TeleMedicine

Unless it’s done carefully, the rise of telehealth could widen health disparities

The Covid-19 pandemic has pushed telehealth — the remote provision of health care resources, tools, and consultation, usually via digital technologies — from the backwaters of medicine to its leading edge.

Though novel to some health care providers, and considered impractical by others, telehealth will likely endure — and become even more appealing — after the Covid-19 pandemic has faded away. We are concerned that this crisis-driven acceleration in the adoption of virtual visits and use of algorithmic tools will have uncertain implications for the equitable distribution of health resources and will widen racial and class-based disparities in health.

The changes that have made possible the wider use of telehealth appear to be temporary. For instance, health insurers, who once declined to fully reimburse virtual visits to physicians, nurse practitioners, and other health providers, are now making exceptions expressly tied to the nature of the pandemic. Yet research and theory from the social sciences on institutional change would predict that there may not be a clear-cut return to “normal” once this crisis is over.

The adaptation to Covid-19 has realigned the power and positions of physicians, nurses, insurance companies, hospitals, and telehealth startups in providing health services to different communities. Providers are establishing new policies and automated systems around triage, virtual visits, and infection control that may become taken-for-granted work routines going forward. Such practices may be laying the foundation for opportunism in the expansion of telehealth markets above and beyond their value in treating disease and saving lives by allowing compensation for unnecessary visits.

Related: 

Telehealth is a ‘silver lining’ of the pandemic, but implementing it permanently won’t be easy

For some time, technology companies have sought to disrupt the health sector with algorithms and other patient-centered digital innovations. These companies are now rushing to consolidate their positions before the opportunities presented by the pandemic abate.

Some providers and hospitals, attracted by potential reductions in cost and in potential improvements in patients’ health outcomes, were early adopters of virtual visits and other telehealth technologies. With the emergence of Covid-19, providers who had once been prudently looking for an evidence-based way to add value to their practices have been pushed into rapidly developing telehealth strategies to keep their practices afloat. Academic medical centers that had previously piloted telehealth as a strategy to expand their referrals or to decrease readmissions are now leveraging this infrastructure to more intentionally maintain contact with patients who have been seen in their outpatient offices.

There’s no question that the expansion of telehealth could be a force for good. These changes may save lives during this crisis by keeping patients out of health care settings where exposure to Covid-19 may be high. In the post-pandemic era, they could provide greater access and convenience for some patients. But they could also worsen health disparities down the road if not implemented carefully.

In its earliest days, one of telehealth’s missions was to ensure greater access to health care services by populations that otherwise would go without proper or timely care and consultation, such as those who are incarcerated or who live in rural areas. Now it is being used as a tool to supplant in-person visits and expand patient markets, partly in response to consumer demand for convenience and efficiency. This emphasis on expanding patient markets and responding to well-resourced consumers’ demand may put marginalized groups with poor health, no health insurance, or few digital resources at risk.

A market-driven, consumer-centered vision of telehealth could have negative implications for marginalized groups that already face discrimination during in-person medical encounters. Marginalized racial and ethnic minorities are more likely to report discrimination within health care settings, influencing their willingness to trust providers and seek medical attention early.

Discrimination and mistrust could be magnified in virtual doctor-patient encounters, in which patients may not feel they can fully communicate and providers may be less mindful of guarding against implicit bias based on attributes such as race, ethnicity, or educational status.

The potential for racism and class bias to be encoded into telehealth algorithms is also worrisome. Predictive tools are imperfect — although they may be able to predict average patterns across groups, they can neither fully account for the complexity of individuals nor incorporate subtle variables that may assist in the identification and treatment of disease. While doctors misuse of these algorithms is mitigated by clinical judgement and training, a patients’ uninformed use of such algorithms in lieu of seeking professional medical advice could be harmful. This is particularly true of patients who belong to social groups underrepresented in algorithmic data.

Hospitals, insurers, policymakers, and health care professionals must carefully consider how the telehealth policies and routines they implement might have durable — and potentially harmful — reverberations. Research into the costs and benefits of specific telehealth applications at the individual and population levels is essential.

Institutional policies created during this pandemic will have long-lasting consequences on health disparities. We must work to ensure they are net positive.

Matthew Clair is a sociologist and assistant professor of sociology at Stanford University. Brian W. Clair is an orthopedic surgeon at Lahey Hospital and Medical Center in Burlington, Mass. Walter K. Clair is a cardiologist, professor of medicine at Vanderbilt University Medical School, and executive medical director of the Vanderbilt Heart and Vascular Institute.

These Telemedicine Companies & Startups are Providing Medical Services in Pakistan

The COVID-19 pandemic has accelerated digitization in many industries and healthcare is no different.

Telemedicine had already been on a rising trend but with the pandemic, it has now become essential for everyone who isn’t able to consult their doctors by physically going to clinics.

The startups and service providers in this regard are anticipating massive growth, which is the need of the hour as well.

Without further ado, let’s have a look at some of the telemedicine services and start-ups in Pakistan that are doing a good job in making people stay at home without having to miss out on their consultations with the doctors.

Shifa4U

Shifa4U is a comprehensive, one-stop-shop healthcare platform for telemedicine services. In addition to online consultations with doctors, the platform allows you to schedule physical appointments for radiology, lab, homecare, and local doctors.

Other options include ordering medicines online and American teleclinic where you can consult with top doctors from the US.

Aman TeleHealth

An initiative of the Aman Foundations, Aman TeleHealth is a 24-hour healthcare helpline which provides easy and timely access to diagnostic services, basic medical advice, mental health, and family planning counseling over the phone.

Via the Aman Foundation

The helpline for Aman TeleHealth is +92 (21) 111-11-9123. Aman TeleHealth has over 10,000 healthcare facilities mapped out on its system enabling callers to access information about the relevant facilities in their vicinity. The telehealth advice is mainly focused on children and women, especially non-communicable diseases.

Ring a Doctor

Ring a Doctor is another reliable 24/7 online consultation platform, giving you a chance to get your condition diagnosed from the comforts of your home through a video session.

Treating a number of diseases and conditions, Ring a Doctor has a number of highly qualified physicians who are available round the clock to assist those in pain. It works in three simple steps such as making a free account, choosing your doctor and finally a video chat with your preferred doctor after paying his or her fee.

Marham

Marham is a similar platform that has already served over 300,000 patients through online consultations. Offering a wide range of specialized services, Marham has a hassle-free process of connecting patients with relevant doctors and physicians online.

You can view doctors’ complete profiles, people’s reviews and feedback, timings, fee, and whatnot, with only a few clicks. Due to coronavirus, a majority of doctors on Marham are offering online services, which can be availed via a video call by paying their fee.

Sehat Kahani

Sehat Kahani boasts 3-click, 24/7 telemedicine services for those in need. It is an all-female health provider network that provides quality healthcare to those in need, using telemedicine. Sehat Kahani has a dedicated app for e-health services.

You can also get free counseling on your medical condition by asking questions on Sehat Kahani forum, which are answered by qualified doctors and specialists. What’s more, you can consult a doctor online for free if you are facing coronavirus symptoms.

Dawaai

Dawaai.pk is an online pharmacy, allowing you to purchase all your medicines in one place. They deliver the medicines to your doorsteps without you having to go out and purchase your meds. Dawaai provides the facility of getting your lab tests done from the top labs in the country, all from the comfort of your home.

You can pay for your medicines through different options such as cash on delivery, bank transfer, or pay with a credit or debit card.

Sehat

Sehat is another renowned online pharmacy, offering home delivery of prescription drugs, over the counter and readily available medicines as well as special orders.

Offering a number of payment and delivery options, Sehat is a premier online pharmacy for Pakistani patients.

doctHERs

doctHERs provide you with 24/7 access to leading specialists and consultants through the simple convenience of a smart-phone.

The main goal of the startup is to ensure financial inclusion and contribution of female doctors to millions of underserved patients via technology-assisted methods.

Oladoc

oladoc allows patients to book appointments, physical and online, in a hassle-free process. Video consultation with doctors is also available, thus allowing the users to get their illnesses diagnosed and treated without having to step out of their homes.

oladoc boasts of having more than 25,000 doctors on-board with them from across the country.

Health Online

A complete healthcare web portal, catering to all your healthcare needs, Health Online (HOL) offers lab tests from home, ambulance service, and an online pharmacy for the patients.

HOL is also offering free coronavirus helpline to consult with doctors and clinical psychologists.

Find My Doctor

Find My Doctor is an app that connects doctors with the patients. During these days, two of the most important services offered by Find My Doctor include doctor at home and lab test at home.

Other services include health cards and therapy room sessions for the convenience of patients.

PIMS Online Doctor

The Pakistan Insitute of Medical Sciences (PIMS) now offers its online consultation service through its official website.

You can write your queries and symptoms to relevant departments and PIMS Online Doctor will respond with the prescription, if necessary.

Medical Store

Medical Store is another comprehensive telemedicine service, using which you can:

  • Order Medicines
  • Set Medicine reminders
  • Store Health Records
  • Order Online with Prescription
  • Live Chat with Specialists
  • Search Alternate Medicines & Substitutes

icliniq

icliniq offers instant medical advice for your health-related concerns through phone calls, or video sessions. Top-rated doctors and physicians are offering their services for a nominal fee and you can avail these in a smooth, hassle-free process.