Telemedicine goes viral

Digital health innovation in the time of COVID-19.

Large economies have slipped into a downturn, workplaces are shut, and once busy streets are now eerily empty. The novel coronavirus, SARS-CoV-2, if anything, has changed overnight the way we communicate, work and live.

In a time when hospitals are overwhelmed with patients, and visiting a clinic presents a genuine health risk in itself, people are turning towards an alternative that allows them to visit a doctor or renew their prescriptions from the safety of their homes—digital health.

“The beating of the digital drum has been going on for a long time, but only recently are we seeing major uplifts in its potential for healthcare,” says Assoc Prof Josip Car, Founding Director of the Centre for Population Health Sciences at NTU’s Lee Kong Chian School of Medicine (LKCMedicine).

“Not only does digitalisation give us the reach, but the insights and interactivity it provides are equally important, especially in a time like this.”

Shaping digital health research

While COVID-19 has indeed changed the way we access healthcare services, it is not possible to re-wire the behaviour of an entire population overnight. Therefore, it is timely that a centre exists for research and education on the use of digital tools for health. “Digital technology will shape our public health for the better—in fact, it already has,” says Assoc Prof Car.

Designated as a World Health Organisation (WHO) Collaborating Centre for Digital Health and Health Education, the Centre for Population Health Sciences aims to shape the transformative impact of digital tools in healthcare.

One area that the Centre works on is how digital health can be used to alleviate the impending global shortage of healthcare professionals, which the WHO estimates to reach 18 million by 2030. Digital technology in the form of telemedicine, like teleconsultations or online pharmacies, offer an alternative venue for the public to receive medical aid and advice.

Telemedicine conducted on mobile devices—one of the many applied technologies of the mobile health (or mHealth) movement—has been particularly useful during the COVID-19 pandemic. For instance, contact tracing applications like TraceTogether, which was developed by the Government Technology Agency of Singapore, use Bluetooth Low Energy signals to log contacts with other users in close proximity.

“From patient education to public health services and now even disease management, we turn to these digital tools as a means towards or even as health solutions in and of themselves,” Assoc Prof Car says. But for digital health technologies to be implemented on a wider scale, more innovation, research and evidence will be required to win the support of health policymakers and regulators, he notes. This is where researchers like his CePHaS team come in.

A dose of digital medicine

As a practising family physician, one of the key areas in digital health that Assoc Prof Car works on is teleconsultation. Specifically, he aims to help physicians navigate their medical practice using digital tools.

“In many countries, consultations in both primary and specialist care are switching to a policy of video consultation first and physical consultation second,” he says. “Therefore, we should look into equipping both physicians and patients with the skills to navigate this digital health terrain and building up evidence for using these tools.”

For example, Assoc Prof Car says that most younger patients with COVID-19 can be managed remotely with self-isolation, remote monitoring and advice on how to manage their symptoms. He advises physicians to opt for video consultations instead of phone calls for patients where both the patient and the doctor have ready access to the technology, as visual cues can provide valuable diagnostic information.

Beyond teleconsultation, Assoc Prof Car and his team are also working on creating digital tools to manage chronic diseases such as diabetes. In particular, they are developing a mobile application that will enable people with Type II diabetes and their carers to better manage the disease at home, using an automated computer dialogue system.

“Our work can augment the current model of care for many patients, empowering them to be more proactive and informed about their condition,” Assoc Prof Car explains. “We hope this can reduce their reliance on hospitals and potentially lower their healthcare costs as well.” As digital health becomes the new norm, it will help to relieve the manpower burden on public health systems everywhere, especially during a crisis like COVID-19.

Catalysing change in public health

Beyond convincing regulators and healthcare professionals to embrace digital health, issues such as insurance and medicolegal matters will also need to be addressed. “There is still much more to be done, but with the current pandemic, I foresee that the introduction of digital technologies will speed up from years to months or even weeks,” Assoc Prof Car says. “It is a special time for digital health that must be seized.”

While it may still be too early to draw any conclusions from the ongoing crisis, the novel coronavirus will undoubtedly bring about changes in public health policies. “The COVID-19 situation, if anything, has taught us that communication via digital technologies, such as video consultations and remote monitoring, can play a critical role in protecting health, reducing the risk of infection, and supporting chronic disease management at a much broader scale than most ever imagined,” says Assoc Prof Car. “True, these interactions will never be the same as face-to-face meetings with a human touch, but digital health is proving critical in fighting the pandemic and keeping patients, nurses and doctors well,” he adds.

The article appeared first in NTU’s research & innovation magazine Pushing Frontiers (issue #17, August 2020).