Telemedicine in the Cloud: Revitalizing the Shape of Healthcare

Countries around the world are taking extraordinary measures to fight the spread of the novel coronavirus as the number of those affected continues to grow. With the World Health Organization officially labeling this a pandemic, people are rightfully concerned. Now more than ever, patients and the general public are looking to healthcare providers for immediate answers, treatment, and reassurance. But as the virus disrupts everyday life, getting that care is a challenge. 

Many within the healthcare industry see a solution in telemedicine.  Through the use of modern technology, telemedicine enables doctors to consult with patients in their home using video-conferencing tools on smartphones, tablets, or laptops. This enables doctors to instantly evaluate, diagnose, and treat patients remotely, while limiting their own exposure to harmful symptoms. 

While telemedicine is still in its infancy, the unfortunate rise of the coronavirus (or COVID-19)  may spark universal adoption of this new type of digital healthcare interaction. Addressing the public about the fight against this pandemic, President Donald Trump said his administration will waive certain federal rules to make it easier for more doctors to provide care remotely using video chats and other services. 

Those who have been practicing telemedicine are already seeing the extraordinary benefits. Last year, a surgeon in China’s Fuijan province removed an animal’s liver remotely by directing robotic equipment over a 5G mobile connection. And that's just the beginning. Let’s look at one of the world’s pioneers of remote medicine: Australia.

Australia: The Flying Doctors

Imagine living in a house where the driveway from the road to your front door is over 100 miles long. Life in rural Australia gives new meaning to “remote.”

From east coast to west coast, Australia is about the same width as the contiguous 48 states of the United States. However, whereas the US has an average 87 people per square mile, Australia has just nine people per square mile.

That means healthcare for many is not a simple matter of visiting the doctor’s office. Since 1928, the answer has been the Royal Flying Doctor Service. It sends medical practitioners by plane to tend to the sick and, when necessary, transport them to hospital.

The RFDS has also been a pioneer of remote medicine. Through radio and satellite phone, the service’s 90,000 patients can access medical advice 24/7, even if cell phone and landline service is rare in the Australian outback. However, as internet access delivered by satellite improves, telemedicine will become even more broadly available. For now, though, driving to the nearest remote consultation room is still a big improvement over flying to see a doctor in person. Australia’s example has shown that remote medical provision is not only possible but vital to the lives of many people. So, how much more can those of us with reliable high speed internet expect from remote health? To answer that, let’s take a trip to 2025.

More Than Just Convenience

It’s a sunny Saturday afternoon and your daughter has just come back into the house after playing in the backyard. She’s complaining of feeling unwell and shows you a rash on her arm. You think it could be a heat rash but there have been some cases of meningitis in your neighborhood.

Rather than leave it to chance, you pull out your cell phone and open your doctor’s app. As you log into the app, an SMS pops-up. It’s a two-factor authentication code allowing you to confirm your identity.

For the past few years, your healthcare provider has offered video consultations. Recently, though, they’ve introduced a new service: an AI-powered service triages non-urgent calls. As you’re not sure what the rash might be, you select the automated option.

The app starts by asking you to describe the symptoms. When you say it’s a rash, the app asks you to point the phone’s front-facing camera at the affected area.

You see your daughter’s rash on the phone screen. The app then isolates the rash in the image and shows you three sample rashes alongside, asking you to select the one that looks most similar. You do so and the app asks you to wait while it connects you to the doctor. A short while later, you’re in a video call with a general practitioner who takes a look at the rash herself and tells you what next steps to take.

All of this is possible now. So, how do we build it?

Building Telemedicine

Ten years ago, it seemed that telemedicine would require expensive and dedicated video conferencing equipment using expensive and dedicated network connections.

Maybe your company had a dedicated video conferencing suite, with a $30,000 screen and camera combination. In 2008, one telehealth trial in Aberdeen, Scotland, used just that type of equipment. Patients would settle themselves in a dedicated room and then a doctor would appear on the, rather expensive, screen.

Today, video calls are commonplace, using the standard webcam on a laptop. Even in meeting rooms, there’s often just a flat screen TV and an off-the-shelf webcam, where previously there would have been a pricey dedicated solution.

It’s the same for telehealth. Around 2.5 billion people have a high quality video camera in their pocket and widespread wifi, plus 3G and 4G networks, mean that most people in the west have all the equipment they need.

On the provider’s side, cloud communication APIs have made it both easy and affordable for developers everywhere to build video, voice, and text communication directly into their apps.

Let’s break down the example we used above. The entire interaction relies on four primary technologies:

  • reliable, high-speed data networks
  • cloud communication APIs
  • augmented reality
  • artificial intelligence

At first, the app verified your identity. It did this by using a two-factor authentication API, such as Vonage's Verify API, to send a one-time code to your phone via SMS. Once you’d correctly entered the code, you were able to access the AI triage service.

Then, you interacted with an AI triage system. Although there wasn’t a human on the other end yet, this took place over a video call as the AI needed both to access the video from your camera and to conduct the conversation using voice. A video API makes it possible to take the camera output from a smartphone and send it to any endpoint, whether that’s another person or another bit of software. Using a text to speech API, the AI was able to interact with you in an easy and friendly manner.

The sound element of the call is just as important to get right as the video. Not only do you as the patient need to feel comfortable conversing but at times sound can be more crucial to the diagnosis than anything else. For example, had the problem been with someone’s heart, rather than a rash, the OpenTok video API could even have adjusted the way it processes sound in order to specifically suit the output from a digital stethoscope.

As it was, the AI was able to use machine learning to isolate the rash in the image it received and then to find similar rashes in its diagnostic database. Using a simple form of augmented reality, it overlaid images of those similar rashes, helping you to identify which looked most similar.

Finally, once your case was triaged, the app connected you directly to a physician using a secure, HIPAA-compliant, video call, again with an API such as OpenTok.

Taking Healthcare to New Places

For those of us fortunate enough to have easy access to healthcare, the next few years will see telemedicine become a convenient enhancement to the service that we already receive.

What, though, does it mean for those people living today without adequate healthcare?

As we saw in the Australian example, telemedicine has the power to make affordable healthcare available to people in even the most remote areas. However, it also showed that the networks necessary to deliver telemedicine are unavailable in many of the same places that lack in-person medical care.

Sub-Saharan Africa is one such place. Not only is it vast, with enormously varied terrain across 46 separate countries, but much of it lacks the copper and fibre optic networks that are taken for granted in much of Europe, Asia, and North America. Instead, sub-Saharan African countries have built communication infrastructure using mobile technologies.

By 2025, more than half the people in sub-Saharan Africa are expected to own cell phones, with 87% of connections being for mobile broadband. Even then, access won’t be universal, but it does provide a basis for communities to share access to remote healthcare, in a similar way to how Australia’s Royal Flying Doctor Service has telemedicine facilities in remote towns.

Start Building Today

It’s possible that your healthcare provider already offers you some form of telemedicine; perhaps you can book a video call with a doctor using an app. However, that’s just the start.

Thanks to cloud communication APIs, connecting people is now easier and cheaper than ever. With 5G, we’ll see network latencies reduced to near-zero, plus bandwidth that will enable previously unthought of applications. And with devices such a smartwatches we have a wealth of information about how our bodies are operating. Combined, those technologies mean that developers can create innovative telemedicine tools that have the potential to improve and save lives, especially in critical times when we are facing a pandemic.

 
Bio
Alyssa Mazzina
Alyssa Mazzina

Alyssa is a writer and editor specializing in technology and the software development space. She lives in central California with her husband, kids, and three rescue dogs.

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