Project Update

I have narrowed/widened my project focus to how telemedicine can reduce the costs of healthcare and create an overall healthier population. I have proposed a new software (app, in this case) to achieve these goals, by combining three solutions that are already on the market. My combining a wearable technology and two apps (specifically DoctorOnDeamnd and Audax). Wearables give users constant, relatively accurate data about their daily activity and heart rate, for example. DoctorOnDemand was chosen because it allows users to video call a physician for less than the cost of a office visit's co-pay. Audax was chosen because it motives users to stick with healthy lifestyle changes and doctor regimens through the user of gamification. All three together can create a healthier population if enough people use the new app and stick with it because people are getting more exercise and have more data available to them to make changes as needed.

What I still need: primary source data, from physicians (preferably) about their thoughts on telemedicine. If they think it's effective to use wearables, seek advice from "video physicians" (DoctorOnDemand), and to gamify healthcare (Audax). And if they think a combination of all three will reduce costs and lead to more healthy lifestyles. If not, then how will telemedicine play a role in the future?

Below is a more detailed version of what I have stated above (my project proposal). Click on the images to enlarge them.

Telemedicine Internationally: Case Studies

Telemedicine is saving lives abroad by increasing access to healthcare to rural areas. A 2010 report by WHO case studies highlight the importance of telemedicine internationally through case studies of Mongolia, Mexico, Norway, and the United Kingdom.

Source: medetel.eu

Above is a screenshot of the software platform implemented in Mongolia to assist rural doctors in diagnosing pregnant mothers and referring them to a specialist in a city, if necessary. This technology encourages rural doctors to stay in a rural practice because they are able to get expert opinions from a distance. This technology saves patients the time and money where traveling to a city hospital for care is a substantial investment. Of the 598 cases looked at in 2009, only 36 needed a referral. Due to the huge success of this program, it had it's funding extended to reach more remote, rural provinces.

Source: who.int

In 2006 when breast cancer became the leading cause of death for women 50-69 in Mexico, the Opportune Breast Cancer Screening and Diagnosis Program was created to transcend economic an geographic barriers to getting screened. With the goal to increase screening from 7.2% to 21.6%, 30 screening sites were connected to two interpretation centers where results are viewed by radiologists.Due to internet connectivity issues, many sites had to use CD's to transmit mammography images to the centers. This process could take up to three weeks to get results back to patients. Due to the success of this program, five more states have been included.

Source: who.int

Norway's teleECG is a telemedicine service for patients not in a hospital (at home or in an ambulance) to facilitate the early diagnosis and treatment of myocardial infarction. ECG images taken are sent to a hospital for analysis and storage, where a cardiologists looks at the images for a diagnosis and immediate course of action. Patient outcomes have improves 15-20%, as over 50% of antithrombolytic treatment is now administered by paramedics. Due to its successes, the service is being expanded countrywide.

Source: who.int

Based in the United Kingdom, the Swinfen Charitable Trust runs on volunteer service to connect physicians in developing countries to an international pool of specialists. Physicians can log in to a secure site and post pictures on a message board, where a consulting physician can give advice after receiving an email from an SCT representative. Most responses are received within 19-24 hours which helps rural physicians get advice and saves patients money from traveling to see a specialist. More languages are now being supported to reach even more doctors, like in Greece, France, Bolivia, and Tanzania. 

State of Telemedicine Globally

A WHO survey looked at four types of telemdicine and how established each was in the world. The survey looked at teleradiology (use of ICT to transmit x-rays to another location for interpretation/consultation), telepathology (use of ICT to transmit microscopic images of cells for interpretation/consultation), teledermatology (use of ICT to transmit medical information concerning skin conditions for interpretation/consultation), and telepsychiatry (use of ICT for psychiatric evaluation/consultation via video or telephone. The levels of development were classified as: established (continuous service supported by government or other funds), pilot (testing and evaluation of the service), or informal (services not part of an organized program).

Above are the results of the survey. It is important to note that, teleradiology is has the highest rate of established service for the four categories. It has over 60% of responding countries offering some form of service.

The results are also broken down by region for the same four categories of telemedicine and ranked on the same three criteria.

It's important to note in the findings that Africa and Middle Eastern Regions had the lowest proportion of countries with established telemedicine services. These two regions also had the highest proportion of informal services offered. 

My next blog post will highlight various countries in case studies of their telemedicine programs.

10 Apps That Are Changing Healthcare

DoctorOnDemand- $40+

A video consultation that allows users to get non-emergency medical questions answered and prescriptions refilled with 1400 licensed physicians in all 50 states. $40 covers a basic 15-minute visit. The app also offers lactation consultation and a video call with a psychologist for an increased fee.

HealthTap- $44+
This app allows users to see theier own personal doctor, if they are on HealthTap. Or users can always ask them to join! Their more premium service allows you to video conference with top physicians across the country for  $99. This app also works even when one is traveling overseas.

HelloMD- Price varies based on doctor

This app specializes in connecting users with a specialist, not providing immediate care. The idea is to connect users with the specialist they need so that a in-person visit can be set up, video calls can be used to second opinions. 

LiveHealth Online- Insurance, or $49 with no coverage
Works similar to DoctorOnDemand where a user can video call for a consultation and have prescriptions refilled, but this app accepts insurance. Users may just have to pay the same co-pay as for a regular office visit. If an insurance is accepted is decided during account setup.

 

Microsoft HealthVault- Free

A place to store personal medical records and share with trusted professionals. This app works with many medical devices, WiFi scales, and fitness trackers to input data. It works well for users with chronic conditions that need daily health metrics.

PillPack- Cost varies based on medication and co-pay
Prescription-by-mail service that puts pills in a date and time stamped packet in a dispenser that come out in the order they are to be taken. It works with a user's healthcare provider to refill four weeks before the supply runs out. Personal vitamins and supplements can be added as well. The service has no shipping charges or additional fees.

PingMD-Free for patients

A secure messaging app that allows physicians to contact other physicians and follow up with patients after a visit or follow disease progression. A  doctor has to recommend this app to a patient for it to work (it means the physician is using the app). Physicians can also use it to get second opinions or opinions from specialists with the image sharing capabilities.

RevUp By MD Revolution- Free app, prices set by physicians
Allows users to connect with a team of health and wellness experts, once invited by a physician, company wellness program, or healthcare network. A user may be assigned a specialist and a coach (fitness experts, nutritionist, nurse practioners). Data can be input from Fitbit devices and the MyFitnessPal app, or manually so coaches can review it.

Text4Baby- Free of messaging charge for most US carriers

Pregnant mothers and new mothers use this service for reminders, tips, and help from the National Healthy Mothers and Healthy Babies Coalition. A users texts BABY (or BEBE for the Spanish service) with her due date and zip code so users remain anonymous. Texts are relevant to that data, like a reminder for the one month check-up or to ask the doctor for the blood test results from the test taken at the last appointment. 

Vida Health Coach- $15 a week

The service sets users up with a personal health coach to focus on stress, weight loss, or diabetes for example. The coach customizes the app with data points to track based on a user's goal. The coach will also meet with a user once a week over video conference or phone call. Coaches also provide motivation and advice, as well as supplementary resources. The idea is to create an ongoing relationship to manage disease and commit to lifestyle changes.

Source: PC Mag