The telehealth revolution

Chilean pediatrician Elisa Aranda, MD, recently gave a worried mother some crucial medical advice for her months-old baby girl, stricken with chronic diarrhea. After diagnosing the infant’s problem as an alimentary allergy, she advised the mom to stop consuming cow's milk and its derivatives, which she suspected was the cause of the infant’s reaction. The mom eliminated milk from her diet and within days, her baby’s digestive problems cleared up.

What was unusual was that Dr. Aranda was able to make her diagnosis and recommendation without ever physically examining the baby. Communicating over the Internet via the “eHealth Virtual Visit” software helped her treat her patient, consulting confidentially with the mother in Purén, located 200 kilometers from her examining room in the Andes Salud Clinic in Concepcion.

Telehealth saved the mother the time and expense of taking her child to an exam by Dr. Aranda, who specializes in pediatric gastroenterology. At the same time, the doctor and her hospital were spared from admitting a young patient at a time when the SARS-CoV-2 virus was rampant and the crisis was putting a premium on available hospital beds.

“But I’ve learned that with many types of cases, I can perfectly diagnose and prescribe,” says Dr. Aranda, a sought after and highly respected specialist, who admitted she was at first reluctant to use telehealth.

Over the past year, the efficiency and value of virtual meetings have transformed society, the workplace and even health care. Prior to the pandemic, physicians and patients alike vastly preferred face to face visits to deal with a health problem, says Gonzalo Grebe, CEO of Andes Salud Clinics, a network whose four Chilean hospitals includes Dr. Aranda’s hospital in Concepcion.

But attitudes changed last year after COVID-19 made patients fearful of leaving their houses for medical appointments and doctors apprehensive of exposing themselves and hospital staff. The result has been a mainstreaming of virtual visits and a telehealth revolution. Research firm Fortune Business Insights projects that the global telehealth market will grow nearly tenfold from US$61.4 billion in 2019 to US$560 billion by 2027. In the bellwether US health system alone, which accounts for almost half the global total,[1] virtual visits exploded from only 0,15% of US health insurance claims in April 2019 to 13% in April 2020.[2]

While telehealth has helped doctors manage their time more safely and efficiently, it owes its rapid growth equally to the satisfaction of patients. One social worker and single mother of two who lives on Chiloe Island in southern Chile, swears by telehealth. Last Fall, in advance of her abdominal surgery, she had two preparatory consultations via eHealth Virtual Visit, thus avoiding the 200-kilometer trip to her surgeon’s office at the Andes Salud Clinic in Puerto Montt where her surgery later took place.

She saved more than just bus fare. “We were on an island under quarantine, so if I had gone to see doctor in person in advance of my surgery, I would have had to remain isolated for 14 days when I returned home, meaning two weeks without work for me, and two weeks that my department would have been without leadership,” she says.

Telehealth’s evolution has been speeded by advances in telecommunications, the ubiquity of smartphones, and the development of remote monitoring devices that doctors can use to wirelessly check in on patients with, for example, heart problems and diabetes. Chile is an ideal laboratory for those advances because the 4,200-km long country includes sparsely populated regions in the north and south that have limited access to good health care, a gap that telehealth can help fill.

The principals of Andes Salud Clinics acquired the four hospitals in 2018 and immediately launched a process of “investment and growth” to extend the network’s reach, modernize health management and services, and add physicians to the network.

Management formed a partnership with Siemens Healthineers soon after taking over, with telehealth becoming an integral part of the new strategy. Grebe says he was not discouraged by the initial resistance of physicians to telehealth. “Their clinics were full and so they were very comfortable with the situation despite that telehealth was growing exponentially in other countries. We felt they would change their habits in the near term once the advantages were better understood.” Those advantages became increasingly clear after COVID-19 struck and patients “saw hospitals as dangerous places”, Grebe says.

Doctors and patients are increasingly comfortable with virtual visits, especially in “medium to low complexity” cases in fields such as mental health, nutrition, and chronic care follow-up. The percentage of Andes Salud Clinics’ physician-patient consultations done over the eHealth Virtual Visit platform is around 30 percent of the total and rising, up from near zero in early 2020. Virtual visits will never replace face to face exams for some ailments and emergencies, but telehealth will far outlive the COVID-19 pandemic, and experience “permanent and growing use over time”, Gonzalo Grebe says.

The challenge facing telehealth is to expand its ecosystem. Toward that end, Siemens Healthineers is working with local government, community, and health officials to increase the penetration of the Internet in remote areas and to make essential hardware – smartphones, tablets, and laptops – more available to patients in need.

The company has helped Andes Salud lay the foundation for telehealth with eHealth Virtual Visit. It provides the essential platform to facilitate what Grebe calls a new relationship between doctors and patients. “Our partnership with Siemens Healthineers gives us the security of having service of very high quality that we can offer throughout Chile with the support of our group of Andes Salud Clinics’ physicians.”

Dr. Aranda says she agrees that applications of telehealth will only grow. “Virtual visits allow me to monitor existing patients and see new ones even during the pandemic. They are a compliment to good medicine and are here to stay.”