Telemedicine and e-health: what's the hold-up?

Connected objects and the Internet of Things, diagnostic algorithms linked to the rise of Artificial Intelligence (AI), blockchain... In the healthcare sector as elsewhere, new technologies are multiplying, opening up promising prospects for telemedicine and e-health.

Roxana Ologeanu-Taddei, University of Montpellier

This new wave of technology is raising new hopes, yet the advances promised by its predecessor have yet to materialize. Why is this? And how can we get patients and healthcare professionals to embrace these new uses?

Technologies only exist in use

Developed many years ago, clinical information systems such as the computerized patient record (CPR ) or the many specialized telemedicine systems, such as those designed to monitor patients at home (in cardiology, for example), have yet to be put to lasting use. Nor have they led to the emergence of new business models for the companies offering them.

The same applies to the shared medical record (DMP). If the latter was one of the hot news items at the end of 2018, it was above all in terms of the uses offered to healthcare professionals and patients. From a technical point of view, this is a project that has been evolving for over 10 years... How can we explain this slowness? It's all a question of usage.

Technologies exist only in their use: if there is innovation, it comes not so much from the technology itself as from its use. A common misconception in the IT sector is that all you have to do to attract users is "build it and they will come". The reality, however, is quite different.

Today, as in the past, the mistake to be avoided is to focus on the technical innovation potential of new technologies, without seeking to remove the long-identified barriers that were highlighted when older technological advances were introduced. The greatest risk of such an attitude is to lose the users, and in particular the patient.

Limited interoperability

A first barrier, which exists in France and other countries, is the lack of interoperability, i.e. the absence of data sharing between the various existing software packages, based on standards such as ISO. In concrete terms, if a healthcare professional chooses a software package to monitor his or her patients at home, for example, the data entered, stored and processed by this software will not be able to be shared with users of other competing software packages without the development of a specific interface.

However, the software on offer is plethoric and fragmented, not only by specialty, but also by country (in France alone, for example, there are currently over 50 applications for monitoring diabetes). If a patient is monitored by professional A with software X, and by professional Y with another software, and his or her data cannot be shared for overall management, the usefulness of the software is limited...

A return on investment that's hard to assess

A second barrier is simply the cost of such software, at a time when healthcare establishments are facing major budget cuts. What's more, it's difficult to estimate the gains to be made from their acquisition, due to the paradox of IT productivity: since software cannot be equated with production machines, it's difficult to measure the associated returns on investment, despite the promises made by the publishers who promote them.

A recent study identifies a number of factors considered by corporate customers in all sectors to be barriers to achieving returns on investment: exponential maintenance costs; integration of upgrades and new versions; the need for human time for management and maintenance; costs too high for the benefits achieved; complexity of use.

Does this mean that such software and applications are doomed to failure? Not necessarily. Above all, we need to focus less on returns on investment and replace them with new value propositions for the customer. For example, in the healthcare sector, advances in information technology are opening up the prospect of being able to monitor patients at home efficiently and safely, limiting hospital stays.

The importance of data quality

A third barrier is linked to the importance of information and data in the use of such software. To ensure data quality, it is necessary to develop a rigorous information architecture, which will enable information to be classified correctly. It is also necessary to ensure the quality of the data entered or captured (for example, has the information concerning the patient's health history been entered in the right field, within the data entry form, and indexed in the right heading in the database?), which requires databases to be completed and "cleaned" to include missing data, rectify incorrectly entered data or delete redundant data.

This work requires human time, and it's a recurring task. Health establishments and health professionals, who are also overworked, must take it into account.

A final barrier is simply the availability of a reliable, high-performance Internet network throughout the country. Indeed, it is in rural areas and medical deserts that Internet access poses a problem, precisely where these technologies could be most useful...

Technologies little known to patients

Beyond these barriers, we must not forget the main stakeholder: the end-user, i.e. the patient! The results of a recent survey carried out by Carte Blanche Partenaires, the Société française de télémédecine (SFT) and the MRM laboratory at the University of Montpellier, in partnership with France Assos Santé and Formatic Santé, reveal that almost half of those questioned (45% of the 8050 respondents) are not familiar with telemedicine.

The number of people who have tried out teleconsultation or telemonitoring is very low: under 1%, despite the fact that telemedicine involves the use of "old" software and that telemedicine practices have been legally regulated for several years. This lack of awareness seems to be offset by a retreat to a relationship of trust with the family doctor, in the traditional colloque singulier.

Fear of losing touch, and of two-tier medicine

The most frequently cited obstacle to adopting these uses is the risk of losing human contact (61% of respondents), well ahead of the risk of sharing personal data (27.7%). Responses to the open-ended question allowing comments and points of view are revealing. The most frequent occurrence of the word "contact" is linked to the fear of losing human contact, as well as the fear of a poorer quality diagnosis in the absence of auscultation.

The fear of replacing the human with technology, leading to "medicine for the poor", is also expressed by many respondents. However, they say they are ready to experiment with telemedicine, provided this is done with their GP, whom they already know, and in certain specific situations (prescription renewals, interpretation of laboratory tests).

It's also interesting to note that the only very positive comments about telemedicine come from people who have experienced it.

Information to build trust

This finding is reminiscent of the work of sociologist Anthony Giddens, for whom the concept of trust is key to understanding technology-related changes in contemporary societies. Social scientists have shown that people's lack of confidence in technology is due to a lack of information, or a lack of understanding of that information.

This is all the more true for the new technologies presented at the start of this article: they place the patient at the heart of some of the most innovative business models. This is particularly true of the My Health My Data projects in Europe and Hu-manity in the USA, which promote secure management by patients of their own health data, thanks to blockchain.

In such a context, a great deal of information work needs to be done to explain to patients not only how telemedicine works, but also the benefits that health information technologies can bring them, while reassuring them that their data will be managed transparently.

Roxana Ologeanu-Taddei, Senior Lecturer in Management Science at Polytech Montpellier, University of Montpellier

This article is republished from The Conversation under a Creative Commons license. Read theoriginal article.