Telemedicine, e-health: why is it struggling?
Connected devices 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 the previous wave are still struggling to materialize. How can these obstacles be explained? And how can patients and healthcare professionals be encouraged to adopt these new practices?
Technologies only exist in use
Developed over many years, clinical information systems such as electronic patient records and numerous specialized telemedicine systems, such as those designed to monitor patients at home (in cardiology, for example), have not yet led to sustainable uses. Nor have they enabled the emergence of new business models for the companies that offer them.
The same applies to shared medical records (DMP). While this was one of the hot topics at the end of 2018, it was primarily in terms of the uses proposed for healthcare professionals and patients. From a technical standpoint, this project has been in development for over 10 years... How can this slow progress be explained? It's all about usage, really.
Technologies only exist in use: if there is innovation, it does not come so much from the technology itself as from its use. A common mistake, well known in the information technology sector, is to think that it is enough to build a technology to attract users ("build it and they will come"). However, the reality is very different.
Today, as in the past, the mistake to avoid is focusing on the technical innovation potential of new technologies without seeking to remove long-identified barriers that were highlighted when older technological advances were introduced. The most significant risk posed by this attitude is losing users, particularly patients.
Limited interoperability
One initial barrier, which exists in France and other countries, is the lack of interoperability, i.e., the inability to share data between different existing software programs based on standards such as ISO standards. In practical terms, if a healthcare professional chooses a software program for monitoring their 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 range of software available is vast and fragmented, not only by specialty, but also by country (in France alone, for example, there are currently more than 50 applications for diabetes monitoring). This situation is obviously a barrier to the development of the use of this software: if the patient is monitored by professional A using software X and by professional Y using other software, and the data concerning the patient cannot be shared for their overall care, the 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 gains to be made from purchasing 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 publishers who promote it.
A recent study identifies several factors considered by client companies across all sectors as barriers to achieving returns on investment: exponential maintenance costs; integration of upgrades and new versions; the human time required for management and maintenance; costs that are too high in relation to the benefits realized; and complexity of use.
Does this mean that these software programs and applications are doomed to failure? Not necessarily. Above all, we need to focus less on return on investment and replace it with new value propositions for the customer. For example, in the healthcare sector, advances in information technology are opening up the possibility of monitoring patients at home in an efficient and secure manner, thereby reducing hospital stays.
The importance of data quality
A third barrier relates to the importance of information and data in the use of this software. In order to ensure data quality, it is necessary to develop a rigorous information architecture that will enable information to be classified correctly. It is also necessary to ensure the quality of the data entered or captured (for example, has information about the patient's medical history been entered in the appropriate field on the entry form and indexed in the correct section of the database?), which requires completing and "cleaning" the databases to include missing data, correcting data that has been entered incorrectly, or deleting redundant data.
This work requires human 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 linked to the availability of a reliable, high-performance Internet network across the entire country. It is in rural areas and medical deserts that Internet access poses a problem, precisely where these technologies could be most useful...
Technologies that patients are unfamiliar with
Beyond these barriers, it is important not to forget the main stakeholder: the end user, namely the patient! However, the results of a recent survey conducted by Carte Blanche Partenaires, the French Telemedicine Society (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 surveyed (45% of the 8,050 respondents) are unfamiliar with telemedicine.
The percentage of people who have tried teleconsultation or telemonitoring is very low: less than 1%, even though telemedicine involves the use of "old" software and telemedicine practices have been legally regulated for several years. This lack of awareness seems to be compensated for by a reliance on the relationship of trust with the family doctor, in the traditional one-on-one consultation.
The fear of losing contact, and a two-tier healthcare system
The most frequently cited obstacle to adopting these practices is the risk of losing human contact (61% of respondents), well ahead of the risk of sharing personal data (27.7%). The responses to the open-ended question allowing for comments and opinions are revealing. The most frequent occurrence concerns the word "contact," linked to the fear of losing human contact and the fear of a lower quality diagnosis in the absence of auscultation.
Many respondents also expressed concern that technology would replace humans, resulting in "medicine for the poor." However, they said they were willing to try telemedicine, provided that it was done with their regular doctor, whom they already knew, and in certain specific situations (prescription renewals, interpretation of lab tests).
I also find it interesting to note that the only very positive comments about telemedicine come from people who have tried it.
Inform to build trust
This result 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 science authors have shown that individuals' lack of trust in technology is due to a lack of information or a lack of understanding of that information.
This observation is particularly true for the new technologies presented at the beginning of this article, which place patients at the heart of highly innovative business models. This is notably the case for the My Health My Data project in Europe and the Hu-manity project in the United States, which promote the secure management of patients' own health data using blockchain technology.
In this context, significant work must be done to inform patients not only about how telemedicine works, but also about the benefits that health information technologies can bring them, while reassuring them about the transparency of their data management.
Roxana Ologeanu-Taddei, Associate Professor authorized 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.