Bangkok Post - - COMPANIES -

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.

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