Extending the reach of medical tourism into pre and post surgical care for clients is now possible. Indeed, the new information and communication technology on the market added to the desire of clients to have a more personalized service in the field of global health services make it attainable using telehealth.
The substantial growth in the medical tourism and the globalization of medicine, in general, has introduced new challenges and opportunities to provide higher quality services to clients. As clients realize access to medical care has expanded and medical choices have broadened beyond the boarders of their local providers.
Clients demand and deserve a higher quality and more personalized service. One approach has come to the forefront is the application of telehealth to deliver personalized health services to clients. Although these technologies are not routinely used in the field of medical tourism at this point in time, their application and eventual integration as medical tourism tools offer the potential to expand the services of the medical tourism industry. This article summarizes the potential of telehealth in the field of medical tourism.
What is Telehealth?
Telehealth is broadly defined as the use of electronic and communication technologies to provide and support health care when distance separates the participants. It is a system connecting primary care physicians, providers, specialists and clients. In other words, telehealth provides health information from a remote location to a client. Basically, Telehealth allows clients to visit with physicians and health care professionals ‘live’ over video for immediate care or capture videos and still images for later consultation.
The term ‘telemedicine’ is used when medical information is transferred through interactive audiovisual media for the purpose of consulting and sometimes remote medical procedures or examinations. Remote Patient Monitoring (RPM), also called ‘telemonitoring’ however is another branch of telehealth. It is a medical practice involving remotely monitoring clients who are not at the same location as the healthcare provider. In addition to objective technological monitoring, some RPM programs include subjective questioning regarding the client’s health and comfort.
Telehealth is not a new concept. It has a surprisingly long history that began with the advent of the telephone. In 1906, Einthoven first investigated the use of electrocardiogram (EKG) transmission over telephone lines. In the 1920s, ship radios were used to link physicians with sailors to assist during medical emergencies at sea. In 1955, the Nebraska Psychiatric Institute was one of the first facilities to use closed-circuit television for healthcare purposes.
In the 1970s, paramedics in remote Alaskan and Canadian villages were able to perform lifesaving techniques while linked with hospitals in distant towns via satellite. Today, telehealth is beginning to exponentially mature with progressive advances in technology. Despite advances in technology with telehealth and its intuitive appeal to industry and clients, its use remains in an embryonic stage.
Why Would the Medical Tourism Industry Consider Telehealth?
Hallmark features of the medical tourism industry are its ability to provide high quality health care services at a reduced cost and the potential to provide greater choice to clients with respect to their health care needs. The use of telehealth services has the potential to provide these as well as empowering the client to assume a nexus of responsibility for his/her own healthcare. We envision four potential benefits of telehealth to the medical tourism industry:
- Improved Access: Telehealth can be used to bring health care services to client’s pre-and post-operative care. The access to telehealth, for example, could help stabilize a client’s condition: stabilize blood glucose levels prior to surgery, aid clients to lose body weight prior to a liposuction procedure and provide education on the upcoming surgical procedure. Patients even can be followed during the post-operative care to insure compliance to medications, rehabilitation regimens and to provide moral support
- Cost Efficiencies: Reducing or containing the cost of healthcare is one of the most important reasons for adopting telehealth technologies. Telehealth has been shown to reduce the cost of healthcare and increase the efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times and fewer or shorter hospital stays. Thus, it represents a powerful platform for the medical tourism industry to assist in reducing health care costs. The use of telehealth is generally considered positive for both patients and the economy. Through remote health monitoring, telehealth may allow countless numbers of clients to improve medical outcomes, avoid return visits to hospitals and allow them to remain productive, stay home longer and consequently incur less health care costs. The economy also benefits from the diminished need to transport patients to other facilities when a health care specialist is needed
- Client Demand: Clients want telehealth. They want a closer interaction with the client manager, specialist abroad and other health care professions. The greatest impact of telehealth is on the patient, their family and their community. Using telehealth technologies reduces travel time and related stresses to the client. Over the past 15 years, study after study has documented client satisfaction and support for telehealth services. Such services offer patients the access to providers and medical services without the need to travel long distances. By definition, the medical tourism industry ‘spans great distances’ to assist patients with efficient and high quality medical care. Thus, the application of telehealth with the medical tourism industry offers significant promise to bridge distances in an effort to deliver a more personalized service
- After-Care: Offering services in the ‘after-care’ period has not been generally considered the domain of the medical tourism industry. It is clear that the length of hospital stays for clients are becoming increasing shorter in an effort to reduce health care costs. For example, hospital stays for coronary artery bypass grafts averaged nine days five years ago, whereas the average stay in 2010 is five days. The prolonged after-care period in the home environment often creates a situation in which patients and caregivers feel unprepared during this time and lack critical information. The after-care period often creates increased anxiety and depression for clients after the abrupt removal from the hospital environment and associated availability of sophisticated medical resources. The application of telemedicine during this critical period could serve a vital role to monitor patients: medications and vital signs, and provide education to patient and family during this critical period. Simply put, the after-care period represents a substantial market for the medical tourism industry given the availability of telemedicine
Collectively, the challenge and long-term goal for the medical tourism industry is to create a seamless and continual care model. That is, the goal would be to personalize patient care plans in order to improve the continuity of care. For example, as soon as the patient is scheduled for their surgical procedure, there needs to be telehealth communication between the destination healthcare team and patient at home to establish a personal patient care plan to prepare the patients for surgery.
After delivery of the surgery and when the patient returns to their home environment, a second personalized health care plan is initiated to assist in the post-surgical care period. The notion of the medical tourism industry personalizing health care pre-and post-surgery would be greatly facilitated by telehealth technology and would broaden the mandate of medical tourism professionals. Lastly, the client manager needs to play a vital and key role in the coordination of this process.
This individual is the gatekeeper to the process. Ideally, these individuals should have a clinical or medical background to help speak the language and actively participate in the coordination of pre- and post surgical care.
What is Remote Patient Monitoring?
The RPM approach extends between personal computers and video equipment to include medical devices that are attached to the client’s computer or other mobile devices, such as iPhone and Blackberry to assess clinical problems and health status. For example, an electronic stethoscope allows a nurse to listen to the patient’s heart and lungs. A cuff and sphygmomanometer can provide measurement and transmission of body temperature, weight, blood glucose levels and pulse oximetry with the newest generation of models.
This data could be sent to diagnostic testing facility for interpretation. These services or data can also be used to supplement the use of visiting nurses. Thus, there now exists the possibility to collect, transmit and interpret health information within the home of the client to assist clients in their preparation for medical procedures as well as in the aftercare period.
How can the medical tourism industry use RPM? The ultimate goal of RPM is to monitor the client’s physiological responses with the goal of changing behavior and then monitor the clients’ physiological responses to this altered behavioral change. From a medical tourism perspective, RPM could be a valuable tool to enhance patient compliance to different types of interventions.
That would eventually enhance the medical procedure and improve medical outcomes. We would suggest that the medical tourism industry could benefit from RPM in the following ways:
- Pre-Surgery Period: To stabilize a patient’s health status, for example blood pressure or lost of body weight, prior to undergoing a surgical procedure. The patient would need to understand that improving their health status prior to undergoing a medical procedure would likely improve their overall surgical outcome
- After-Care Period: To enhance compliance and increase education after a surgical procedure. For example, bariatric surgical procedures are known to be quite effective in reducing body weight in clients. It is also well-known patients will frequently regain the lost body weight and ‘lose’ many of the cardio-protective effects associated with weight loss. RPM could serve as a valuable tool to instruct and implement changes in dietary and exercise habits over time to assist patients in maintaining the lost body weight and thus, preserve the health benefits of their weight loss
- Better Informed Decision Making: When patient information is limited, choosing an effective treatment can be challenging. However, RPM offers a detailed picture of each patient’s situation, based on weeks – or even months – of reliable data collection. This history enables more informed treatment decisions and helps increase the chances of a better health outcome
- Financial Benefits: In pay for-performance environments RPM helps you bring more clients through the door- by improving health outcomes, increasing clinical efficiency and providing the attraction of cutting-edge technology. In addition, a strong movement is underway for policy changes that would result in reimbursement for RPM services, from both public and private payers
A Telehealth Case Study
To foster a greater understanding of the use of telehealth within a medical tourism context, we provide a case study. Client X is a man 42 years, with a body mass index of 47 kg/m2 who was referred to the pre-surgical program in April 2006 by his primary care physician after being unable to sustain weight loss and after developing multiple comorbidities. Client X has tried multiple commercial weight-loss programs but could not achieve and maintain a healthy body weight.
He has never had a bariatric procedure. He has developed numerous comorbidies despite his young age related to his weight, including type II diabetes for more than 13 years, with diabetic nephropathy, hyperlipidemia, hypertension, erectile dysfunction, gout and depression. His diabetes has been steadily worsening despite his taking multiple oral polyglycemic agents as well as insulin. Client X was considered a good candidate for a laparoscopic band procedure but needed to improve his overall health profile prior to undergoing surgery.
How could Telehealth and RMP help client X achieve his goals? The table below suggests several interventions that a clinically-trained medical tourism facilitator could accomplish to prepare client X for his bariatric procedure as well as monitor his post-operative period.
Potential Barriers to Telehealth
While Telehealth continues to evolve, there are some barriers that may prevent its widespread use and implementation. We briefly summarize some of the challenges involved with this technology.
- Access to broadband networks can still be a major issue in rural and remote communities. This is unfortunate because the populations in these areas represent target client populations for telehealth and RMP
- Issues of client privacy and protection of client health information continue to plague the industry. Not only must personal records be protected, they must be seen and believed by the general public to be totally safe from abuse or misuse. Because the electronic transmission of personal health information is critical to Telehealth and RMP, it must be safeguarded through effective and enforceable privacy legislation and meticulous monitoring
- The main concern today for the implementation and integration of home telehealth in the current health system is who will pay? There is relatively little information on the economic cost perspective, although several initial studies suggest telehealth reduces hospitalization and emergency room visits. It is unclear whether clients in the Medical Tourism industry will pay ‘out of pocket’ for this service
- Who is the trained professional that is qualified to deliver telehealth? The logical response is nurses who are specifically trained in Telehealth education. However, one of the greatest challenges the nursing profession faces is the current and projected nursing shortage. Hiring and training client managers with a clinical background will be an important next step
- Liability is an obstacle in proving telehealth. There is debate related to whether the physician and nurses would be liable for a poor patient outcome
- Despite the broad appeal of telehealth, it is unclear whether the medical tourism views telehealth as part of its mandate
The State of the Market
Despite the challenges associated with telehealth and RPM, projections for the growth projections for this market are optimistic, and much of this optimism is predicated upon the increasing demand for remote medical care. It is been estimated that nearly three-quarters of U.S. consumers say they would use telehealth. The application of personal health care holds great promise for the medical tourism industry.
Just as the medical tourism seeks to reduce costs of medical procedures for clients, the driving force, at least initially, underlying telehealth will be its potential to lowering costs. However, it is important to keep in mind that the Medical Tourism industry should not become intoxicated with the sexiness of the technology.
The technology is the means to an end. The end is the ability of telehealth and RPM to induce behavioral change in patients in the management of their acute and chronic disease processes with the ultimate goal of personalizing health care.
About the Author
Dr. Antonia Arnaert is the President and CEO of Debson Medical Tourism Inc. She has an active interest in the development of telehealth for patients with a chronic or life threatening disease, and for aftercare to patients who had surgery. She is currently pursuing research activities in these areas both nationally and internationally. After earning a bachelor’s degree of science in nursing, a master’s degree in public administrations, and master’s and doctorate in public health, she worked on clinical research operatives in Canada.
