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[Kwon Soon-yong] Telemedicine in the era of post-COVID-19

As the coronavirus crisis emerged, South Korea distinguished itself on the global stage on the basis of its excellent health care system, quality of medical staff and personnel, and most of all, the collective strength of its citizens coming together to rise above the challenge of a potential epidemiological crisis. Korea’s response to the crisis -- the rapidity with which diagnostics kits were developed, produced, and distributed as well as early adoption of innovative practices such as drive-through testing centers -- set Korea apart as a role model for effective epidemic countermeasures. Now, the health care system must contend with the challenge of reforming and building flexibility into the existing infrastructure around telemedicine in the era of social distancing and quarantines.

The rate at which such reforms take place varies from country to country, and in Korea’s case, necessary reforms are being delayed due to opposing views between the government and the medical community. The government is in favor of more telemedicine practice -- though limited in scope -- so as to broaden the availability of treatment and to adapt the health care delivery system to the forthcoming digital revolution. Medical professionals, on the other hand, are wary of rapid changes due to concerns around patient safety, quality of care, and the relative lack of established standards/guidelines around telemedicine.

As a doctor as well as a manager of community-based general hospital, I believe that face-to-face medical treatment enables more accurate diagnoses, thereby providing safe and high-quality care, which I consider to be my responsibility and duty as a medical professional. With that said, when the hospital I was working at closed for 17 days due to the coronavirus pandemic, I recognized that telemedicine -- on a selective basis -- could provide medical care complementary to face-to-face treatment.

With hospital closures, patients were abruptly disconnected from their health care providers. To exacerbate matters, they also found it difficult to seek treatment elsewhere due to insufficient patient records. As a result, treatment -- including prescriptions -- stopped almost entirely. It became evident that immediate measure needed to be taken so that patients that would otherwise be left stranded could continue to be treated. Fortunately, the hospital relaxed restrictions around telemedicine to allow for basic treatment -- via phone or other means -- for a limited period of time. Doctors at this time noticed that patients’ minds could be put at ease from the simple interaction of speaking with their doctors.

Likewise, the government temporarily relaxed regulation and authorized primary care to be provided remotely to Korean nationals living abroad. In light of such events, interest in, and receptiveness to, telemedicine has increased among medical professionals as well as among the public.

Advocates of telemedicine point out that telemedicine allow patients to access medical treatment anytime and anywhere. It could readily increase the frequency of patient-doctor contact, which may turn improve treatment effectiveness in many cases. It also expands the pool of potential patients. However, there are currently many drawbacks and unknowns to telemedicine which need to be thoroughly and carefully considered. In the latter section of this piece, I will address four points of concern that must be addressed to mitigate some of the risks of telemedicine and ensure that telemedicine can be implemented in a way that enhances patient outcome.

1. Identification verification through biometrics

It would not be an exaggeration to say that patient identification and verification is a prerequisite to proper medical care via telemedicine. At present, there are few, if any, measures in place to remotely verify a patient’s identity with accuracy even in the case of video consultations. Accurate authentication is essential to not only providing the best medical care but also for preventing medical insurance fraud or prescription abuse. For telemedicine to have a future, both biometric technology and accompanying infrastructure and regulations must be developed.

2. Automated documentation through AI based voice-electronic medical record (V-EMR)

Patients must have the means to access and store their medical information, and all conversations between the patient and health care provider must be promptly stored in electronic format. Currently, most mobile telemedicine platforms are not linked to electronic medical records at hospitals or clinics, and the onus is on doctors to manually record the patients’ symptoms. In some ways, the advent of telemedicine is the perfect impetus for developing a system by which AI based V-EMR system can be leveraged to transcribe and contextualize the interactions between patient and doctor. There should also be a system in place to update the patients’ records in real time.

3. Treatment scope and prescription guidelines

Detailed guidelines and restrictions must be put into place to prevent patients from inadvertently abusing the telemedicine system. Suggestions include limiting the scope, frequency, and duration of consultation, mandating face-to-face consultations for new symptoms, and closely monitoring and putting restrictions around telemedicine prescriptions.

4. Legal Precautions and Provisions

If telemedicine is to become commonplace, so will legal disputes that stem from telemedicine. Currently, there is little precedence in place to aid and protect either the patients or health care providers. Research into the types of disputes that may specifically arise from telemedicine should be conducted to minimize the disputes, minimize the negative fallout from such disputes, and put in place a legal framework to handle these disputes in a manner equitable to all involved parties.

The government should gather and take into consideration the medical institutions’ and medical personnel’s perspective to properly address the issues raised above so that telemedicine can be practiced without compromising on the quality of care to the patients. If implemented properly, society at large would benefit from telemedicine, particularly Koreans that live overseas. For patients with chronic diseases or other conditions that do not require special treatments, telemedicine would be the more efficient alternative to frequent examinations at large hospitals, eliminating commutes and long wait times for the patient and treatment load for doctors. Particularly relevant to today, it has been already observed that telemedicine can be a useful alternative to in-person treatment when patients are unable to visit the hospital due to emergencies such as the coronavirus pandemic.

COVID-19 has already had immeasurable impact to society and culture, and the health care system is no exception. The medical community and the government should come together to formulate a future that best enhances the health of all Koreans.

Kwon Soon-yong
Kwon Soon-yong is president of the Catholic University of Korea’s Eunpyeong St. Mary’s Hospital. -- Ed.