THE HOME-BASED POINT OF CARE PROVIDED BY MEDICARE AND OTHER PAYERS COMPRISES A BROAD RANGE OF SERVICES THAT ARE DELIVERED IN A PATIENT'S HOME, INCLUDING INJECTIONS, POST-OPERATIVE AND CHRONIC WOUND CARE, REHABILITATION, PHYSICAL THERAPY, INTRAVENOUS OR NUTRITION THERAPY, ETC. THESE TYPES OF FACILITIES CAN BE A LIFELINE FOR SUSCEPTIBLE PATIENTS, INCLUDING THE MEDICARE POPULATION THAT IS BOTH AT HIGHER RISK OF EMERGING SERIOUS COMPLICATIONS FROM COVID-19 AND MORE LIKELY TO ENDURE CHRONIC DISEASES WHICH IS POSSIBLY A LETHAL COMBINATION. FOR INSTANCE, IN MID-JULY 2020, JOE BIDEN THE PRESIDENT OF THE UNITED STATES ANNOUNCED AS PART OF HIS PRESIDENTIAL CAMPAIGN A POLICY PROPOSAL TO INVEST USD 775 BILLION TO EXPAND ACCESS TO HOME-BASED HEALTH CARE DELIVERY FOR THE NATION'S AGING POPULATION.
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR THE DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE CAN BE DETERMINED AS AN INTEGRATION
OF SEVERAL COMPONENTS INCLUDING INFORMATION AND
COMMUNICATION TECHNOLOGIES, HARDWARE AND SO?WARE
TECHNOLOGIES AND MEDICAL SERVICES OPERATING TOGETHER IN
ORDER TO PROVIDE REQUIRED FEATURES OR SERVICES TO USERS
TELEMEDICINE CAN BE DETERMINED AS AN INTEGRATION
OF SEVERAL COMPONENTS INCLUDING INFORMATION AND
COMMUNICATION TECHNOLOGIES, HARDWARE AND SO?WARE
TECHNOLOGIES AND MEDICAL SERVICES OPERATING TOGETHER IN
ORDER TO PROVIDE REQUIRED FEATURES OR SERVICES TO USERS
TELEMEDICINE CAN BE DETERMINED AS AN INTEGRATION
OF SEVERAL COMPONENTS INCLUDING INFORMATION AND
COMMUNICATION TECHNOLOGIES, HARDWARE AND SO?WARE
TECHNOLOGIES AND MEDICAL SERVICES OPERATING TOGETHER IN
ORDER TO PROVIDE REQUIRED FEATURES OR SERVICES TO USERS
AS SHOWN IN FIG 1. ?E UNDERLYING TECHNOLOGIES ARE SEEN
AS A BLACK BOX TO THE USERS AND THEY ARE RESPONSIBLE FOR
FACILITATING PROCESSES OF EACH PROPOSED SERVICE
.......... .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... ...........
....................................... ................................
EDUCATION AND PRACTICE FUNDAMENTALS
" INTRODUCTION TO THE PRACTICE OF TELEMEDICINE
JOHN CRAIG* AND VICTOR PATTERSON*
W
?
DEPARTMENT OF NEUROLOGY, ROYAL VICTORIA HOSPITAL, BELFAST, UK;
W
CENTRE FOR ONLINE HEALTH, UNIVERSITY OF QUEENSLAND, BRISBANE,
AUSTRALIA
SUMMARY
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE AND THE EXCHANGE OF HEALTH-CARE INFORMATION ACROSS DISTANCES. IT IS NOT
A TECHNOLOGY OR A SEPARATE OR NEW BRANCH OF MEDICINE. TELEMEDICINE EPISODES MAY BE CLASSI?ED ON THE BASIS OF:
(1) THE INTERACTION BETWEEN THE CLIENT AND THE EXPERT (I.E. REALTIME OR PRERECORDED), AND (2) THE TYPE OF
INFORMATION BEING TRANSMITTED (E.G. TEXT, AUDIO, VIDEO). MUCH OF THE TELEMEDICINE WHICH IS NOW PRACTISED IS
PERFORMED IN INDUSTRIALIZED COUNTRIES, SUCH AS THE USA, BUT THERE IS INCREASING INTEREST IN THE USE OF TELEMEDICINE
IN DEVELOPING COUNTRIES. THERE ARE BASICALLY TWO CONDITIONS UNDER WHICH TELEMEDICINE SHOULD BE CONSIDERED:
(1) WHEN THERE IS NO ALTERNATIVE (E.G. IN EMERGENCIES IN REMOTE ENVIRONMENTS), AND (2) WHEN IT IS BETTER THAN
EXISTING CONVENTIONAL SERVICES (E.G. TELERADIOLOGY FOR RURAL HOSPITALS). FOR EXAMPLE, TELEMEDICINE CAN BE EXPECTED
TO IMPROVE EQUITY OF ACCESS TO HEALTH CARE, THE QUALITY OF THAT CARE, AND THE EF?CIENCY BY WHICH IT IS DELIVERED.
RESEARCH IN TELEMEDICINE INCREASED STEADILY IN THE LATE 1990S, ALTHOUGH THE QUALITY OF THE RESEARCH COULD BE
IMPROVED-THERE HAVE BEEN FEW RANDOMIZED CONTROLLED TRIALS TO DATE.
INTRODUCTION
ONE OF THE GREAT CHALLENGES FACING HUMANKIND IN THE
THE 21ST CENTURY IS TO MAKE HIGH-QUALITY HEALTH CARE AVAILABLE
TO ALL. SUCH A VISION HAS BEEN EXPRESSED BY THE WORLD
HEALTH ORGANIZATION (WHO) IN ITS HEALTH-FOR-ALL STRATEGY
IN THE 21ST CENTURY.
1
REALIZING THIS VISION WILL BE DIF?CULT,
PERHAPS IMPOSSIBLE, BECAUSE OF THE BURDENS IMPOSED ON
A GROWING WORLD POPULATION BY OLD AND NEW DISEASES,
RISING EXPECTATIONS FOR HEALTH, AND SOCIOECONOMIC
CONDITIONS THAT HAVE, IF ANYTHING, INCREASED DISPARITIES IN
HEALTH STATUS BETWEEN AND WITHIN COUNTRIES.
TRADITIONALLY, PART OF THE DIF?CULTY IN ACHIEVING
EQUITABLE ACCESS TO HEALTH CARE HAS BEEN THAT THE
PROVIDER AND THE RECIPIENT MUST BE PRESENT IN THE SAME
PLACE AND AT THE SAME TIME. RECENT ADVANCES IN
INFORMATION AND COMMUNICATION TECHNOLOGIES,
HOWEVER, HAVE CREATED UNPRECEDENTED OPPORTUNITIES FOR
OVERCOMING THIS BY INCREASING THE NUMBER OF WAYS THAT
HEALTH CARE CAN BE DELIVERED. THIS APPLIES BOTH TO
DEVELOPING COUNTRIES WITH WEAK OR UNSTABLE ECONOMIES
AND TO INDUSTRIALIZED COUNTRIES. THE POSSIBILITIES FOR
USING INFORMATION AND COMMUNICATION TECHNOLOGIES TO
IMPROVE HEALTH-CARE DELIVERY ('HEALTH TELEMATICS') ARE
INCREASINGLY BEING RECOGNIZED. THE WHO HAS STATED THAT
WITH REGARD TO ITS HEALTH-FOR-ALL STRATEGY IT RECOMMENDS
THAT THE WHO AND ITS MEMBER STATES SHOULD:
INTEGRATE THE APPROPRIATE USE OF HEALTH TELEMATICS IN
THE OVERALL POLICY AND STRATEGY FOR THE ATTAINMENT OF
HEALTH FOR ALL IN THE 21ST CENTURY, THUS FUL?LLING THE
VISION OF A WORLD IN WHICH THE BENE?TS OF SCIENCE,
TECHNOLOGY AND PUBLIC HEALTH DEVELOPMENT ARE MADE
EQUITABLY AVAILABLE TO ALL PEOPLE EVERYWHERE.
2
SUCH A COMMITMENT TO IMPROVE HEALTH-CARE DELIVERY,
BY UTILIZING INFORMATION AND TELECOMMUNICATIONS
TECHNOLOGIES, IS ALSO BEING CONSIDERED BY THOSE WITH THE
?NANCIAL MEANS TO DO SO, FOR EXAMPLE, THE PARTICIPANTS
IN VARIOUS EUROPEAN COMMISSION PROJECTS. AT THE
NATIONAL AND SUBNATIONAL LEVEL, THERE IS ALSO EVIDENCE OF
GOVERNMENTAL INTEREST IN THE BENE?TS THAT THESE
TECHNOLOGIES MIGHT BRING TO HEALTH CARE. FOR EXAMPLE,
IN THE UK, INFORMATION TECHNOLOGY INCLUDING
TELEMEDICINE IS AT THE HEART OF THE GOVERNMENT'S
STRATEGY TO MODERNIZE AND IMPROVE THE NHS.
3
TELEMEDICINE, THE AREA WHERE MEDICINE AND INFOR-
MATION AND TELECOMMUNICATIONS TECHNOLOGY MEET, IS
PROBABLY THE PART OF THIS REVOLUTION THAT COULD HAVE THE
GREATEST IMPACT ON HEALTHCARE DELIBASED ON SERVICE, THE MARKET IS FRAGMENTED INTO TELE-CONSULTING, TELE-MONITORING, AND TELE-EDUCATION. THE TELE-CONSULTING SEGMENT GENERATED MORE THAN 45% REVENUE IN 2020. THE MARKET IS EXPECTED TO GROW AT A SIGNIFICANT RATE DURING THE FORECAST PERIOD. AS IT PERMITS PATIENTS TO HAVE APPOINTMENTS WITH EXPERTS AT ANY INSTANCE OF TIME, WITHOUT ANY WAITING PERIODBASED ON DEPLOYMENT, THE MARKET IS FRAGMENTED INTO CLOUD-BASED AND ON-PREMISES. THE CLOUD-BASED SEGMENT ACCOUNTED FOR THE MAJOR REVENUE PORTION IN 2020. AS, THE COMPANIES SUCH AS QUALCOMM LIFE INC., OPZOON TECHNOLOGY CO., LTD., AND FIBOCOM WIRELESS INC. ARE INVOLVED IN THE SALES OF WIRELESS AND CLOUD-BASED TECHNOLOGY PRODUCTS USED IN THE HEALTHCARE INDUSTRYBASED ON PLATFORM, THE MARKET IS FRAGMENTED INTO STANDALONE AND INTEGRATED. THE INTEGRATED PLATFORM SEGMENT ACCOUNTED FOR THE MAJOR REVENUE PORTION IN 2020. THE SECTOR IS ANTICIPATED TO OBSERVE SIGNIFICANT GROWTH IN THE UPCOMING YEARS AS WHEN PAYERS AND OTHER STAKEHOLDERS MAKE SIGNIFICANT INVESTMENTS, THEY PRODUCE ADDITIONAL PROFITS.
THE MAIN OBJECTIVE WHICH IS DRIVING THE IMPLEMENTATION OF HOME-BASED POINT OF CARE IS THE GROWTH IN COVID-19 CASES AS IT HAS PROVEN ITSELF AS A HEALTH CARE REVOLUTION CATALYST, BOOSTING THE BENEFITS AND GROWTH POTENTIAL OF THE HOME-BASED POINT OF THE CARE INDUSTRY. WHILE WIDER CONSUMPTION OF HOME-BASED POINT OF CARE SERVICES CONTINUES TO FACE A MULTITUDE OF CHALLENGES MOST NOTABLY FROM A COST, COVERAGE, AND POLICY PERSPECTIVE. THE FUTURE OF HOME-BASED POINT OF CARE IS BRIGHTER THAN EVER BEFORE.
BASED ON THE PRODUCTS, THE MARKET IS FRAGMENTED THERAPEUTIC, DIAGNOSTIC, AND MOBILITY ASSIST. THE DIABETIC CARE UNIT IN THE DIAGNOSTIC SEGMENT IS ANTICIPATED TO OBSERVE LUCRATIVE DUE TO THE SUCCESS OF HAND-HELD GLUCOSE METERS, OWING TO THEIR HIGH ACCEPTANCE RATE AMONG THE POPULATION ACROSS THE WORLD.
BASED ON THE SERVICES, THE MARKET IS BIFURCATED INTO PHYSICIAN/PRIMARY CARE, NURSING CARE, PHYSICAL/OCCUPATIONAL/ SPEECH THERAPY, NUTRITIONAL SUPPORT, HOSPICE & PALLIATIVE CARE, OTHER SKILLED HOME CARE SERVICES, AND UNSKILLED HOME-BASED CARE. THE NURSING CARE SEGMENT GRABBED THE MAJOR MARKET DUE TO THE INCREASE IN CHRONIC DISEASES AND GERIATRIC POPULATION WORLDWIDE.
BASED ON THE PURPOSE, THE MARKET IS BIFURCATED INTO CHRONIC DISEASES, INFECTIOUS DISEASES, PSYCHOLOGICAL DISEASES, GERIATRIC DISEASES, PAEDIATRIC DISEASES, FERTILITY TREATMENTS & PREGNANCY, INTENSIVE & CRITICAL CARE, INJURIES & ACCIDENTAL DEFORMITY, NUTRITION & GENERAL CONSULTANCY, AND OTHERS. THE CHRONIC DISEASES SECTOR GRABBED THE MAJOR MARKET DUE TO THE GROWING NUMBER OF PATIENTS SUFFERING FROM CHRONIC OR ACUTE DISEASES LIKE URINARY INCONTINENCE OR END-STAGE RENAL DISEASE (ESRD) WHICH DEMAND ADVANCED DEVICES FOR THEIR TREATMENT.
BASED ON THE TYPES, THE MARKET IS BIFURCATED INTO HOME-BASED HEALTHCARE MONITORING, HOME-BASED HEALTHCARE SERVICES, AND HOME-BASED HEALTHCARE SOFTWARE SOLUTIONS. THE HOME-BASED SOFTWARE SOLUTIONS SECTOR GRABBED THE MAJOR MARKET AS IT OFFERS A SOLUTION TO REORGANIZE OPERATIONS, THEREBY HELPING COMPANIES KEEP WELL-INFORMED OF REGULATORY AND GUIDELINE CHANGES AND IMPROVE PATIENT CARE.
FOR A BETTER UNDERSTANDING OF THE MARKET ADOPTION OF THE HOME-BASED POINT OF CARE, THE MARKET IS ANALYZED BASED ON ITS WORLDWIDE PRESENCE IN THE COUNTRIES SUCH AS NORTH AMERICA (UNITED STATES, CANADA, AND REST OF NORTH AMERICA), EUROPE (GERMANY, FRANCE, ITALY, SPAIN, UNITED KINGDOM AND REST OF EUROPE), ASIA-PACIFIC (CHINA, JAPAN, INDIA, AUSTRALIA AND REST OF APAC), AND REST OF WORLD. NORTH AMERICA CONSTITUTES A MAJOR MARKET FOR THE HOME-BASED POINT OF CARE INDUSTRY AND GENERATED THE MAXIMUM REVENUE IN 2020 OWING TO THE PRESENCE OF KEY COMPANIES AND HEALTHCARE INFRASTRUCTURE WITH THE HIGHEST SPENDING ON HEALTHCARE.
SOME OF THE MAJOR PLAYERS OPERATING IN THE MARKET INCLUDE SIEMENS HEALTHINEERS, ABBOTT LABORATORIES, DANAHER CORPORATION, JOHNSON & JOHNSON, NOVA BIOMEDICAL, F. HOFFMANN-LA ROCHE AG, TRINITY BIOTECH, QIAGEN, BECTON DICKINSON (BD), BIOMERIEUX SA. SEVERAL M&AS ALONG WITH PARTNERSHIPS HAVE BEEN UNDERTAKEN BY THESE PLAYERS TO DEVELOP A HOME-BASED POINT OF CARE MARKET.
