Contents Introduction
Only a few of months ago, in early 2020, no one could have predicted the range and scope, and the fundamental effects of COVID-19 on human society. Rapid spread of COVID-19 (see Fig. 1 ) have prompted governments to issue mandatory lockdown which was done in an attempt to limit the spread of the virus, the only method which at the time was considered effective. A dramatic side effect of lockdown has led to a global economic crisis (see Fig. 2 ). Although, as of 2020, digital health has been around for some years, it has become evident that it represents a viable solution to limiting (often superfluous) physical contacts with risk group. Digital health is perhaps the only solution that could quickly and effectively be developed and deployed. Moreover, it is clear that part of the impact of the COVID-19 crisis could have been softened if one could have altogether avoided a visit to a doctor, a clinic or a hospital. Arguably, the ability to reach a provider as symptoms begin to appear would have drastically reduced the number of emergency doctor & hospital visits. As a response to the COVID pandemic, companies and schools adopt a ‘smart working solution’, which include biosensors that help monitor infected patients, and various telemedicine solutions that have limited contact with, e.g., medical staff. That trend continues to gain momentum [2] , [3] , [5] , [10] , [11] , [16] . Remote medical consultation is becoming an increasingly attractive option. Digital health is proving to be a valuable tool in the fight against the spread of the virus. Telehealth has shrunk the distance between patients and doctors; it allowed patients, especially symptomatic patients, to stay at home and communicate with the doctors through virtual channels, helping to reduce contagion [1] , [4] , [12] , [13] , [17] . In fact, the pandemic has necessitated telehealth to render medical advice whereby limiting physical contact & the risk of contagion. Due to the Coronavirus, applications of technology, including biosensors, telecommunications, cloud solutions and artificial intelligence have preceded regulatory actions. In some corners of the globe this has created a ‘wag the dog’ paradigm, where diagnostic and prescription solely based on a telehealth paradigm has become a standard of care. Based on historical precedence, it’s not likely that many regulators (of the 193 UN-member states) will intervene to intercede, stymie or halt what is surely is becoming a standard process involving patient care.
Fig. 3 compares the number of deaths in Italy in 2020 (red line) against each of the five preceding years. Soon after the detection of the first COVID-19 case (21 st of February), daily deaths have increased rapidly. In less than four weeks, death rates have almost tripled from 477 in the month preceding February 21 st to 1,338 to between February 21 st and March 21 st . Death rates prior to the COVID-19 outbreak were fairly similar to deaths in 2016. Assuming that mortality trends would have continued, estimated deaths attributable to COVID-19 have exceeded 15,000 people, or about 0.1% of the total population during the period of February 21 st and March 28, 2020 (the last day covered in the dataset.) Around its peak of March 21 st , the daily death rate was just under 10 per 100,000 inhabitants. In simulations involving the UK population, the authors of [15] has predicted that in the absence of changes in the delivery of healthcare, COVID-19 would result in 10 deaths per 100,000 inhabitants per day over the following few months.
Moreover, the vast majority of Coronavirus deaths are occurring in hospitals. For example, according to the data, which covered seven days in UK (see Fig. 4 ), 501 of the 539 deaths have occurred in the hospitals (but some have occurred in hospice-care, and homecare.) Additionally, Coronavirus is a mild illness for most who are affected; it is estimated that only about one in twenty cases develop symptoms that require hospitalization. This is another factor contributing to the importance of care-at-home rather than hospitalization. There have been cases involving health workers, younger adults and children, but the virus has - as expected - preyed largely on older people, particularly the frail and those with existing health problems (see Fig. 5 ). For example, data from hospitals, in England, during the week ending on the 24 th of April, more than nine in ten deaths have been in the over-60 cohort. The number of non-hospital deaths remains similar. The Office for National Statistics (ONS) has analyzed the effects of pre-existing health conditions. Again, more than nine out of ten fell into a risky category. Heart disease was the most common risk factor.
Fig. 6 reports the estimated effects of COVID-19 on the average daily deaths per 100,000 inhabitants, separately for men and women, and across different age groups. Effects for individuals below fifty years of age are not reported, as these are not statistically significant. Mortality increases exponentially with age, but at much higher levels for men: the effects of COVID-19 for men are three times those of women. These results confirm that gender differences play a crucial role in understanding the distribution of risk from the epidemic [14] .
Telehealth & medical devices in patient homecare
As mentioned earlier, telehealth isn’t altogether a new concept. According to the American Hospital Association (AHA) report (2018), 75 percent of hospitals partially or fully implement a subset of telemedicine capabilities. However, with a few exceptions, projects related to telemedicine tended to be small and limited in scope to, e.g., support multi-party video conferencing. Experience from those nascent, boutique projects and small-scale utilization have accomplished the following
It amplified the need for standardization.
Gained broad acceptance from the medical community and patients.
Brought recognition that advisement over telehealth channels consist of paid service.
The saving potential achieved with telemedicine became apparent.
Highlighted the potential for additional business for healthcare providers.
Experience gained over the past few years have proved that telemedicine can indeed work in favor of all stakeholders [6] – [9] . Currently, remote visits serve more to skim through the most urgent requests aimed to dish out preliminary advice and/or to follow up with patients, but as of yet, it’s rather uncommon that remote visits are used to triage patients, determine a diagnosis and prescribe medicine and plan for treatment. As technology matures and with that, advancement in accurate and affordable (wearable) sensors and other medical monitoring devices, and an overall improvements in sensor-based diagnostics, remote visits that result in ‘action’ like diagnoses cum prescriptions will become more common. Based on recent history, it’s safe to assume that baseline technology together with artificial intelligence (AI) will allow a physician to analyze data, make diagnoses and prescribe effective treatments.
The state of telehealth
Telehealth can be an effective way to contain the spread of coronavirus while still providing essential primary care. Wearable personal ‘IoT’ devices can track vital signs and alert when an outlying conditions are detected. With the aid of chatbots an ‘initial triage’ based on data gathered by wearable sensors & symptoms identified by patients can be made. In countries where cost of healthcare is high, it’s important to ensure telehealth will be covered by insurance. Implementation of telehealth require a certain level of technical literacy to operate, reliable internet and/or robust cellular connectivity. As medicine is one of the most heavily-regulated sectors, doctors typically can only provide medical care to patients who live within a commutable distance. Regulators could not have envisioned a world where telehealth would be available (see Fig. 7 ). We argue that the need for telehelath solutions will transform the healthcare sector provided solutions are simple to operate serve a vital purpose for a large percentage of the populous.
The global telehealth market is projected to reach 55.6 billion USD by 2025 from 25.4 billion USD in 2020. Growth in the telehealth market is mainly driven by factors such as the rise of aging populations, the need to expand healthcare access, the growing prevalence of chronic disease, a shortage of physicians, advancements in telecommunications, and government support & raising awareness (see Fig. 8 ).
Integration with health information systems
The spread and magnitude of COVID-19 has accelerated the development and use of COVID-specific medical applications. This include remote monitoring of patient conditions in real time. The experience gathered from the COVID-specific applications are valuable and undoubtedly will become more so in a post-pandemic world. Developing standards and guidelines relating to the uses and applications of telemedicine are necessary to meet the challenges to follow. Continuing to invest in telehealth together with an overall strategy to expand adoption of telemedicine are critical to success. Business and governments will find the need to invest in the development of new technology to address a wide-range of healthcare services. Those components will invariably include; digital marketing, a simplified method to on-boarding new customers, integrating and securing communications channels, simplifying access to patients’ healthcare records while keeping the data safe & secure, chronic illness management system (e.g., diabetes, hypertension, COPD, etc.), mental health and overall mental wellness, infectious disease management system, Lifestyle and the promotion of healthy habits, simplified and secure payment system, scheduling and reminders, prescriptions management, rehabilitation, post-operation, home recovery.
Perhaps paradoxically, the COVID-19 emergency had caused a reduction of medical visits, fewer elective procedures, postponement of treatments, etc. Consequently, providers have experienced less business, and a decrease in revenues (while cost of business remained largely fixed.) Built into telemedicine is the ability to increase providers’ utilization and with that, billable visits. It is estimated that approximately 51 percent of providers (doctors, nurses, etc.) worked remotely during the COVID emergency. This alone makes it imperative to increase the development and utilization of telemedicine. In a universal public healthcare system, such as the Canadian healthcare system, telehealth must be a part of healthcare where access to standardized electronic medical records is an absolute necessity. Mobile computing, i.e., iPhone & Android, has become the standard access endpoint to end users (especially the patient). Therefore, demand for healthcare-related mobile applications will remain robust. Indeed, mobile applications will allow for continuous interaction between patients, providers and administrators. This will increase utilization of wireless channels. Accordingly, it’s likely that increase in mobile utilization will necessitate increase capacity & modifications to current architecture to meet the demand from healthcare-related usage.
Conclusion
The time for digital healthcare that include telehealth, remote patient monitoring and supporting applications has clearly arrived. Explosive growth in online business will continue to grow around the globe. The days of hesitant online consumer are over. In spite of early resistant, we buy shoes online without trying them first. We certainly don’t think twice before making an online purchase, making a payment, calling Uber or making airline reservations, and more and more, we do those things on our iPhones and Androids. This hasn’t happened overnight; the trend has been around for at least two decades. Trust in a functioning and secure payment systems was build over many years; it’s been more than two decades since online payments appeared on the scene. Sure, we still go to the store and to the bank but not as often as we once did. We still do go to the shops to conduct commercial transactions, maybe, but not always as a first choice. There is no reason that telehealth won’t become a standard tool in healthcare. But healthcare is a sensitive topic. It is highly resistant to change. When it comes to our health, we still want to see a doctor. Telehealth does not replace the ‘seeing of the doctor’ part. Telehealth merely enhances the experience, augment the mode of interaction with providers and allows for a fuller spectrum of information to be exchanged, absorbed, analyzed and disseminated. Trust will be built over time provided we don’t take privacy and security lightly. The providers of telehealth and custodians of healthcare data are obliged by law to adhere to privacy standards lest they will lose their credibility and their license will be revoked. To that end, regular audits of business practices and processes will be conducted and annual certificates and licenses be issued by trusted auditing agencies.