Telemedicine

Falling behind on posts due to lack of internet…the one below is actually from Switzerland, although I’ve already been in Chennai for a few days and am thoroughly enjoying it here. Apologies!

Anyway, back in Basel we visited Medgate, the largest telemedicine institution in all of Europe. Previously I had come across the concept applied to low-resource areas (to deliver care to places without doctors and hospitals), but this was the first time I witnessed the idea applied to patients in developed countries. Despite fears of increasing commoditized healthcare or strained patient-doctor relationships, the system appears fairly efficient, serving as a first-line service for patients and saving valuable time and healthcare resources. (The merits or dangers of such a system deserve an entire other entry.)

Instead, this entry is about an auxiliary program our presenter mentioned in the second-to-last slide: using telemedicine to help patients manage chronic diseases from home. I was intrigued. After the talk I spoke to the presenter and managed to get a visit to Medgate’s chronic disease management center (located in a different part of town). During today’s visit, two doctors showed me how their system works:

A patient receives a package including equipment for taking basic indicators (blood pressure, blood glucose, weight, heart rate, etc.) along with a neat little device that takes the data and transmits it to the central office. There, doctors and medical assistants monitor patients’ conditions, communicate with “house doctors” (primary care physicians), and counsel the patient by phone. My host showed me an example of a patient whose blood sugar readings over a course of a few weeks looks like a ski slope; highlighted points near the beginning indicate abnormally high readings, the house doctor was contacted, the medication regimen changed, and the patient’s blood sugar dropped gracefully to settle into the “acceptable” range.

I was impressed with its efficiency in a developed country such as Switzerland. I was really there to see if it could be applied to rural areas of developing countries. i.e. China, this coming summer. My proposed project is, in writing, centered around finding cataract patients…but if village health workers are interacting with villagers anyway, it presents the perfect opportunity to begin to confront the looming (and increasingly dire) problem of chronic diseases. There is currently—to my knowledge—very little infrastructure in rural China to help manage chronic diseases. Telemedicine may provide a promising method.

Of course, I will need to critically examine the need for such a system before thinking about ways to implement it, lest I fall into what a recent reading of ours called “the kid with hammer” problem—give a kid a hammer and he will think everything is a nail. A telemedicine system connecting village health workers and higher level hospitals is only necessary if (1) village health workers are unable to prescribe interventions to manage villagers’ conditions themselves, or if (2) village clinics lack the equipment, resources, or time to monitor patients’ health.