COVID-19 and telehealth–promise or peril? And the perils of digital health in conflict countries and India.

The Journal of the International Society for Telemedicine and eHealth (JISfTeH) has published its latest issue today (13 Jan). JISfTeH is one of the few journals which shine a bright spot on digital health in developing countries. This month concentrates on conflict countries and COVID in India: 

  • Scaling Up Digital Health In Conflict Countries discusses the lack of any form of digital health and coordination in Afghanistan, Somalia, Sudan, and, with some exception, Nigeria. It compounds the extreme lack of healthcare services–for instance, 23 percent of Afghanis have poor access to healthcare, resulting in a high mortality rate. It can change. Rwanda, once synonymous with war, has one of the best healthcare systems in Africa due to the use of digital health services. India is using digital health in combating the TB explosion of 300,000 cases in one year. The exception in Nigeria is the liftoff of 54Gene, a genomic studies company in the world’s most genetically-diverse continent, which has secured $4.5 million in seed funding.
  • Speaking of India, telehealth has been kickstarted there due to COVID-19. The Indian Government is prioritizing the use of telehealth in the population and both public and private institutions have rolled out initiatives. India’s challenges are how patients pay for it (70% of healthcare expenses out of pocket) and how it reaches the two-thirds of population in rural areas where there is inadequate telecom and broadband for services. The irony, of course, is that India is a huge exporter of software and telecom services to the world. COVID-19 As A Catalyst for Telehealth Growth In India: Some Insights.

The editorial by Richard E. Scott of Canada and Prof. Maurice Mars of South Africa, COVID-19 and eHealth: A Promise or Peril Paradox?, cautions on the floodgates opening for telehealth in COVID’s wake. Spontaneous telehealth, where “healthcare providers themselves saw the value of an eHealth solution and implemented it independently and without traditional steps or approval” is quite separate from evidence- and needs-based telehealth. There is a lot of pressure at the national level, by the WHO, and by vendors to ‘make hay while the sun shines’. “Enthusiasm must be tempered with thoughtful guidance” on multiple and quite variable factors.

Digital health versus eHealth: ‘here we go again’ with the confusion and the differences. Plus Women in eHealth (JISfTeH)

Editor Donna (and Editor Steve before her) always likes a good dust-up about terminology. One of the former’s pet peeves is the imprecise usage of telemedicine (virtual visits) versus telehealth (remote patient monitoring of vital signs); she will concede that the differences have been so trampled on that telemedicine has nearly faded from use.

The Journal of the International Society for Telemedicine and eHealth (JISfTeH) makes a grand attempt to parse the differing definitions of digital health and eHealth in their opening editorial of this month’s (24 Jan) issueeHealth has fallen so far from use that the few times one does see it is in associations such as ISfTeH and the New York eHealth Collaborative. Even the World Health Organization, which has always been a fair arbiter for the industry, defined eHealth back in the salad days of 2005 as “the use of Information and Communication Technologies (ICT) for health”–broad, but workable. After a witty aside in defining digital health as “an area of healthcare focused entirely on fingers and toes” (plus), and examining the overly broad definitions of Eric Topol and Paul Sonnier, the authors Richard E. Scott and Maurice Mars seem to settle on this: that while digital health is given a  much broader but nebulous definition (to the point of linguistic absurdity cited in Mesko et al.), and may incorporate related technologies like genomics (another poorly defined term) and ‘big data’, it would not work without that ICT. And that at least there’s a settled definition for eHealth, as stated above, for which this Editor assumes we should be happy. In the author’s closing, “Will we be sufficiently motivated to rise to such a challenge-globally agreed universal definitions? If not ……here we go again …..”

This month’s journal theme is also Women in eHealth, with articles on Brazilian eHealth distance education, digital technology in midwifery practice, and how online social networks can work for drug abuse treatment referral. There’s also a change in format, with article links opening to full PDFs of each article.

Telehealth in Brazil: a special JISfTeH issue

The Journal of the International Society for Telemedicine and eHealth (JISfTeH) turns to Latin America in its latest issue with a focus on the versatile ways that telehealth has been used in Brazil. Nine papers range from distance healthcare education to store-and-forward imaging to building rural telehealth networks. Brazil’s government has supported remote care initiatives with the development and implementation of projects at the national, state and municipal levels. The telehealth model primarily has been connecting universities to primary care in remote cities (of which there are many!) with an emphasis on education and assistance. Topics include the nine-year-old telehealth project in Minas Gerais between Rio de Janiero and Brasilia, and its declining use; distance learning in dentistry; usage in the Amazon region and legislation. Registration required, but the journal is open access. Hat tip to its lead editor, Prof. Maurice Mars of the University of KwaZulu-Natal, South Africa.