Delays in 5G and IoT technologies due to lockdowns and politics have impacted telehealth growth. How can these challenges be overcome?

According to the World Health Organization (WHO), about 40% of countries have fewer than one physician per 1,000 people and less than 18 hospital beds per 10,000 people (data: 2005-2015).

Even Singapore’s healthcare system was at risk of being overwhelmed when its 11,321 acute hospital beds filled up rapidly as Covid-19 cases at home skyrocketed.

Telehealth seems to be the solution for such healthcare problems, especially since it bypasses social distancing issues while offering medical self-service. However, the rising need for telehealth also places significant strain on existing data management practices at healthcare facilities.

So far, poor data quality and transmission lag have been the biggest challenges to offering telemedicine. This will change as countries roll out 5G nationwide. For healthcare organizations seeking digital transformation, 5G will emerge as an accelerator with seamless transmission of large data files and enablement of technologies like augmented reality (AR), virtual reality (VR), and spatial computing.

The three major ways 5G will revolutionize healthcare through telemedicine are:

  1. Medical data at our fingertips: Today, patients bring manually screened images like X-rays and scan reports to a specialist. With 5G architecture in place, test results can be shared virtually, reducing the need for physical contact and lowering the risk of Covid-19 infection.
  2. Real-time monitoring: Currently, physicians spend anywhere from 30 minutes to a couple of days studying the vitals of a patient before initiating treatment. A combination of 5G and Internet of Things (IoT) would enable real-time, automated collection of patient data without the need to visit a clinic.
  3. Expanded reach of healthcare: In many countries, treating patients in remote areas with near-zero healthcare infrastructure is challenging. 5G connectivity could help doctors administer virtual treatment through AR, VR, data-capturing equipment and 4K 360° panoramic images.

However, while the communications technology is great, it will still require an interface that facilitates seamless data exchange across the healthcare value chain between hospitals and businesses. What does this entail? DigiconAsia posed this question to a consultancy service, TCS Asia Pacific, that leverages the Cloud to provide comprehensive solutions to increase connectivity and collaboration among healthcare professionals. The firm’s president, Girish Ramachandran, gladly shared some of his deep insights about the state of telehealth implementation in India and around the world. 

DigiconAsia: With 5G efforts hitting some hurdles in Europe and the US due to the USA’s decision to shut out a major 5G innovator, will progress in telehealth implementation also be affected?

Girish Ramachandran (GR): To date, the biggest challenge to the widespread adoption of telemedicine is poor data quality and transmission latency. Telehealth can still be implemented through the current generation of cellular transmission technology in well-connected areas, but our hope is for 5G to allow telemedicine to fill gaps in healthcare in rural areas.

In countries such as Singapore where the advent of 5G is anticipated, every sector including healthcare will be disrupted. This will drive the growth of telemedicine going forward. The advancements in the area of the Internet of Things (IoT) is also furthering the growth of automation, with increasing interest in the technology augmenting the use of wearables, leading to enhanced patient well-being and diminishing costs.

At present, we are witnessing the automation of medical coding, logistics, staff training, diagnostics, and patient monitoring: this is making a positive impact on the development of telehealth. 

However, a successful telehealth implementation is not just about 5G for a faster data transmission capability, or IOT for abundance of data. Other technologies are also at play when it comes to revolutionizing healthcare: players in this sector can make use of streamlined processes and emerging techniques such as ‘low-code’ that live up to strict accuracy standards to save countless lives in quick time. Electronic Health Records have enabled rapid collaboration between payers and providers so that payers have access to clinical data, a vital asset which they previously lacked. This enhances cost transparency, quality metrics, and evidence-based care.

On top of that, AI can drastically improve voice recognition and enhance enterprise image management, while pharmacy robots can perform logistical operations rapidly, pick prescriptions, and reduce dispensing errors by a staggering 50%. 

Through its focus on streamlining hospital processes, automation provides more time and space to internal stakeholders for providing better quality patient care. All these elements will contribute to successful telehealth management now and in the future.  

DigiconAsia: Is it correct to say that cloud computing will enhance the centralization of data exchange between global healthcare infrastructures, and that Edge Computing (5G and IoT) will take care of the rest? Would you like to add any insights into how the two technologies (cloud and edge) complement Telehealth?

GR: Yes. The key thing that cloud computing provides is visibility and transparency. This is invaluable to the healthcare sector as it enhances agility and responsiveness to enable better quality of care for patients. The centralization of information in the cloud also allows both patients and healthcare workers to access data rapidly, remotely and in real time, and reduces the need for physical collection of test results: this is important in helping reduce healthcare costs as well. 

With increasing innovation in technology, more data can be processed faster with accuracy. This will lead to quicker diagnoses and better patient monitoring. At the edge, IoT is being currently used in healthcare, and advances in technology can leverage IoT even more in the future. This can lead to remote patient-monitoring from anywhere in the world, thus ushering in an unparalleled care delivery system for providers. The stage is also set for payers to actively participate in such a highly-efficient and fully-automated system.

As countries move towards smart healthcare, IoT will drastically increase the accuracy and type of data that healthcare practitioners have access to, enabling remote monitoring and higher quality of care for selected patients such as the elderly. Together with 5G significantly improving the transmission of data, all the Cloud and Edge technologies have set in motion the next generation of transformations in healthcare and telehealth, and will continue to do so even in the ‘new normal’ caused by the pandemic. 

DigiconAsia: In under-developed countries with weak healthcare infrastructure, would it be easy to deploy 5G connectivity in the first place? Although we tend to focus on the technology aspects of Telehealth, what are the logistical, fiscal and other challenges (e.g., corruption, extensive training required) of getting the front-liners in those underdeveloped countries to handle and facilitate the high tech?

GR: Public-private partnership is crucial in the successful implementation of telehealth and a robust regulatory framework is needed for this to happen. A key criterion is that regulations need to support the adoption of telemedicine-related products and policies by providing the necessary arrangements. For instance, regulations should be implemented to allow patients to access care in their homes while quarantined during the COVID-19 pandemic and enable healthcare workers to deliver their services remotely.

There are certainly some challenges associated with countries with less advanced healthcare infrastructure and practice. For example, poor user interface and user experience (UI/UX) design of a telehealth system can be challenging for many physicians and users. There is also a fear of data security being compromised in the absence of stringent data standards and proper governance, but rigid compliance requirements are an additional burden on the labor and finances of healthcare firms. 

Another challenge would be infrastructural and technical challenges. Often, healthcare players will find it challenging when migrating from or connecting their services with legacy systems and manual processes, as there is a certain comfort level associated with them.

DigiconAsia: Other than 5G, IoT and cloud computing, under-developed countries may lack modern equipment, medicines and medical professionals trained in such modernization. How will technology and governments take care of the high cost of both modernization and digitalization while delivering advanced treatments over long distances to the nearest modern medical facility and so on? Who foots the bill, disburses the donations, and ensures the right administration and training? 

GR: The role of technology has the potential to reduce healthcare costs, but a robust regulatory framework must be established by health ministries in order to allow telemedicine to be practiced in a fair and accessible manner. The key lies in automation, as it represents a significant amount of reform to the healthcare system. As such, the importance of every stakeholder is crucial.

Normally, major stakeholders in the healthcare ecosystem are patients, physicians, insurance companies, hospitals as employers and care providers, pharmaceuticals and of course, the government, which in a lot of countries is a major player in the healthcare system. Also, many countries have moved towards a Public-Private Partnership (PPP) to move digital healthcare forward.

In the underdeveloped countries, the government, payers and providers oversee critical aspects of healthcare. They are affecting care delivery from a quality point of view while keeping a close eye on costs. Any important disruptions in the industry are usually a direct consequence of recent innovations ushered in by such PPP collaboration. Importantly, the crucial objectives of improving clinical and financial outcomes, and most importantly, improving the patient experience, need to be perfectly aligned in PPP partnerships.  

To be successful at providing efficient and high-quality healthcare at affordable prices, nations have to create a digital backbone which I call the ‘digital spine’. For example: in India, the spine has four layers: the presence-less layer, paperless layer, cashless layer and consent layer. This digital spine is the foundation on which the country’s National Digital Health Blueprint is built.

The key features of this blueprint include a unified architecture, a set of architectural elements, a five-layered structure of architectural institutional blocks, a Unique Health ID (UHID), privacy and consent control, national portability, electronic health records, appropriate principles and guidelines, and, health analytics.

Within the blueprint, the private sector needs to play its part and build the 4Cs:

  1. Connectivity: creating reliable networks for the many life-saving medical systems housed inside hospitals and other healthcare facilities, and to deliver health care remotely outside them.
  2. Collaboration and communication mechanisms: This will facilitate co-working across healthcare ecosystem, and virtually where needed.
  3. Cloud: This takes digital assets onto the cloud to make medical record sharing easier and safer to access when required, as well as automating backend operations, and facilitating the creation and maintenance of telehealth systems.
  4. Cybersecurity: This protects the sensitive personal information of patients. Highly secure citizen privacy and trust are crucial for shaping community attitudes to deal with the new threats posed by a health crisis.

For public-private partnerships—especially those in the underdeveloped countries—to move digital healthcare forward, it takes multi-disciplinary and multi-stakeholder coordination to ensure a strong foundation is built. For example, in India, the TCS Digital Nerve Center (DiNC) fosters innovation in healthcare delivery to help care providers expand their reach and serve large numbers of patients without overwhelming the current physical infrastructure. This is especially relevant in current pandemic situation.

The DiNC focuses on healthcare delivery, making it accessible to millions of people by building a digital backbone bridging the gap between medical specialists and patients, and providing a myriad of Virtual Healthcare Services.

The platform, which has a network of over 2,000 specialists, has connected more than 600 health facilities including the Regional Cancer Center in Trivandrum and the Cancer Institute in Chennai. Over 3.11 million patients have benefited from care coordination by the platform.

DigiconAsia thanks Girish for sharing his thoughts on this interesting topic.