We are now moving to the second half of our series on healthcare. In the first four articles we provided an overview of the significance of technology in healthcare and how the partnership between technology and healthcare is evolving rapidly and fundamentally altering the nature of healthcare and the manner of its delivery. We suggested that Thailand needs to ensure that it keeps pace with these changes or it will run the risk of being left behind.
In this article we will focus more closely on telemedicine and consider some of the related issues that arise. The word "telemedicine" itself requires some explanation, as definitions vary from country to country. In some cases it is also known as "e-health" or "telehealth".
Differences notwithstanding, there are common underlying concepts. They are the delivery of healthcare services at a distance (that is, where the provider and the patient are not in close physical proximity to one another) and the use of information and communication technologies to do so. One definition is "the systematic provision of healthcare services over physically separate environments via information and communications technology".
Telemedicine has become increasingly important and more in demand because of many factors including:
A shortage of healthcare professionals, whether it be due to a real lack of numbers or the concentration of professionals in major cities.
Heightened consumer/patient expectations arising from innovations in technology.
Greater consumer/patient demand driven by lifestyle choices and limitations, including traffic congestion.
Increased availability of cross-border medical services.
Changing demographics and unequal standards of healthcare in different locations.
Telemedicine clearly has the potential to help address and overcome gaps and deficiencies in existing healthcare systems, especially by making specialist services more readily available to those in remote rural areas. Technology can be applied to help overcome the many challenges facing the healthcare industry in general. Its potential cannot be ignored.
However, in many jurisdictions legal and ethical issues surrounding telemedicine remain unclear and/or unresolved, and in some instances controversial. There can be resistance to the successful adoption of telemedicine at both the provider and patient levels. Further complications can arise in the context of the cross-border provision of services. To help resolve some of these issues, certain jurisdictions have issued comprehensive guidelines, the National Telemedicine Guidelines of Singapore being a good example.
Under the Singapore guidelines, healthcare professionals providing services by telemedicine remain fully responsible for meeting all legal and ethical requirements and must exercise due diligence when delivering these services remotely. However, in other jurisdictions healthcare professionals resist assuming a duty of care in the case of telemedicine. For example, the Medical Council of Thailand has expressed the view that a duty of care should be established only when there is an actual physical meeting between doctor and patient.
On occasion there may also be resistance from patients and potential patients. Some may not like the idea of receiving medical advice or treatment other than in a face-to-face meeting with a doctor, irrespective of considerations of access and convenience. It also appears that consumer attitudes to telemedicine may vary significantly in different countries. For example, in one US study it was reported that 70% of patients were comfortable communicating with their healthcare providers via text, email or video rather than seeing them in person.
Maybe there is a need for Thailand to follow Singapore's example and give serious consideration to developing our own set of guidelines. Perhaps these guidelines could make it easier for both healthcare providers and patients to understand and accept the delivery of healthcare services through telemedicine and alleviate any concerns. After all, none of us can hide from advances in technology. Perhaps the time has come to fully embrace telemedicine and its benefits in Thailand.
If this is to be done effectively it is important to understand telemedicine is complex and diverse and applies in a number of different situations and environments. The Singapore guidelines identify four of them, as follows:
Tele-treatment: (at-a-distance interaction between a healthcare professional and a patient with direct clinical diagnosis, treatment and care).
Tele-collaboration: (at-a-distance collaboration between healthcare professionals at both ends of the communication, such as specialty consultations).
Tele-monitoring: (at-a-distance data collection from patients for monitoring and remote disease management).
Tele-support: (use of online services for non-clinical support, such as health education).
Responsibilities and standards of care may need to vary depending on which of the four categories is involved. There should be no simple or "one size fits all" approach.
In our next article we will examine some of the implications of telemedicine, including those in cross-border contexts and for healthcare professionals and facilities providing telemedicine services.
Peerapan Tungsuwan is a partner and head of the healthcare industry group at Baker McKenzie in Bangkok.