Telehealth in low-resource settings: In conversation
INTERNATIONAL HOSPITAL FEDERATION, Geneva, Switzerland
Article by Victoria Del Pozo from the International Hospital Federation blog:
Dr Sai Praveen Haranath, Lung and Critical Care specialist and part of the leadership of the Apollo Hospitals Telehealth Initiative, sat down with Sharon Allen CEO of the World Telehealth Initiative (WTI), for a conversation on the use of telehealth in low-resource settings; how can virtual care help overcome barriers and ensure that critical healthcare reaches those in need? Dr Sai, who chairs the IHF Telehealth Special Interest Group, is based in India but sees ICU patients in the US virtually, as well as monitoring patients remotely from all over India through the Apollo telehealth division.
“What we have seen through the IHF is that there’s great interest in delivering care remotely. Many people have realized that through this medium, you’re able to cross barriers and reach those who cannot be reached otherwise. It has huge potential for underserved populations. We can support patients in ambulances, emergency rooms, wards, or even at home and you can give them access to experts who they otherwise might not see”.
Sharon Allen described how WTI started as the vision of Dr Yulun Wang, who has been in surgical robotics for his entire career. With the knowledge that half the world’s population does not have access to adequate healthcare, he knew the technology he had developed could help deliver necessary expertise where it’s needed.
“WTI leverages volunteer medical experts and telehealth to deliver care to impoverished areas of the world. We use advanced telehealth technology, yet we can establish programmes in vulnerable communities for low to no cost. And we do that because Teladoc Health donates their network access and their telehealth devices to WTI. Our medical experts also donate their time and expertise, which allows us to serve very low resource communities for free”.
As an example, Sharon shared the compelling story of Julian, a three-year-old boy from rural Argentina, who had weakness in his limbs, and was having difficulty breathing. WTI connected his local clinic with a pediatric neurologist, who worked with on-site colleagues to review MRI images and was able to point out tiny lesions in Julian’s nerves. With this expertise, they were able to diagnose and prescribe medications.
“He rapidly improved and started breathing on his own. Now I’m told he’s at home playing with his five siblings”.
Is lack of technology a barrier in low-resource settings?
Dr. Sai explained that all patients want to know if you understand them and their health issue, regardless of the setting. Are you able to communicate with them effectively so that you can bring about effective treatment ?
“People have the notion that tech is difficult. But to be honest you see people all around the world using their phones for various services. Mobile phones have become integral to our lives and a lot of telehealth is being done through that. What I realized is that technology is not a barrier anymore, what might be a barrier is access to bandwidth and data”.
Sharon added that in many countries internet access is becoming increasingly available thanks to the efforts of government and NGOs.
"With 5G and Starlink, WTI can connect clinicians requesting support to providers that have that required expertise. Since the start of the conflict in Ukraine, our partners have primarily been using Starlink and it has been tremendous. One example is a patient requiring neurosurgery. The team of neurosurgeons in Ukraine were familiar with a new procedure that would yield the best outcome but hadn't ever done it. They requested virtual support by a neurosurgeon familiar with that operation, who gave surgical mentoring throughout the procedure, leading to a very successful result for the patient" - Sharon shared. She also added how one of their devices at a referral hospital in Kenya was loaded into a pickup, and driven for hours to a soccer field in a remote town, where a health fair enabled 300 people to receive care they wouldn’t have otherwise accessed.
Telehealth to reduce financial barriers
Although the initial investment in telehealth can be high, the technology saves patients time and money. Dr. Sai highlighted Apollo’s telehealth facility in the Himalayas, which offers diagnostics for remote communities including a centre offering ECGs.
“That has helped us to triage relatively quickly patients who need urgent assistance. For these isolated communities, we have realized that when a patient moves from a village to the town, it is not just a patient, but 7 other people accompanying them, so this triage reduces the substantial costs of seeking medical care for isolated populations”.
Sharon added that most of the patients served through WTI have no capacity to pay for healthcare. To expand their reach they created hub and spoke models which build local expertise. The hub clinicians increase their skills and knowledge in a train the trainer model, then can then support more remote clinics and hospitals and outposts. All of this reduces costly patient transfers and equips local clinicians to manage more cases independently.
Supporting workforce
Healthcare providers around the world face workforce shortages, and hospitals everywhere struggle with efficiency with backlogs, unnecessary costs, as well as morbidity and mortality because patients are not in the right place at the right time. Dr Sai sees telehealth as one of the solutions.
“The need for global healthcare professionals will only increase. If we make the existing workforce more efficient, especially in low-resource areas, they’re less likely to leave, avoiding further brain drain. Technology keeps improving and allows care providers to provide excellent care at a distance. It allows doctors to stay in urban hubs while connecting with isolated communities. For example, we have volunteers in the villages who take smartphones and go to the patient’s house in the village. And then I just do consults in a row, like I was just seeing them in one room”.
Patient and clinician mistrust of telehealth
When it comes to patient trust, Dr. Sai has found that most patients focus on the outcome rather than the delivery method.
“You know, when you’re on an airplane, you don’t know who the pilot is, nor who filled the fuel in the plane. And then it turns out that you’re safe and you’re moving from one place to the other”.
Sharon shared a story of the positive reception of telehealth by patients in one of the remote WTI sites.
“We work in the very remote village of Opoji, Nigeria and it was very difficult to get our devices there as there were bandits on the road. The patients in this very remote village were moved to tears at the sight of advanced healthcare tools reaching their community, creating lasting trust and appreciation. We had medical students go into the community with their cell phones and beam into our devices in Santa Barbara in our Technical Innovation Center and they would show how you can connect anywhere. They demonstrated this to village residents to create an educational environment”.
From the perspective of telehealth care providers, Sharon points out the positive experience of many doctors, based on a very rich engagement between providers in different locations.
“For example, we’re doing POCUS training with many of our partner sites. A group of emergency room physicians from the US share the curriculum that they use with new doctors. Doctors in the partner sites learn how to diagnose pneumonia, one of the primary causes of death in sub-Saharan Africa for children under 5, and how to diagnose internal bleeding. We’re able to teach this in a live simulation of training. The teachers in Florida can see the ultrasound images via telehealth because of the interoperability of the Butterfly diagnostic device”.
The technology of telehealth is changing so rapidly that we are only at the start of the telehealth journey. This conversation highlights telehealth’s potential to expand care access, reduce costs, and support healthcare workers in low-resource settings, delivering vital support to patients who would otherwise struggle to receive care.
“We are at a critical juncture where we can make healthcare delivery far more efficient and effective and actually make a meaningful and sustainable impact on global health disparities”.
As mentioned by Dr Sai, Apollo Hospitals has strong leadership, vision and direction in its Telehealth work, including from Dr Sangita Reddy, Joint Managing Director of the Group. The advent of enhanced patient-monitoring using low-cost wearables, drones to deliver medicines, expanding clinical service delivery to other countries including the U.S. and many other locations as well as being a technology resource provider for small and large hospital systems globally is all part of this commitment to bringing excellence in care everywhere.