Goal of this paper

Tele-Medicine (Tele-Med) also called Tele-Health, needs a formulation of a vision and workplan.

This document tries to reflect on the issues, and make some suggestions.

 

Introduction

And then there was Corona / COVID-19: improvisations like ‘eHealth over Skype’ (or WhatsApp, Zoom, or . . . ) may have served in the emergency situation with people subject to lockdown or other restrictive measures, but cannot be considered a longer-term solution, if already a solution in the first place.

 

Instead, the COVID-19 pandemic has demonstrated the need for real Tele-Med:

  • The inability of patients, medical personnel and caregivers to meet physically under lock-down
  • To protect patients and medical personnel and caregivers against the risks of infecting each other
  • To keep ‘light’ and non-COVID-19 patients away from overloaded hospitals and contamination risks
  • To avoid unnecessary consumption of Personal Protective Equipment (PPE), that may be scarce

 

In addition, there are well-known advantages of  Tele-Med:

  • Faster response and more frequent consultations, contributing to a higher quality of treatment
  • Reduced costs for society (although Tele-Med itself may be adding costs rather than save on costs)

 

However, the increased costs for the health sector itself have been for long a factor that has weighted negatively on the development and wide-scale application of Tele-Med. Furthermore, industry has not enough aimed for standardization of equipment for use in Tele-Med.

Tele-Med has been developing in areas with low population density and hence transport complications, such as distances and adverse weather conditions, e.g. Norway, Sweden, Scotland, etc.

The COVID-19 pandemic has, however, shown more generally to local authorities and ‘smart cities’ the need to develop Tele-Med solutions for daily use, and not only for epidemic / pandemic, natural and not so natural disaster situations, and transport complications.

 

 What is required

As a minimum, what is needed is an application

  • providing extended video conferencing and imaging capabilities and
  • giving access to local equipment at the side of the user /patient (hereafter User), and
  • giving sufficient access and control to the health care provider (hereafter Provider)

 

In more detail:

  • A federating application providing Communication and Remote Access to Devices (CRAD-APP),
    • With secure access to the patient health record (EHR), and
    • Controlling a secure person-to-person text, voice and video link, that could be based on a suitable commercial video conferencing system
    • With access and control for general purpose User side equipment such as
      •  A movable high-resolution camera system with auto-focus and integrated light source
      •  ECG recording device with memory
      •  Recording blood pressure meter with memory
      •  Recording SPO2 meter with memory
      •  Recording temperature meter with memory
      •  Recording scales with memory
      •  Recording activity tracker with memory
      •  Etc.
      • With access and control for equipment for specific conditions such as
        •  Recording insulin measurement device with memory
        •  Etc.

Note: typically, such equipment includes dedicated software applications for e.g. smartphone, PC, etc. that provides recording and memory functions with local or cloud storage.

 

What could be done

Here are some suggestions as a starting point.

 

Possible approaches

A.   A complete new set of equipment built to new widely accepted standards

B.   One or more sets of standards for harmonizing equipment on the market; this would allow equipment on the market to be used also without their dedicated software application

C.   A set of standards for adapting to and using tools and equipment on the market; this would allow sets of equipment from different leading suppliers to be used and combined

In more detail:

Ad A.  A complete new set of equipment built to new widely accepted standards. This represents a ‘clean-sheet’ approach, that would require convincing the market leaders in different equipment classes to join such an effort

Ad B. One or more sets of standards for harmonizing equipment on the market: this would allow equipment on the market to be used also without their dedicated software application, which would have to be absorbed into the CRAD-APP, making individual use of devices potentially more complicated.

Ad C. A set of standards for adapting to and using tools and equipment on the market: this would allow sets of equipment from different leading suppliers, organized in suits,  to be used with their dedicated software, and use and combine them under a CRAD-APP making extensive use of features in the suites of these leading suppliers. It would be beneficial for such an approach if a common set of standards could be agreed for access to the functions available in each suit.