The strengthening of the health sector after the COVID-19 outbreak
The COVID-19 emergency is pressuring the healthcare sector and the practice of medicine all around the world. In this tough period, it is important to cast light on the unprecedented challenges posed in the hospitals to avoid putting at risk those swathes of the population (elderlies, immunocompromised, multi-pathological patients, etc.), that might be most vulnerable to the transmission of the virus. In this difficult context, telemedicine appears as a promising option for both patients and the whole sector.
So far, the adoption of telemedicine has been pretty limited to specific cases and for basic consultations. The current necessity to respect social distancing, together with the overall limitation of the movements in the cities, have lately provided momentum to a rapid and global development of telemedicine.
The vast majority of the governments are now turning to telemedicine as an outstanding solution to provide general consultations avoiding patients to move from their places and potentially get exposed to a risk of contamination but also as a decisive support tool to identified home quarantined COVID-positive patients with mild symptoms.
Although telemedicine exists since quite some years now, it is not yet regarded as an official medical act. In most cases, the adoption of telemedicine has been slowed down by the lack of national regulatory frameworks, IT infrastructures and trained doctors. At the same time, patients were also reluctant or deterred by such technological solutions, in particular because of the major changes it implies on the doctor-patient relationship.
The rapid spread of the SARS-Cov-2 coronavirus and its high degree of contagion are leading governments to reconsider their approach to remote and connected health options. The health systems are today brought to their limits: hospitals, are facing important shortages of medical equipment (from ventilators to masks, gloves and hydro-alcoholic solutions), overcrowded ER and ICUs, and finally a shortage of healthcare professionals, who are among the most exposed to the virus. Digital solutions can definitely help mitigating the risks of contamination and favouring the flattening of the transmission curve.
Under these circumstances, accelerating the adoption of telemedicine at legal and regulatory levels is becoming a compelling need.
Telemedicine around the world
All around the world, there are various approaches to telemedicine. In developing countries, as well as in regions short of medical aid, the use of telehealth proved its effectiveness in the care of populations in remote and rural areas. In the Asia-Pacific region, the telemedicine market is expanding and it is expected to further develop in the future, given the on-going growth of the aging population and the spread of chronic diseases such as diabetes.
In the United States, 82% of the population does not use telemedicine services due to a lack of adequate infrastructure and reimbursement schemes. The situation in Europe is quite similar. Across the region, most of the policy makers are hesitant to include telemedicine in their reimbursement schemes, in particular for privacy related concerns. The most advanced countries with regarding telemedicine services around Europe are UK, Norway, Denmark, Sweden, the Netherlands and France. The others have not yet elaborated national policies in this matter.
However, with the outbreak of the COVID-19, many barriers seem likely to be overcome. Indeed, the United States and China have actively promoted the uptake of telemedicine solutions to tackle the emergency by lifting previous restrictions. In India, the government is looking for remote solutions to avoid the overwhelming of hospitals, limit the movements around the country and cover the majority of the population.
Remarkable is the recent evolution of telemedicine in France, where the practice is considered a legal medical act only since 2018 and therefore subject to reimbursement by the national Social Security. Before COVID-19 outbreak, the digital services were barely used, except in few cases. But, over the last few weeks, the number of accesses to these services skyrocketed: between the 1st and the 28th of March, 601 000 consultations have been conducted across the country. Such dramatic growth has also been fueled by the decision made by the Assurance Maladie, the French Health Insurance, to increase the reimbursement of the practice from 70% to 100%.
Ireland is also implementing its national approach, thanks to the support of Enterprise Ireland, the start-up WELLOLA launched an app and a portal for teleconsultation to respond to the current health emergency, and to favour the interactions between doctors and patients. Such an example is raising interest of other European countries, as for Italy where the vice minister of Health, Pierpaolo Sileri, recently presented to the government an amendment to boost telemedicine practice in the country.
What about space-based technologies and health in this moment?
As pointed out in our previous posts (What we can learn from the corona crisis with satellite data, and Call for space assets in response to COVID-19) the space sector is actively trying to respond to the emergency by inviting start-ups and SMEs to propose solutions to tackle the COVID-19, with a specific focus on telemedicine and e-education. Indeed, space-based technologies can be adopted to enhance the control of infectious diseases such as COVID-19. Especially satellite navigation and communication can be exploited on a large scale to help containment strategies and to assess the treatment of the patients while protecting the medical staff. Also, Earth observation satellites have been put to work during multiple health crises. In 2014, the Copernicus Emergency Management Service (EMS-rapid mapping) was activated during the Ebola epidemic crisis. The Italian Ministry of Interior and the Civil Protection recently asked for the activation of the EMS service during the month of March 2020 and beyond. The main driver for activation was the urgency of mapping stable and temporary health facilities, such as triage, and so on.
Moreover, the SES satellite-based eHealth communication platform, SATMED, is now available free of charge for the healthcare professionals’ community to fight the pandemic. The Government of Luxembourg, that owns the platform, is giving free access to the eHealth applications available, offering also cloud storage capabilities in compliance with data protection and regulations.
The European Space Agency also deployed Tempus Pro devices in response to COVID-19. These lightweight all-in-one monitors are normally used by doctors at ESA’s European Astronaut Centre (EAC) to assess and communicate the condition of astronauts when they return to Earth.
In Europe, apart from specific cases where telemedicine has been successfully adopted, in general terms, it can be rightfully affirmed that the lack of supporting policies, awareness, and training are limiting the revamp of the health sector. Even if EC adopted a series of measures and initiatives to respond to the vacuity of the legal schemes in the field, still at the national level the legal and policy bottlenecks are burdening the implementation of new solutions and impeding the scale-up of telemedicine providers’ solutions.
However, in the very near future things might radically change. The novel coronavirus confronts Europe with the need to re-invent and re-organise the health sector. In 2018, the European Commission estimated that by 2021 the global telemedicine market would reach €37 billion value, with an annual growth rate of 14%. After the emergency, these numbers are poised to evolve. Indeed, the business of telemedicine might face a much stronger acceleration that should encourage the governments to better take advantage of this practice for more efficient national health policies.
The space sector has a role to play in this process. The technical and budgetary involvement of the European Space Agency and national space agencies can favour the integration of space technology within the health sector. Additional support could be granted to users by providing training and education to professionals in the field. Institutional space actors and service providers should interact more with users and with governments to support and contribute to the decision-making process.
In conclusion, this crisis may lead to a reorientation of the health sector and to eventually speed-up the adoption of telemedicine practice. In this sense, the exploitation of telemedicine should not be considered as a by-product but a mainstream solution.