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eVisits: the 21st century housecall


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Outside the health care field, the most obvious beneficiaries are the technology and telecommunications industries. As the market grows, they will see growing demand for data volumes, quality of service data, high speed broadband and machine‑to‑machine connectivity, on wireline and wireless networks. Device manufacturers are likely to benefit, and as mHealth (mobile health) accelerates in 2014 and beyond, there are likely to be new growth opportunities for devices, peripherals, and apps. One report that discusses the 66 percent CAGR in data growth between 2012‑2017 identifies ‘medical applications’ as one of the key drivers of this traffic increase.

Public and private organizations should continue the push to reform policies that disallow payment to providers offering eVisits. Such payment reform has already begun in areas with mature telemedicine programs. Ontario, Canada recently added a public insurance payment code for physicians to bill for “eConsults” and the Australian and French government health ministries changed funding rules to actively support and promote eVisits. From a private‑sector perspective, US payers are showing interest in eVisit programs, particularly with the number of insured Americans increasing exponentially under health reforms. However, at the moment only 18 US states have passed laws that require or will require private payers to reimburse for telemedicine visits.

Educational, research‑based, and non‑governmental organizations have the ability to accelerate eVisit adoption by supporting pilot studies and conducting comprehensive evaluations. North America’s organizations dedicated to the advancement of telemedicine – Ontario Telemedicine Network and the American Telemedicine Association – will likely need to play a key role in publicizing eVisit potential using these avenues.

Governments with successful eVisit solutions will be in a position to share their insights about impacts, effective incentive structures and ways to combat legal and technical barriers to adoption. Denmark has offered eVisit services for years and is piloting several new variations, such as tele‑psychiatry. These pilots will undergo large‑scale testing in an effort to produce proven, established solutions that others can draw on to help justify their own eVisit services.

Physicians, hospitals and other healthcare providers should consider which investments they need to make in patient portals, electronic medical records, and security and privacy systems to benefit from all the efficiencies and improvements in patient care that eVisits promise to deliver. Technology providers should likewise model the burgeoning telemedicine ecosystem that eVisits are likely to accelerate, and then determine how and where their companies should participate in a future where patients themselves are part of the healthcare management solution, leveraging sensors, devices and communications systems to monitor treatments and health status.

Regardless of the institution implementing eVisit services, human resource training, familiarization with computer use and telemedicine, and overall organizational readiness are imperative to success. Support from governments and other partners (such as employers, who will benefit from reduced absenteeism for doctor visits) should include recommendations, public education on the benefits of eVisits, policy changes and financial allocations for implementation.

One critical step will be to communicate the many benefits of eVisits for physicians. Media coverage tends to focus on the benefits for patients and insurers/payers; however, for eVisits to take root, physicians will need to invest in improving their technology infrastructure and staff up for a potential flood of new online interactions. Although some physicians may view eVisits as impersonal and lacking in human interaction, others will see them as an opportunity to spend more time on more serious and complex cases, while improving quality and efficiency for simpler cases. Also, as long as liability for virtual diagnoses is handled properly, physicians will likely enjoy many other features of eVisits, including: the ability to share clinical data and information virtually with colleagues, the ability to help more patients in less time and across greater distances, and the potential for more flexible work arrangements.

Middle East perspective

Although the potential benefits of eVisits present an attractive proposition to all, their adoption in the region, unlike in North America and Europe, will be more gradual.

The region has been known to be a relatively late adopter of medical equipment and technology compared to its Western counterparts and will also need time to fully develop the technical information infrastructure required for the wider proliferation of eVisits to take hold. This is especially the case with large scale national eHealth programs, where in Saudi Arabia implementation is planned over a ten-year period.

Cultural factors also play a role, with the general concept of eVisits still new to the Arab patient. Healthcare after all is a very private and personal issue, and though eVisits are proven and adopted in the Western world, Arab patients will need more time to develop their trust in it.

Lack of local regulation in eHealth, including data protection and cyber security are also key issues which need to be addressed at the governmental and ministerial level. Frameworks for the security of information systems, confidentiality of patient data, technical data security programs and legal safeguards to protect information being shared and accessed must be developed and put in place. If not addressed adequately, patients may never gain confidence in eHealth and therefore eVisit solutions as a fair and proper alternative to in-person doctor visits, limiting their potential uptake. Health ministries in the region should work with their Western counterparts such as those in Canada and Denmark, in which the market for eHealth and eVisits is more advanced and mature.

Local expertise is also lacking in the areas of healthcare, ICT, project management and business, and with the transient turnover of expats, talent is often temporary. The right talent and experience needs to be brought into the region to oversee and implement new eHealth initiatives, but investment in the national population’s relevant skills to enable them to use the upgraded eHealth systems should not be left behind.

In the meantime, mHealth will emerge as a more disruptive force in the healthcare system over the next few years, in terms of enhanced patient record keeping and monitoring rather than for eVisits.

As eVisits emerge as a new phenomenon around the world, the Middle East will be watching, as Arab patients may also one day seek treatment from the comfort of their homes.

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