Role of e-health, m-health, and telemedicine or telehealth during the COVID-19 pandemic

INTRODUCTION

Because of the COVID-19 epidemic, physicians are reconsidering remote patient care, converting the terms E-health, telehealth, and M-health into a broader word that incorporates telehealth, telemedicine, online data analytic, electronic health records (EHR), and M-health etc. This transformation has resulted in a rethinking of remote patient care, allowing doctors to access virtual consultation rooms from the comfort of their own homes and improving their overall digital health practices. In March 2020, the world health organization (WHO) stated that COVID-19 a pandemic, which troubled the modes the health services are carried and ranked the insistence of stopping public spread.¹ Telemedicine applications in healthcare facilities enhance efficiency and utility while educating the public about diseases. COVID-19 affects medical and paramedical staff, who are most frequently affected due to highly transmissible characteristics.² In Africa, telemedicine apps efficiently treat Ebola and malaria, and E-health solutions are both competent and reasonably priced. Smart hospital systems (SHS) and internet of things (IoT) technologies are also becoming more and more popular.³ Alaboudi et al outlined several obstacles to the effective implementation of telemedicine, including as erratic funding, ambiguous services, a vague vision and objective, and initially uninterested patients.⁴ A probable cause may be the nonexistence of consciousness about new technologies related to telemedicine applications.⁵ Studies showed that the E-health system and telemedicine project failure rate was 75% globally.⁶ An Australian origin study showed the causative factors for telehealth adoption were having a transparent vision aiming the services, involvement of all stakeholders, the expertise of clinicians, honest value, and cost-saving to patients.⁷ The last 20 years have witnessed extraordinary speeds and there is rapid technological advancements such as radio frequency identification (RFID) technology, low energy, near field communications, mobile computing, and larger capacity storage in computer and data clouds have ushered in the fourth paradigm of science.⁸ Healthcare IoTs denote web-linked healing devices equipped to create, assemble, and stock data, analyse the data, and communicate that data of diverse classes like images, bodily, and genomics data.⁹ By 2022, the A modern term named internet of medical things (IoMT) market is expected to grow to 158 billion US dollars.¹⁰

Regarding the history of telemedicine, in 1879, the Lancet cited the probable usage of the telephone for health discussions and the national aeronautics and space administration (NASA) played a significant part in the advancement of telemedicine.¹¹ It's found that in USA, China, and Italy etc. during epidemic a ten-time upsurge in telemedicine consultation was noticed.¹²

This review was under taken to assess the role of digital health especially E-health, M-health, and Telemedicine/telehealth during pandemic.

LITERATURE REVIEW

This study followed the PRISMA 2020 guideline, examining articles in credible journals and books related to E-health, M-health, and telemedicine or telehealth. The researcher searched using the names of these terms based on their previous knowledge. Additional searches were performed in databases like PubMed, EMBASE, SCOPUS, Web of Science, and Google Scholar etc. After removing duplicates, the retrieved articles were screened based on title and abstract. Full-text articles were assessed for eligibility, and only those related to the subject matter were included. No limitations were made on time or location, but the language was restricted to English. The selected texts were then examined to extract data related to E-health, M-health, and telemedicine or telehealth for inclusion in the study.

Total 1536 articles were downloaded from the databases mentioned above. After removal of 801 duplicate texts 735 articles undergone screening based on title and abstract. The 633 articles excluded after screening and 102 full text articles were assessed for eligibility test related to or part of the subject matter related to E-health, M-health and telemedicine or telehealth. The 71 articles were excluded with reasons (Figure 1) after full text assessment and 31 articles included for current study.

DISCUSSION

Solutions for E-health, telehealth, and telemedicine are essential for disaster response because the COVID-19 pandemic has sped up the transition from in-person to virtual medical consultations. These technologies have demonstrated efficacy in offering medical support for long-term conditions. The term "E-health" describes the application of information and communication technology to health-related domains, such as education, literature, surveillance, and healthcare services.¹³ It comprises technologies for medical advancement, screening, and inspection as well as evidence and messaging technologies. Although telemedicine and telehealth are interchangeable, telehealth includes both clinical and non-clinical remote services.¹³ Innovations in digital technology can help health organizations respond better to outbreaks like Zika and Ebola by improving community alertness, contact tracing, and testing accessibility.¹⁴

India launched 'Aarogya Setu', an M-health technology-based solution to control COVID-19, following WHO's "test, trace, isolate, quarantine" guidelines to alleviate and advance the epidemic.¹⁵ Digital apparatuses can significantly sustain these actions in two ways, firstly, they enhance electronic data currents, closeness outlining, and geographical location tracing by reporting and phone tracing.¹⁶ Secondly, keeping aside the internet connectivity and devices, crowdsourced scrutiny could noticeably extend for the population base and surge the rapidity to real-time. Truly, net-based resident information on sicknesses existed for the long run (e.g., Google Flu) and was in operation in some nations with achievement.¹⁷ Patients who lack education and inadequate infrastructure might have a detrimental effect on the healthcare system.

Furthermore, there are several references (Table 1) associated with the practice of digital health in developing countries. Infrastructure should incorporate intelligence, adaptability, flexibility, usability, and interoperability in order to get better. Underprivileged telecommunications and a lack of internet providers are problems in poor nations.¹⁸ When building infrastructure, the cost-effectiveness and utility of telemedicine-based solutions are important considerations. After the careful analysis of the 31 articles, author came to the following three thematic areas as below.

E-health and telehealth

E-health, a collective practice of electronic information, communication, and technologies (ICTs) in the healthcare sector, has emerged as a result of the COVID-19 pandemic's acceleration of medical care digitalization. Through the transmission of pertinent information between patients and providers, this technology facilitates medical treatment and patient care while guaranteeing adherence to rules and specially created paperwork. Patient-centred care and surveillance systems to monitor sick people and control epidemics can be supported by telehealth, which is a subset of E-health and encompasses telemedicine, M-health, EHR, and informatics.^19-25 Gong et al in a surveillance study used an integrated medical informatics technology of the Honghu hybrid system to control COVID-19 in Honghu City, China. This system was used to collect and analyze data from several devices together with social media on mobile devices and syndromic surveillance was displayed through a mobile phone-based display covering more than 95% population.¹⁹ In order to facilitate data collection and preventive measures during the Ebola outbreak, a clinical HER was created in 2015. Onco-Kompas, an online self-management program, has gained widespread acceptance among cancer patients.

E-health solutions are favored for recovering patients' medical effects, protecting medical personnel, and promptly recognizing COVID-19.^26-33 Research indicates that the incidence of COVID-19 was associated with an increase in anxiety and depressed symptoms. For evidence-based monitoring and management during medical emergencies, eHealth-a fusion of electronic communication and medical information technology-is essential. It has been demonstrated that telehealth can lower COVID-19 mental health problems such anxiety, depression, and post traumatic stress disorder (PTSD). When it comes to funding and assisting health systems with telemedicine, governments are crucial.^34-42

M-health

Mobile healthcare, or M-health, is one of the key pillars of ICTs for healthcare that consists of telemedicine, telehealth, E-health, and M-health. In the past two decades, mobile health has converted into a transformational idea for healthcare delivery novelties worldwide. Many people in healthcare settings with low resources have been in worse health and have had restricted access to basic healthcare services since the introduction of the M-health idea twenty years ago.^26-34,43-55 This scenario has gotten worse due to the pandemic, so selecting the right M-health technology is essential. Challenges include the disease's intricacy, asymptomatic individuals, financial and cultural barriers, privacy and payment issues, and juggling the demands of patients and doctors. Another major problem is the integration of EHR arrangements with M-health technology.^28-32,55-60

People with COVID-19 positive self-quarantine can be closely watched at home with the help of M-health technology. Particularly during the pandemic, the digital revolution has expedited the integration of M-health technology with clinical flows. Social distancing, education, digital well-being, and regulation and monitoring through app-based solutions have all benefited greatly from mobile technology.^35-41 Epidemiology has employed a variety of applications to track and manage epidemics.

Although M-health has advanced more quickly as a result of the COVID-19 pandemic, the digital gap is still a major obstacle. Notwithstanding the ease of use of applications, the digital divide continues to be the source of all problems, emphasizing the necessity of further M-health technology integration in clinical settings.^{12-14,20-31,41-58}

Telemedicine and telehealth

Particularly during the COVID-19 pandemic, telemedicine is a rapidly expanding healthcare facility that provides effective, affordable, and high-quality care. Since the Nebraska Psychiatric Institute began employing videoconferencing for telepsychiatry in 1959, the technology has advanced. Telemedicine services were offered by NASA during the 1970s and 1980s.^{8-12, 22-35,48-56} The internet revolutionized telemedicine services in the 1990s by making it possible to share medical images in real time. The 90% of Americans use the internet nowadays, and 81% of them possess a smartphone, 75% own a desktop computer, and 50% own a tablet. Between 2010 and 2017, percentage of healthcare telemedicine patients using mobile devices and the internet rose from 35-76%.^{23-27,32-38,43-57} Insurance claims for telemedicine increased by 53% between 2016 and 2017, according to American medical association. Radiologists, psychiatrists, and cardiologists were the most frequent users, whereas immunologists, gastroenterologists, and gynecologists were least. Compared to other nations like the European Union, Korea, and Japan, United States uses telemedicine more frequently. Nevertheless, 13.3% of consumers think telemedicine is more costly than traditional services, and 74.3% of consumers are not aware of telemedicine services.^25-37,47-51 Age, education, computer proficiency, bandwidth, and ignorance are obstacles to telemedicine, while providers must contend with issues including cost, pay, and skill.^52-55 The lack of in-person interaction between a patient and a physician presents difficulties for telemedicine. Advances in AI may help get beyond these restrictions. Medical liability regulations, indemnity coverage, malpractice insurance and cross-jurisdictional medical license are obstacles, nevertheless. Telemedicine lessens the need for expensive medical facilities and long-distance appointments by resolving these problems and introducing workflow changes.^41-49,52-60

Challenges and opportunities

Some specialty doctors are not able to work from home using telemedicine like surgeons, anaesthesiologists, obstetricians, interventional cardiologists’ pathologists, etc. and some doctors could able to do like psychiatrists, (non-interventional) radiologists, clinicians, etc.^42-56 In clinical medicine, there is no replacement to personal interface, with sympathy and the 'human touch'. Though telemedicine might be compensated by expertise, the circumstance remains the same, being social being’s humans desire community interface. Incapacity to do physical examinations is a foremost handicap in several specialties, though this restraint may partially overwhelm using distant one-to-one care, but on no occasion be a whole replacement.^{5-12,22-35,55} Furthermore, not every patient is a computer wizard, especially elderly patients who will be the most benefited from telemedicine, such patients may fail to get the care. There are numerous literature examples where it mentioned that though telehealth is valuable, but usefulness is slow because of clinician resistance.^34-42,47-52 Other issues like health economics, problems of insurance exposure, billing, and compensation make telehealth a higher cost. In a 5-year study of two hospitals, it was stated that the costs of telemedicine services were 1 million units as compared to the cost of 1.6 million units for in-person hospital visits.^55-60 Another work comparing the in-person vs telemedicine visit cited significant savings in equally out-of-pocket expenditures and time consumed. Before concluding anything, the key goal of Telemedicine services should be the greatest probable medical facility at the correct time, appropriate way for the patient.

Future direction

With the introduction of smart gadgets and wearables, telemedicine has advanced substantially in recent years. These gadgets monitor vital signs and may be linked to healthcare experts and hospitals, allowing unwell people to be monitored at home.^4-7,33-41 The COVID-19 pandemic has had a significant impact on this movement from institutional-centric to community-centric or homocentric treatment. However, worries about confidentiality, self-esteem, and moral problems exist across borders.^44-57 The pandemic has emphasized potential and future adoption of telemedicine. Far-flung admittance to registered medical practitioners having MBBS degrees, using telemedicine can decrease extensive quackery. Success will be incomplete unless India also efficiently controls the other social determining factors of health. Digital interventions offer several chances for firming up medical systems.^39-44 Digital health and practice ICTs for well-organized and judicious delivery of medical care aiming at community promotion.

CONCLUSION

Digital health is a multi-disciplinary field with proficiency in medicine, manufacturing, social sciences, health economics, and information management. Telemedicine provided a short-term solution for the pandemic, but its use will wane once the crisis is over. Understanding telemedicine consumers, providers, policymakers, academics, and society is critical for moving the health system forward. The literature shows deficiencies of studies on the results of costs related to these services but, experts agreed that these technologies have immense opportunity of carrying healthcare services to chronic disease patients during and after this epidemic. This highlights the urgency of steering additional studies to measure the role of these technologies in enlightening facilities for patients. We may learn from telemedicine users' experiences and ensure the essential proof for a sustainable development, objectively by concentrating on them, which will benefit future generations and help the healthcare system to flourish.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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