I was reading Scott Shreeve’s crossoverhealth blog the other night, and I stumbled upon maybe the most insightful article on IT and healthcare I read in the last couple weeks. He is stating that governments are spending more and more money in Telemedicine projects that use their proprietary network and hardware software. These guys have missed the train, and are doing an anachronism. Sadly, this article just clearly states the IT medical space is still taken from another perspective than other fields and is still in its infancy while it should clearly be mainstream nowadays. In fact, all technologies needed to support it are available.

But we need to not forget that people are driving the revolution themselves, by using web 2.0 tools to communicate, find information about health and wellness, and even practice auto diagnosis. People are then ready to use more advanced tools to perform other tasks, like auto managing their health, their medications intakes, and health in general. They also want to use these tools to talk to their doctors. 

Some startups have seized the opportunity, and are developing tools, using technology that has existed from some time now, to enhance patient experience with health care, making the end user happier and healthier.

I have been thinking all day long about ways to enhance the experience for the people that will be using a teleconsultation service over the Internet. One simplistic idea will be to allow patients to consult a doctor without caring about his/her location. This is what I call the global healthcare marketplace. As for any disruptive idea, there will be many hurdles that should be surpassed:

• Developing countries physicians are not as competent: A number of doctors in developing countries have degrees outside their country and attend international conferences to keep up to date.
• Laws protecting doctors like in Quebec, Canada and North America in General: Like for any other service, the globalization and internationalization of medicine is something that cannot be fought against for a long time from now on. Medicine is becoming more and more transparent. The people that want to keep it opaque are doing it to protect their interests and those of a community of doctors. This has nothing to do with the consumer. The consumer/patient should be empowered and should be the central piece of the puzzle. We need to give the consumer its lost place. (Rate my doctor).
• Cultural Difference: Most doctors in the United States and in Canada are immigrants. There are some minor specificities to the medicine and sicknesses but a doctor has the same formation and the human body is the same wherever you go. Many studies have reaveled common traits in humans no matter their ethnicity or skin color.
• Remote consultations are not as reliable as face to face: There has been many studies in the subject. In Ontario for instance, it was shown that patients resent no major difference compared to face to face visits with their psychiatrists. Also, it has been shown that more than 80% of the visits to a general practitionner end up without having a physical contact with the patient.This idea to develop the service into a world wide advice network of physician has grown up and could present an alternative to the shortage for doctors in Canada and the States.

A new report shows that providing patients with e-mail access to their surgeons improves communication. The conclusion of authors of the  report says that “People who use e-mail certainly would like to have e-mail access to their physicians”.

Concerning the issues raised in the emails, we have general information (55%), post operative recovery (21%),  results (13%) and reassurance (11%).

This data gives us the reassurance that a service that will be offering interactive consultations with physicians will be well accepted. People are already using tools like email, social tools, and the new tools for web 2.0 to interact with each other. We won’t be changing the habits of people just suggesting a better way to interact with your doctor. Medicine just like other disciplines is in a great need to take the leap for the information age. Right now there is so a huge amount of  medical information on the web, what is needed is to give it a human face. Your TeleDoctor will be the regulator of information. It is in between people doing auto diagnosis online and people visiting their family physician at the medical office.

P.S. The original article can be found here.

Online auto diagnosis can be viewed as the use of the Internet to research for health related reasons, mainly for conditions. In Canada, and according to the NFO CFgroup, a study shows that 75% of Internet users use the Web to search for health-related information. Also, 50% of online Canadians claim that researching health information on the Internet makes them better able to discuss treatment options with their physician. Regarding the most visited Canadian health websites, we have on the top 3:

1. Official Health Canada website.
2. Health sections of Sympatico.ca
3. Health sections of Yahoo.ca 

Concerning the top medical conditions researched online by Canadians, the list is as follows:

1. Depression.
2. Arthritis.
3. Diabetes. 
4. Allergies. 
5. Migraine headaches.
6. Heart condition.

Yes those are lots of statistics.  Let’s take a minute and make a quick analysis.

People are naturally curious, and they tend to talk about their conditions within their close circles before heading to a physician. This comes from a fear of the unknown. There can be many factors that make us reluctant to go to see a physician right away. Among these factors, we can note the waiting time and the accessibility of a physician. So we tend to go online or ask our friends in order to get access to the medical information right away. I came accross the other day on Trusera’s website. I am fortunate enough to not have to sign in and “tell my story”. This website aims to connect people with the same problems. In a sense, they are trying to organize the health information on the web and make it patient/person wise. In my opinion, information should come from physicians. It is legitimate to look at the information online, but we will still be in doubt until we ask a real physician. Medicine is not an exact science and the expertise of a healthcare professional is and will always be, in most cases, the best source of information. 

With Your TeleDoctor, we want to address the void between the visit to a physician and the moment when we start questionning ourselves (online?) or entourage.  Note that the service will be used for minor conditions, only. We had a long talk with our lawyer, as well as with our medical advisor and the best way to avoid lawsuits is to use our service for conditions that are likely to be diagnosed remotely. When we know, that 70% of people that visit a general practionner have minor concerns, we can say that a market opportunity is right there for us. However, the critical question is how to acuratly address this market. 

More to come soon on this question…Please feel free to comment/ask/disturbe my positions. 

These are old news. But still, this matter is crutial for anyone wanting to start a telemedicine service in Quebec.  Myca, a Quebec based company that is going to offer virtual -on call- visits  over Internet, has done a great deal of PR noise which has made the governement react immediatly. Health Minister, Philippe Couillard, was not informed by such a project and personnaly asked that a report should be made available within the next few weeks. In fact, the time span has elapsed and we are still waiting…

The Quebec Party, which is often depicted as the conservative wing in the government, thinks that the project is “extremely disturbing”. For me, thinking that the project cannot replace tradional face to face visits is defendable. However, I think that if you see telemedicine and virtual visits as a complement to the current system, you can easily draw the benefits of such a system. In fact, a video visit can be beneficial for the public health sector as well as this is going to free up places for other people. Understand by other people, patients that could be diagnosed by face to face visits, Jaundice for example. In contrast, other minor medical conditions, like cough or sore throat, can be very suitable for virtual visits. 

The Democratic Action of Quebec, in the other hand, thinks that this is an interesting project. They think that such a service will relieve, to some extent, the waiting rooms in the public sector. I would like to add that their position, similar to the other Canadian provinces as well as our neighbors south, is going to play a decisive role during the next few months, in the decision of the government for the rapid adoption of Internet visits.

Running an Internet medical service right now, in the abscence of legislation, should comply to the same rules as a private clinic. In other words, you need to comply to the deontological code and doctors working with this tool need to take the same precautions as they would when doing medical office consultations. The diagnosis and prescription have to be carefully provided when all the necessary information about the patient is verified and known.

By the way, if someone got any information or statistics on the Quebecers towards Internet medicine, I will be more than happy to have a look at it. I am in the process of looking at this data, maybe compare it with other provinces. Those are the best indication for the success of such a service. Know your market, they say.Please, shoot me an email, if you got any relevant information about Internet medicine. Also, I may be rolling out a poll, when this blog starts to get some traction as well.