While it has existed in the healthcare landscape for over a decade and its benefits lauded, telemedicine adoption has so far been modest, if not disappointing, as several interconnected and difficult barriers have not yet been overcome--which could use a shot in the arm with greater collaboration between the public and private sectors.
Telemedicine, broadly defined, is the provision of healthcare or medical information and services via communication networks such as telephone and broadband lines. Over the last few years, as broadband initiatives around the world became more pervasive, telemedicine has been "revived and revolutionized", said Sash Murkerjee, senior market analyst, IDC Health Insights Asia-Pacific.
From just phone calls between a doctor and patient, telemedicine now includes teleconsultations, videoconferencing, and real-time remote patient monitoring using mobile devices, she noted.
As a healthcare delivery program, it has been around for more than a decade, but adoption rates have remained "disappointing" and deployments worldwide are at best described as emerging and "siloed", said William Chew, managing director of myHealth Sentinel. The company is a Singapore telehealth service provider offering applications that enable doctors to monitor vital signs of chronic care patients from their homes.
One of the most prevalent reasons for the low adoption was the lack of support by governments and insurance companies to reimburse patients for the cost of telemedicine services and devices, he said in an e-mail.
Murkerjee also noted that despite the potential benefits and growth for telemedicine services, actual adoption had been "steady but modest". A lack of clinical reimbursement--and hence incentive--was one longstanding barrier preventing telemedicine initiatives from taking off beyond pilot programs, she pointed out.
Another key reason why people were still reluctant to take it up was the lack of examples of telemedicine succeeding on a wider scale beyond pilot programs, she added.
Lack in access, awareness and legal understanding
Another common lament among market players was that broadband penetration has continued to be a major hurdle for telemedicine adoption.
Ron Emerson, global director of healthcare at Polycom, emphasized that broadband network infrastructure was crucial to the implementation of telemedicine in order for a seamless connection between doctors and patients. "A well-working telemedicine solution ensures the quality and efficiency of the technology and the practitioner as well as the patient's well-being." Still, bandwidth penetration has remained a challenge particularly in emerging markets such as Vietnam, Indonesia and the Philippines, he said.
Chew noted that the limited availability of broadband networks is more pronounced in large, poorer rural populations within countries too, such as those in India, China and Indonesia.
He added that the low awareness of the benefits of telemedicine among practitioners and patients has also been stalling adoption. Patient reluctance and incompliance were part of this barrier--for instance, patients above the age of 65 may have difficulty or be hesitant to adapt to the new technology.
Murkerjee pointed out that legal implications and liability issues were also impeding progress, as medical practitioners may be reluctant to practice telemedicine for medical indemnity issues.
Standards, regulations to create ubiquity
According to Chew, developments in telehealth markets have so far been sporadic and siloed, rather than ubiquitous. For instance, the institutional telehealth market, comprising public agencies and hospitals, has been stable--but stagnant--with deployments limited to pilots and usually based on proprietary device technologies and siloed management systems. Even in the consumer telehealth market, which has seen an explosion of innovation such as mobile apps, most are also proprietary with data either stored in the user's smartphone or uploaded to the vendor's own Web portal, he pointed out.
The telehealth landscape will have to move from a multiple siloed, proprietary technology-based model to more client-oriented, open standards service platform models, so as to eliminate the need for heavy investments from end-users, be they doctors, patients or caretakers, Chew emphasized.
Emerson added that the alignment of telehealth with the overall goals of healthcare organizations was still an issue to overcome. In emerging markets, for instance, the lack of defined policies and regulations was a hurdle since clear procedures were needed to govern any implementation of telemedicine, ensuring practitioners can perform their jobs efficiently and patients' comfort is safeguarded.
That is one reason why telemedicine adoption has been uneven across the globe, he noted. In developing regions, regulations and policies for telemedicine implementation are still in their infancy and have yet to be finalized, whereas in developed markets, telemedicine implementation--thanks to electronic health records--has led to clinical efficiency, cost benefits and high patient satisfaction, he said.
Needs public-private joint support
Observers also highlighted that both public and the private sectors played important roles in pushing for greater adoption of telemedicine.
Murkerjee emphasized that if the challenges and barriers were resolved at the government level, telemedicine adoption would become more rampant. Nonetheless, she noted that telemedicine projects tend to be government-funded initiatives and eventually die down once funds dry up, particularly in developing countries. Instead public-private partnerships should be carried out as these are more sustaining, she said.
Chew said telehealth is already widely acknowledged by governments and healthcare providers around the world as the "future of healthcare". The essential ingredient for success is the "concrete and sustained support" by governments in terms of educating the general public as well as developing economic incentives which will drive user acceptance and adoption.
For example, governments could create policies that require insurance companies to officially recognize telemedicine and reimburse doctors for its use. There can also be subsidies or tax incentives for patients to purchase remote monitoring devices with the supporting broadband access.