Turn these 4 Telemedicine challenges into opportunities

Telemedicine has been a growing market for years, and thanks to its efficacy during the COVID-19 pandemic, it’s now booming. Companies looking to embed telemedicine in their practice can enjoy myriad benefits, from increased convenience to improved user experience. But they also face significant challenges.

At Healthily, we can help you transform your workflow, increasing capacity and reducing the time it takes for users to get the right information for their health. We help companies navigate these complex challenges with watertight processes and cutting-edge digital health technology – from AI symptom checking to medically-verified digital health information.

Here are four challenges and accompanying lessons we’ve learned while helping companies transform their healthcare workflows.

While telemedicine consultations are convenient for the consumer, they usually take up the same amount of physician time and according to research sometimes longer. So while there is no need for bricks and mortar premises, doctor time is still the biggest challenge for telemedicine providers.

There’s also no way to syphon off unnecessary consultations, which also take time. If people had better knowledge about when to self-care or see a pharmacist versus visiting a doctor, it could help reduce the burden on physician time. Simply replacing face-to-face consultations with telephone or video ones doesn’t do the job.

Longer opening hours mean telemedicine is more convenient than a traditional doctor’s surgery. But those who could have used self-care may end up paying for a consultation. Recent studies also show that at least 30% of patients have to physically be seen by a clinician after their telemedicine consultation. Rather than time-saving, this may double or even triple face-to-face waiting times – as well as cost – for those in low and middle income countries.

This 30% is also a substantial impact on public health services.

Every day, 1 billion people use Google to understand health queries and what they need to do next. At Healthily, we understand health ‘intent identification’ and can confidently direct consumers to the right services and health information via our Smart Symptom Checker.

Our Smart Symptom Checker AI technology can be integrated with any telemedicine service to help streamline consultations with pre-assessment options. This can sift out customers who don’t need to see a doctor, or reduce the consultation time by gathering information and directing the clinician to relevant areas of investigation.

Use our flexible API to integrate our Smart Symptom Checker into your organisation's workflow, app or website.

With a health economics’ lens, telemedicine cannot be seen as ‘transformational’ because it doesn’t break the iron triangle of global healthcare concerns, made up of cost, quality and demand.

Face-to-face healthcare is balanced: if you increase quality, costs and demand go up; if you diminish quality, costs and demand go down.

The convenience of telemedicine has increased demand – there are existing patients who have been happy to switch to telemedicine, existing patients who still want face-to-face appointments, and new patients on top of that. But research suggests this demand negatively impacts quality and cost.

Many patients won’t know how and when to self-care, which leads to more unnecessary consultations and ones that end up recommending face-to-face appointments – adding further strain on public services.

A study by IPSOS Mori into Babylon’s virtual GP practice in Hammersmith, London, showed that a shift to telemedicine encouraged more bookings from younger patients. This massively increased costs for the area’s clinical commissioning group, and while the Care Quality Commission made sure quality didn’t drop, it highlighted the fragility of the iron triangle. If the model were to scale up, either cost or quality would likely suffer.

Other issues might include:

• doctor shortages
• shorter appointments
• wage inflation
• quality dilution
• increased wait time
• unsustainable profit margins
• poor quality consultations

Our smart software is designed with doctors and brings medical knowledge out of the clinic and into everyday life, using a combination of advanced AI and user-friendly design. We can sift out unnecessary consultations and streamline services and provide relevant, quality information for users to self-care at home.

As smart symptom checkers have almost infinitely extensible datasets, we will evolve to include external factors such as social determinants and lifestyle models in the Healthily algorithm. Smoking is one such influencing factor that’s already included.

This may lead to early presentation and diagnosis, significant increases in life expectancy, and a reduction in healthcare spending in the long run.

As a result, we’ve been able to identify how users describe symptoms (rather than, say, pointing to a pain point) and interpret conclusions from their final report. We can establish what further questions we need to ask to understand conditions and how to improve our user experience fully - and our technology and intelligence grows.

Telemedicine is highly regulated as it involves the employment of doctors and diagnosis of patients - which in turn makes scaling cost intensive.

The obvious place for the telemedicine expansion is the USA, but a combination of barriers from the Food and Drugs Administration and state law have made it hard going. In particular, 40 states in America have a Corporate Practice of Medicine (CPOM) restriction which means that only physicians and companies licensed in those states can practise medicine. There must also be a state-licensed physician running your company in the state you are operating in i.e you can’t use a doctor licensed in New York State to treat a patient calling from Los Angeles.

This restriction has been lifted for telemedicine companies under emergency legislation during the COVID-19 pandemic, but it is unclear whether states intend to return to the status quo. In the UK, telemedicine companies are treated like clinical practices and are regulated by the Care Quality Commission. This means they are subject to inspection and receive a grading.

The current model of telemedicine - where the workflow is the same, just not face-to-face - is costly to expand on a global scale.

Safety is our top priority at Healthily, which is why we meet the strictest possible standards.

• The Medicines and Healthcare products Regulatory Agency (MHRA) has registered our Smart Symptom Checker as a Class I medical device based on our self-declaration. This means that our device works in accordance with the intended purpose and meets legislation requirements relating to safety and performance (the European Union’s Medical Device Directives and Medical Device Regulation) and is recognised by CE mark.
• The Professional Record Standards Body (PRSB) has audited our quality management system to check that the way we work is safe.
• We apply the principles and quality statements of The Information Standard fully to make sure our process for producing high-quality, evidence-based, actionable health information follows best practice.
• Our self-care platform has acquired the ePrivacy seal to demonstrate compliance with GDPR’s data security requirements.

For more information, read our full list of safety standards.

The cost of getting one person to click on a telemedicine ad on Google is in the region of £14. When you consider an average consultation is £50, and the doctor is costing £25 per consultation, plus your infrastructure, insurance and regulatory costs account for another £6 each - you are probably making £5 profit per call.

In the UK, Babylon ended up buying a GP practice in order to connect to the NHS payments system and take advantage of laws that allowed consumers to register at any practice. Other companies have done individual deals to either service one of the 200 Clinical Commissioning Groups in England or one of the 8,000 GP practices.

Other providers have bolted themselves onto health providers in the US or health insurers globally. But all of these deals have to be fought for, providers can be switched out quickly, and the usage is never as high as the volume of lives insured or cared for.

That leaves marketing your service in a world where Apple estimates it has close to 54,000 health apps in its store and digital advertisers are pocketing up to $36bn a year in revenue from companies advertising health products and services. Unfortunately, if you build it, people won’t necessarily come.

Read our blog on how digital can help the pharmaceutical industry reach their customers

Healthcare companies and retailers have used our condition checkers to enable their customers to assess the probability of having specific conditions and provide information about care solutions and services.

Livehealthily.com also has millions of customers looking for healthcare information. Through web advertising we have been able to provide Swedish telemedicine provider Livi qualified referrals at a price well below Google.

If you’re interested in helping your users navigate their own health needs with digital content, health technology or AI symptom checking, we’d love to hear from you.