Pakistan Needs E-healing

With growing penetration of the Internet in things in Pakistan, telemedicine is the medical prescription to achieve the so-far elusive goal of “healthcare for all,” writes DR MARIA AHMED QURESHI

Last year, the federal government evolved its first-ever Digital Policy; involving different sectors. It incorporated a health section to facilitate and assist the Ministry of National Health Regulations & Coordination to develop its e-health policy in promoting telemedicine, digitised hospitals, ICT tools and technologies; the progress of which remains blurred to date. The current landscape dictates that in Pakistan at large, the provision of total primary medical care in the rural areas remains questionable whereas even secondary and tertiary medical care is not uniformly available, even in suburban and urban areas.  The failure of various health programmes in the country in bridging the gap to provide quality services across Pakistan, by impregnating our health with technology to give birth to “telehealth & telemedicine” may be the best-proposed solution to mitigate the considerable strain faced by our healthcare systems.

It is high time that the government steps up to own these programs and make them sustainable rather than relying on a few existing, scattered and disjointed project-based funded programmes. The current conventional public-sector health infrastructure in Pakistan consists of 220,829 registered doctors, 22,595 dentists and 108,474 nurses; meaning there is one doctor available for every 963 persons and one dentist for every 9,413 persons. There are 1,279 public-sector hospitals with 52,671 Basic Health Units, 686 Rural Health Centres and 5,671 dispensaries.

In Pakistan, even though a few scattered telemedicine initiatives are underway in public and private sectors, such as docthers, edoctor, Aman Telehealth Doctory, these programmes mainly focus at the re-introduction of female doctors who are unable to continue working due to their family life commitments. They help them work from the vicinity of their homes and are mostly donor-funded and disjointed.  With more than 163 million mobile phone users, 73 million 3G/4G subscribers and 75 million broadband users in Pakistan, Information Technology can open doors of quality health to every underserved household.

Telehealth services could potentially help health systems cope better with the growing demands arising from changing population dynamics, the need for chronic disease management and ever-increasing consumer expectations

What we need is an integrated telehealth system, with government ownership, involving public and private sector hospitals. A platform where not only basic primary but also tertiary level quality clinical support is provided by overcoming geographical barriers using ICT to improve health outcomes.

“Telehealth involves the use of telecommunications and virtual technology to deliver health care outside of traditional health-care facilities,”whereas according to the World Health Organization, “Telemedicine is the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication 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.” Luring doctors, especially specialists, to practise in suburban areas remains a challenge, whereas, in contrast, computer literacy is booming. Pakistan is ranked fourth for freelance development, with more than 2000 IT companies and call centres and 20,000 IT graduates every year. It will be easier to set up an excellent telecommunication infrastructure to provide an integrated quality health system for all than building an excessive and costly infrastructure; equipping and enticing doctors to work there.   Telehealth services are not intended to replace the need for in-person consultations, but to substitute in-person consultation when clinically appropriate. In countries such as Australia, the government and state health services promote telehealth as a solution to the challenge of delivering health services across the geographically dispersed country.

American Telemedicine Association estimates that more than half of the US hospitals use some form of telehealth today, with about 200 networks connecting 3,000 rural sites to large metropolitan speciality medical centres. Telehealth enhances healthcare delivery in underserved communities by facilitating access to diagnostic tests as well as increasing communication between primary care practitioners and specialists in tertiary care centres. Telehealth is increasingly being recognised as an essential tool to achieve care coordination and improvements in health disparity outcomes to ensure that patients receive proper care, at the appropriate site (closest to where they live and work, aided by electronic links) by a suitable provider (based on explicit and rational triage criteria) while avoiding duplication and waste (using uniform protocols for diagnostics and procedures).

Telehealth may improve accessibility and timeliness to primary, secondary and tertiary care for the sub-rural and rural patients, women or merely those not able to access a health care facility. Telehealth also has the capability of extending care for chronic diseases to the home, consequently decreasing emergency department visits, hospitalisation and overall mortality. Rapidly emerging adoption of IT, such as that seen in prevalent technologies (e.g. tablets, mobile phones, body sensors), into telehealth service, adds a more significant benefit and convenience. Telehealth services also allow health consumers to access health education and support for self-management through the Internet, via their home computers or wireless devices. Patients can obtain personalised education materials and coaching and may contribute to online discussions and support groups as additional means of managing their health.

The real challenge in telehealth today lies in creating sustainable, profitable business models that can meet the needs of governments, clinical practice, patients and services operators. Telehealth could be organised to play a significant role in enabling changes to the health service models and delivery required to respond to the growing demand for healthcare. Applications of telehealth have become common throughout the healthcare sector, including diagnosis, care management, and patient education in dentistry, ophthalmology, chronic disease monitoring, counselling, physical therapy, and other areas and disciplines. Health information can be collected in the digitised form such as heart/lung sounds, blood pressure, blood glucose levels, electrocardiographic signals and can be easily transferred to a healthcare professional without requiring his/her physical presence for examination. Linking patients and physicians through the internet may increase the connection of patients in supervising and documenting their healthcare, processes that may stimulate patients and contribute to improving health.

In hospital settings, it may ensure more appropriate patient admissions and possibly reduced the length of stay or improved patient outcomes and decreased costs of patient travel.  Through its mobility, it can provide urgently needed healthcare. Ambulances and emergency rescue teams equipped with telemetry equipment to allow physiological data to be transmitted to a nearby hospital for interpretation and treatment to begin even before the patient arrives at the hospital.  Telehealth services could potentially help health systems cope better with the growing demands arising from changing population dynamics, the need for chronic disease management and ever-increasing consumer expectations.

Our health system is overburdened and constrained for resources. This is not a situation that is going to change anytime soon, so we need to come up with ways of working that enable us to do more with less. Reversal of issues of the “brain drain” or “flight or human capital”, geographical constraints by cross-site or intercountry collaborations. Telehealth calls for all stakeholder’s such as community leaders, health professionals, academic institutions and educators, health administrators and policy-makers to build an alliance to make changes necessary to reflect and react to our societal needs.  Telehealth might just be a small step for IT but it a giant leap for Healthcare which may aid in revolutionizing healthcare in Pakistan.

  • Dr Maria Ahmed Qureshi specialises in Health Services Management from Griffith University, Australia.

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