This kind of technology can have a huge social impact, rapidly improving access to healthcare with relatively little investment.

Video appointments and testing apps also facilitate affordable and timely healthcare at a time when many clinicians are struggling with overbooked schedules. Patients are able to access appointments at a time convenient to them, and clinicians may be able to see patients more quickly.

Improved engagement with healthcare services is also the advantage of telemedicine. It is estimated 200 million Americans require an eye test, yet only 106 million eye tests are conducted each year. A testing app would be an excellent way to engage patients in eye health alongside improving awareness of conditions like age-related macular degeneration (AMD) or glaucoma.

The challenges for telemedicine

Telemedicine is a very promising area of healthcare, but it needs to be managed well in order to be safe and useful for patients and healthcare providers.

The best way to view telemedicine is a way of bridging a gap or encouraging engagement with medical professionals rather than providing a replacement for traditional healthcare.

Regulatory challenges are one of the major obstacles for telemedicine. The challenge is not just to develop a product that works but in having it approved for use by medical and governmental bodies.  There are many regulations and licensing concerns to overcome, and they need to be tackled on a country-by-country basis – or, in places like the USA, on a state-by-state basis.

Security of data is also a concern for telemedicine, the sharing of and use of sensitive medical data needs to be tightly controlled for patient confidentiality. Vulnerabilities are created because smartphone apps often use cloud-based storage. When transferring data there is a risk that hackers could gain unauthorised access, where they may plant malware or distribute data to other parties.

A study in the AMA Journal of Ethics reports that privacy and security risks may also affect people’s trust in telemedicine, in order for the industry to grow it needs data regulation. Currently, medical products are approved based on safety and efficacy, without much emphasis on privacy or security. Bodies like the FDA may need to introduce new standards in the future to protect patient data used in apps and stored on cloud-based servers.

These regulatory and security challenges obviously have an economic implication for a healthcare app developer, which is what could stall the wider use of telemedicine.

What’s next for telemedicine?

Despite regulatory concerns, it is estimated that the telemedicine market will be worth $36.2 billion by 2020, from $14.3 billion in 2014.

The industry has grown fast and will continue; the DoctoronDemand app already has 1,400 licensed physicians on its books in 50 U.S states with an average consultation fee of $40. Such uptake shows a positive attitude within the healthcare community with indications that adoption will continue to grow. A survey conducted by Jackson Healthcare in 2016 showed that 57% of primary care physicians in the US are open to holding appointments via video.

The NHS in the UK is also investing in telemedicine – it launched an early version of their NHS Digital Apps Library this month. The library is still in beta but the NHS hopes to expand access in the future, offering patients health data, self-assessment apps and test apps. The NHS scheme won’t offer personal consultations but is placed to offer patients a way to manage and improve their health on an ongoing basis.

Telemedicine will definitely not replace traditional healthcare but it will help to engage people in managing their health and improve efficiencies in primary care. This may lead to earlier diagnosis for many common conditions, which could prove to be beneficial for the eye care sector too.

Conditions like AMD and glaucoma need to be detected early if treatment is to be effective. The more flexibly and efficiently patients are able to engage with healthcare services, the more effectively key risk factors can be managed and the more likely it is that the threat of serious vision loss can be reduced in future.