While telemedicine is being used throughout the world to fight the coronavirus pandemic, Thailand's telemedicine infrastructure lags behind with a lack of government guidelines and limited availability.
Consumer-facing telemedicine, whereby a doctor can have a video call with patients and diagnose minor ailments, is a powerful tool for fighting the virus simply because it prevents patients from going to a hospital.
Hospital visits pose a risk to both patients and caregivers, as a patient has the chance to either give the virus to a medical professional or contract it while seeking treatment. Thailand's medical system is particularly vulnerable because hospitals remain the primary place of care for everything big and small, as opposed to a network of smaller clinics.
According to Peerapan Tungsuwan, a partner at Baker McKenzie specialising in the healthcare industry, Thailand's Medical Council is in the process of rolling out guidelines for telemedicine.
"This is quite a nice commitment for us to see, but there are no guidelines to do medical treatment from a distance," she said. "You can still communicate through a webcam to get basic household medicines or get advice such as drink lots of water for minor ailments. We need patients to start doing this to free up time for doctors who are quite busy right now."
But the commitment may be too little, too late to respond to the coronavirus crisis.
While telemedicine can be practised in Thailand, doctors are only legally liable for medical treatment they perform in person, leaving some telemedicine operators legally exposed.
"The outbreak is an unfortunate event, but it validates the view that we need to put the telemedicine programme in place," Ms Peerapan said. "We lack the infrastructure and a law to allow people to do certain things via telemedicine without carrying legal exposure."
TOO LITTLE, TOO LATE?
Doctor Raksa, the largest telemedicine platform in Thailand, has seen the number of video consultations nearly double since the start of the virus and deliveries from its online pharmacy grow five times. But it has yet to attract much interest from the Public Health Ministry to scale its platform nationwide.
"The infrastructure is insufficient for telemedicine in Thailand right now," said Jaren Siew, chief executive of Doctor Raksa. "There is only one scalable player in town, and that is us."
Doctor Raksa has had 400,000 users since its launch last year. Mr Siew said the app could scale up -- it's hosted on Amazon Web Services, an easily scalable cloud storage platform -- but it would require funding and participation from more hospitals, public and private.
He said some hospitals are using the Line app or telephone calls to engage with patients without them coming to the hospital. But this is an imperfect solution because it doesn't link with medical records or payments.
"We would be happy to work with the government, but they have not reached out directly," Mr Siew said.
He said the company is working with the Disease Control Department at the Public Health Ministry but has not been contacted by anyone high up in the ministry interested in pushing telemedicine on a national scale.
While the government has participated in multiple telemedicine pilots, like one last year between the Public Health Ministry and the National Broadcasting and Telecommunications Commission, the concept has yet to draw significant traction necessary to be used as an effective tool to contain the spread of coronavirus.
PILOTS IN PROGRESS
Borderless Healthcare Group (BHG), a China-based healthcare company, has begun its own telemedicine programme in the Deep South, connecting 10,000 homes to a satellite clinic through a telemedicine app for a three-month pilot.
"In Thailand, which is very hospital-centric, they do not have a lot of clinics or primary health care general practitioners outside the hospital system," said Dr Wei Siang Yu, founder and executive chairman of BHG. "When everyone goes to the hospital, the doctors have a high risk of being infected and the whole hospital could break down, with no alternative location for receiving treatment."
He said telemedicine could provide a vital barrier to a system on the brink of being slammed by coronavirus patients, allowing people to find treatment and preventing contact with medical professionals.
While the shutdowns resulting from the pandemic have affected various parts of BHG's business, grinding to a halt medical tourism and in vitro fertilisation services, the company is shifting to telemedicine.
"In certain parts of Thailand the local governments are very interested in creating high-tech satellite clinics that can enable different rural or suburban areas to go to this first line of primary health care screening," Dr Wei said. "Eventually the hospitals will be able to remotely deploy their specialists to homes and satellite centres without having a potential breakdown of the system."
After the pilot, Dr Wei hopes the programme can expand nationwide to take some of the burden off the hospital system. But like so much of Thailand's telemedicine potential, it may come too late to alleviate the worst outcomes of the virus.
