DEVELOPMENT OF TELEHEALTH AT LOCAL AND INTERNATIONAL LEVEL

Telehealth is a technology that connect patients with their preferred health care service providers without limitations of their geographical boundaries or territories. It facilitates both patients and healthcare professionals to become more independent and improve connectivity without traveling hassle. It helps health professionals to provide remote patient monitoring where physical visit is not possible. This can improve patient accessibility especially in those areas which remains underserved.

Telehealth is assisting healthcare systems, organizations, and providers in expanding access to and improve the quality of rural healthcare. Using telehealth in rural areas to deliver and assist with the delivery of healthcare services can reduce or minimize challenges and burdens patients encounter, such as transportation issues related to traveling for specialty care.

Telehealth became a more prominent mode of providing healthcare during the COVID-19 pandemic, when patients and providers sought to decrease in-person contact for routine visits. To expand access to telehealth from patients’ homes and increase provider flexibility, laws, reimbursement policies, and regulations were temporarily changed through emergency orders and legislation.

Telehealth uses telecommunications technology and other electronic data to assist with clinical healthcare services provided locally, which can also include providing education, administrative functions, and peer meetings. While one of the most common images of telehealth is that of a patient speaking by videoconference with a healthcare provider who is located remotely.

In this era of modern world, telehealth advances in many different forms:

1. It uses any form of ICT device such as a desktop PC, laptops, I-pads, smart devices, and sensors
2. It covers preventative, promotive, and curative aspects of health
3. It uses simple or complex multimedia to videoconferencing to virtual reality
4. It can be interactive as synchronous – “real-time” or asynchronous – delayed messaging such as e-mail
5. It engages and links all types of users such as highly trained clinicians to minimally trained community health care workers, to patients, to the general population
6. It can be used as an alternate or complementary approach for almost any health issue imaginable.

The first use of “ICT for health” may have been in the 1860s when telegraph messages were sent to seek help for treating wounded soldiers during the American Civil War. Increasingly, the link between use of information and communications technology (ICT) and the future of health and health care is acknowledged. Use of ICT in health is termed e-health. The first significant and systematic use of e-health was primarily for military and space applications, but its use has steadily broadened. Bringing any innovation to maturity is a challenge, yet this seems inexplicably so for e-health, particularly telehealth, which, in various guises, has been “in development” for well over 100 years.

Investment in innovative e-health research, followed by adoption and integration of proven e-health solutions, is becoming a key aspect of sustainable economic development and health system restructuring, particularly for the developing world.

The developed world has a vested interest in improved global health and developing world solutions. The resource limitations of most developing country settings will require telehealth solutions to be not just effective, but simple and inexpensive (i.e., technologically appropriate). The developed world can benefit from such developing world innovation.

There are some reviews, books, and reports available that demonstrating the spectrum of telehealth in developing countries. Telehealth has been used in response to conflict-based or disaster-based humanitarian need. Beyond this, it can be seen in many developing countries, for example, Brazil, Cambodia, Ecuador, India, Nepal, Philippines, and South Africa, among others. In Asia, recent growth in application of telehealth has been seen in both India and People’s Republic of China, with continued growth expected in the coming decade. Many countries in Africa also exhibit this activity. In LAC countries, a tremendous level of activity can be seen in Brazil, where telehealth has become embedded in the delivery of health care.

Although most initiatives remain locally focused and at the pilot or project stage, sustained telehealth networks also exist, providing humanitarian telehealth internationally. The networks typically provide support for educational or clinical purposes and adopt one of two models for clinical referrals (targeted model and open/distributed model).

Cell phones have rapidly evolved in the last 2 decades giving rise to “smartphones” and other smart devices (i.e., sensor-rich, and Internet-enabled). With the advent of “m-health” (simply e-health using mobile devices) and availability of smartphones, the developing world has seen a plethora of initiatives, many directed toward the support of rural and isolated CHWs and child and maternal health needs. Piette reported that automated telephone monitoring and self-care support calls have been shown to improve some outcomes for chronic disease management, such as glycemia and blood pressure control, in low- and middle-income countries. Sustained m-health projects exist, such as Mobile Alliance for Maternal Action (http://www.mobilemamaalliance.org/), which sends health messages to new and expectant mothers in developing countries via their mobile phones. Mobile Alliance for Maternal Action focuses its efforts on countries where high maternal and newborn mortality rates intersect with a proliferation of mobile phones, and currently is active in Bangladesh, South Africa, and India.

Thus, the future of telehealth is in our hands. The shortage of health workers and specialist services is still the major problem in growing telehealth locally and international levels. Judicious use of telehealth offers a partial solution through direct clinical services (both intra- and interjurisdictional), training, and task shifting to lower levels of health workers. Achieving this at a national level requires political will, insight, coordination, and management of seemingly disparate factors. It must start with answering the population health and health system “needs”, utilizing technologically appropriate and cost-effective solutions that are sensitive to the reality of the poverty of those most in need. Such an approach cannot be achieved through technological imperative or status quo approaches but requires a structured approach through the development of synergistic e-health strategy (incorporating telehealth) at the national, subnational, and facility levels to guide public and private innovation, and broad user adoption.