Technology opportunities: Telemedicine and Telehealth
ID: INTERACTIVE DIALOGUE
LAST week I indicated what changes Jamaica would have to make in order to attract largescale local and international investments in the technology arena, pointing to the actions of the Costa Rican government in the past to attract Intel, and making the suggestion that we leverage our relationship with the Chinese and consider focusing on attracting companies dealing with green technology.
This week I am focusing on another area that many Jamaicans may not have considered: Telemedicine and Telehealth. Telemedicine is most often defined as "the use of medical information exchanged from one site to another via electronic communications to improve, maintain or assist patients' health status" and "Telehealth" is a term that usually encompasses more than clinical services, covering continuing education, remote monitoring of vital signs and more.
The ideas are very simple to understand and I use this example: An X-ray can be sent via the Internet to a specialist in another location for interpretation and then the result sent back. This applies to many other things such as CT scans, MRIs and can be done live or stored and then forwarded. The recipient could be in another room or in another country.
Decades ago, it may have seemed more appropriate for a science fiction movie but today it is quite possible for a doctor in another country to examine a patient. They can "see" inside your ear, "listen" to your heartbeat and even conduct surgery thanks to the Internet and the right equipment.
The "continuing education" aspect is even easier to understand, thanks to the increased visibility of online universities and courses. The University of Kentucky's Neurology Department has initiated online streaming of some rounds made by doctors, as well as streamed lectures, generating attendance from doctors in Brazil, Ethiopia and Jordan at the same time. This is especially beneficial for countries that do not have as many specialists in certain areas of medicine because the exposure improves the local healthcare that is provided.
Another application of Telehealth is increasing access to services in rural and underserved areas. Last week Wednesday, February 23, AT&T announced a Telehealth partnership with the Saint Joseph Health System in California. The goal is to "make healthcare more accessible across the region" and they intend to accomplish this by enabling physicians and specialists to tend to patients "in a personalised real-time visit".
In the book Telehealth and the Developing World, the editors relay real-life examples from countries such as The Philippines and Brazil. In 2003, the BH Telemedicine project was launched in Brazil "to promote the continuing education of health workers in primary care units, as well as contributing to the modernisation of the public health system" with a focus on connecting primary care centres in the Belo Horizonte area to the Federal University of Minas Gerais teaching units and focusing on medicine, nursing and dentistry.
Thanks to the initiative, there was a 71 per cent reduction in the number of patients needing to travel to the Clinics Hospital of Belo Horizonte. We can only imagine how much money Jamaica could save by reducing the number of patients needing to travel to hospitals while improving the delivery of healthcare in a similar fashion.
I have two personal examples of exposure to Telehealth in Jamaica. My doctor who treats all my football injuries, Dr Mansingh, explained to me that as part of the medical team for the West Indies Cricket team, a player would be injured and they would send him the MRI or X-ray for him to take a look at. He would open it on his iPad, make the diagnosis and relay his information without ever having to hop on a flight to just make a diagnosis. This saves money and is far more efficient.
On the education side, I recently observed my father, a medical doctor at UHWI for decades, taking part in a lecture with a number of other doctors, via his computer. Having listened to the lecturer, they engaged in discussions when required, and this saved money in the form of having to fly down a presenter and cover travel and accommodation expenses.
Where are the opportunities for Jamaica?
There is no question that Jamaica produces some of the world's best doctors and nurses, hence the reason the USA, Canada and UK recruit these individuals from Jamaica in large numbers. While I agree that we should invest in establishing more nursing schools with a view to training overseas candidates, we can also do so virtually.
Jamaica, through eServices, already provides back office support for three of the four largest healthcare providers in the USA, so we have no doubt proven that our geographic location, similar timezone to the US East Coast and native English-speakers present advantages. We could go further by actively courting pilot projects that allow our medical professionals to provide services such as reading X-rays and MRIs.
This sort of work is much more knowledge-based and higher up the value chain. The first group of US "baby boomers", people born after World War II up to 1964, started retiring this year, having turned 65. This group covers 79 million people in the USA.
The cost of healthcare has grown exponentially in the USA and they are drastically looking for ways to reduce healthcare costs. Many people travel to Canada for cheaper care and cheaper medicine while others are traveling to countries like Mexico and even as far as India. Primary care, remote monitoring and remote diagnosis are all opportunities to reduce costs dramatically. Paying Jamaican specialists would be a fraction of what it costs for an American specialist.
Jamaica could also serve other English-speaking countries in the Commonwealth that have much lower ratios of primary care doctors and specialists to citizens. Jamaica would also benefit from similar access to doctors and specialists who have encountered conditions that may be rare in Jamaica and/or for which we have only a handful of specialists.
Some will say that Jamaica has a shortage of doctors and nurses, so how can we provide service to other countries? But do we really have a shortage, or is that due to the current setup of our health sector we have a shortage but can correct it?
If we can reduce the number of patients that need to travel to hospitals by improving access to healthcare via ICT in local clinics, especially in rural and inner-city areas, we would have fewer patients per doctor at the hospitals. Prevention is always cheaper than the cure, and improving access to regular checkups, increasing the chances of catching medical problems earlier, and giving more people access to the limited number of specialists through technology instead of forcing them to travel miles could reduce patient load and save money.
Applying ICT to the healthcare industry will benefit locals, and that is why the government must do more than move to electronic records.
Government support, Private Sector support and infrastructure
Thanks to Flow, I can get 100mpbs Internet connections in Jamaica but in Orlando, Florida, the fastest connection I can get is 40mpbs. Jamaica has the infrastructure in place and continues to upgrade capacity as seen by the recent announcement of a new undersea cable by LIME.
Our medical professionals are world-renowned, our healthcare system needs serious upgrading and our largest trading partner is desperately looking for ways to reduce the medical costs associated with the largest portion of its population.
Malaysia passed a Telemedicine Act in 1997 but I have never heard similar discussions in Jamaica. In the USA, AT&T is partnering with healthcare providers on pilot projects to increase access to healthcare, so I can only hope that between Flow, Digicel, Claro and LIME, even one of our telecommunications companies will step in and be more like AT&T instead of throwing millions of dollars at entertainment events.
ICT has a real place in the health sector and the local and international opportunities clearly indicate opportunities to reduce costs, increase efficiency, have a healthier population and provide a global service that earns foreign exchange.
David Mullings is the Future Leaders Representative for the USA on the Jamaican Diaspora Advisory Board. He is on Twitter at twitter.com/davidmullings and Facebook at facebook.com/InteractiveDialogue