Telemedicine, e-health: Why Are There Obstacles?
Connected devices and the Internet of Things, diagnostic algorithms linked to the rise of artificial intelligence (AI), blockchain…In the healthcare sector, as in other fields, new technologies are proliferating, opening up promising prospects for telemedicine and e-health.
Roxana Ologeanu-Taddei, University of Montpellier
This new wave of technology is sparking new hopes, yet the advances promised by the previous one are still struggling to materialize. How can we explain these roadblocks? And how can we encourage patients and healthcare professionals to adopt these new practices?
Technologies exist only in their use
Clinical information systems—such as electronic health records and the many specialized telemedicine systems, including those designed to monitor patients at home (in cardiology, for example)—have been in development for many years but have not yet led to sustainable practices. Nor have they enabled the emergence of new business models for the companies that offer them.
The same is true for the Shared Medical Record (DMP). While the DMP was one of the hot topics at the end of 2018, this was primarily due to the ways it could be used by healthcare professionals and patients. From a technical standpoint, however, this is a project that has been in development for over 10 years… How can we explain this slow progress? It all comes down to usage, precisely.
Technology only exists in its application: if there is innovation, it stems not so much from the technology itself as from its use. A common misconception, well known in the information technology sector, is the belief that simply building a technology is enough to attract users (“build it and they will come”). However, the reality is quite different.
Today, just as in the past, the mistake to avoid is focusing on the potential for technical innovation offered by new technologies without seeking to remove the long-standing barriers that were highlighted when earlier technological advances were introduced. The greatest risk posed by this approach is losing users—and, in particular, patients.
Limited interoperability
One major barrier, which exists in France and other countries, is the lack of interoperability—that is, the inability to share data between different existing software systems based on standards such as ISO standards. In practical terms, if a healthcare professional chooses a software program to monitor patients at home, for example, the data entered, stored, and processed by that software cannot be shared with users of other competing software programs without developing a specific interface.
However, the software market is vast and fragmented, not only by specialty but also by country (in France alone, for example, there are currently more than 50 apps for diabetes management). This situation obviously hinders the widespread adoption of these software solutions: if a patient is monitored by healthcare provider A using software X and by healthcare provider Y using a different software, and the patient’s data cannot be shared to support their comprehensive care, the software’s usefulness is limited…
A return on investment that is difficult to assess
A second barrier is simply related to the cost of this software, at a time when healthcare institutions are facing significant budget cuts. Furthermore, the benefits of acquiring such software are difficult to estimate due to the paradox of information technology productivity: since software cannot be equated with production machinery, it is difficult to measure the associated return on investment, despite the promises made by the software vendors promoting it.
A recent study identifies several factors that corporate clients across all sectors view as barriers to achieving a return on investment: exponential maintenance costs; the integration of updates and new versions; the amount of staff time required for management and maintenance; costs that are too high relative to the benefits realized; and complexity of use.
Does this mean that these software programs and apps are doomed to fail? Not necessarily. Above all, we need to focus less on return on investment and instead focus on new value propositions for the customer. For example, in the healthcare sector, advances in information technology are opening up the possibility of effectively and securely monitoring patients at home, thereby reducing the need for hospital stays.
The Importance of Data Quality
A third barrier relates to the importance of information and data in the use of this software. To ensure data quality, it is necessary to develop a rigorous information architecture that will allow information to be classified correctly. It is also necessary to ensure the quality of the data entered or captured (for example, was information regarding the patient’s medical history entered in the appropriate field on the data entry form and indexed under the correct category in the database?), which requires supplementing and “cleaning” the databases to include missing data, correct data that was entered incorrectly, or delete redundant data.
This work requires staff time, and it is a recurring task. Healthcare facilities and healthcare professionals—who are already overworked—must take this into account.
Finally, one last barrier is simply related to the availability of a reliable, high-performance Internet network throughout the country. Indeed, it is in rural areas and medically underserved regions that Internet access poses a problem—precisely where these technologies could be most useful…
Technologies that patients are largely unfamiliar with
Beyond these barriers, we must not forget the person most affected: the end user—namely, the patient! However, the results of a recent survey conducted by Carte Blanche Partenaires, the French Society of Telemedicine (SFT), and the MRM Laboratory at the University of Montpellier—in partnership with France Assos Santé and Formatic Santé—reveal that nearly half of those surveyed (45% of the 8,050 respondents) are unfamiliar with telemedicine.
The percentage of people who have experienced teleconsultation or telemonitoring is very low—less than 1%—even though telemedicine involves the use of “older” software and telemedicine practices have been legally regulated for several years. This lack of awareness seems to be offset by a return to the relationship of trust with the family doctor, in the traditional one-on-one consultation.
The fear of losing contact, and of a two-tiered healthcare system
The most frequently cited barrier to adopting these practices is the risk of losing human contact (61% of respondents), far ahead of the risk of sharing personal data (27.7%). The responses to the open-ended question, which allowed for comments and opinions, are revealing. The most frequently mentioned term is “contact,” reflecting both the fear of losing human contact and the fear of a lower-quality diagnosis in the absence of a physical examination.
Many respondents also expressed concern that replacing humans with technology could lead to “medicine for the poor.” However, they said they were willing to try telemedicine, provided it was done with their primary care physician—whom they already know—and in certain specific situations (prescription renewals, interpretation of lab tests).
I also think it's worth noting that the only very positive comments about telemedicine come from people who have tried it.
Inform, 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 individuals’ lack of trust in technology stems from a lack of information or a lack of understanding of that information.
This is especially true of the new technologies mentioned at the beginning of this article: these technologies place the patient at the center of some of the most innovative business models. This is particularly the case with the My Health My Data initiative in Europe and the Hu-manity project in the United States, which promote secure, patient-led management of their own health data through blockchain technology.
In this context, significant efforts must be made to educate patients not only about how telemedicine works, but also about the benefits that health information technologies can offer them, while reassuring them about the transparency of their data management.
Roxana Ologeanu-Taddei, Associate Professor with the authority to supervise research in Management Sciences at Polytech Montpellier, University of Montpellier
This article is republished from The Conversation under a Creative Commons license. Readthe original article.