[News Focus] As 'remote' gains momentum, how will medical system change?

 

The unprecedented spread of the novel coronavirus in the past months has forced medical professionals to seek ways to minimize their contact with patients in testing while maximizing the scope of tracking the infection.

Industry watchers say that the South Korean Health Ministry’s smartphone applications, for instance, are an applied form of rudimentary telemedicine by allowing people to self-test during quarantine to report their conditions to medical professionals.

In Korea, while remote health checkups have so far proven effective in the Korean government’s efforts to curb the number of COVID-19 infections, it has also consequently reignited the nation’s age-old debate on the benefits and detriments of non-face-to-face medical appointments.

In the tug-of-war between cautious medical professionals and ambitious technology providers, there lies the chance of enhanced quality of life for patients or the risk of erroneous diagnosis.

According to the Health Ministry’s estimate from July 2017, some 9 million patients are likely to benefit from telemedicine. 

These patients include those with chronic illnesses such as high blood pressure or diabetes who require regular monitoring after initial visits to a hospital, those who have physical or mental disabilities that obstruct them from frequent visits to a medical facility, the elderly, post-surgery patients requiring follow-up checks, victims of sexual abuse or domestic violence and those living in remote areas with low accessibility to essential health care systems.  

However, unilateral opposition from medical professionals here has long hampered the growth of remote health care via wearable medical devices.

 
Unwelcoming foreign wearable ECG tech

Apple Watch’s electrocardiography function is not yet available in devices sold here due to government regulations. Elsewhere, Hong Kong and 19 European nations have allowed for the ECG function.

Philips and Garmin, as well as several other makers of smartwatches, face the same situation and are unable to penetrate the Korean market. 

This is due to various medical professional associations’ reluctance to accept what they call imperfect technology to treat patients. If something goes wrong, it would become their liability. 

In a report by the Health Ministry in 2017, the Korean Medical Association said, “Should telemedicine be permitted, concerns will arise about the collapse of the medical health care delivery system, as well as the want of clinical efficacy or safety that may lead to scapegoating of doctors. Matters of data security and privacy issues are present, not to mention that patients in vulnerable conditions such as senior citizens, those with chronic illness and victims of sexual or domestic violence need heightened protection through face-to-face consultation.”

The Korean Hospital Association aired a similar sentiment.

“The primary principle should be that the doctors and patients meet in person for the fundamental qualities and effect of medicine. However, should it become imperative to allow telemedicine, it must be done to facilitate follow-up care of patients under specific disease categories so as not to hinder their right to choose the medical institution and professional, or cast negative effects on the health care delivery system.”

“Telemedicine directs patient flow to large hospitals, potentially causing a collapse of small-town doctors or provincial hospitals. It destroys the medical order and leads to commercialization of medicine, as well as distorting the national health care system,” said the Association of Korean Medicine, which represents practitioners of traditional medicine.

On the other hand, the Korean Nurses Association said, “Nurses’ visits are enforced for cases that require remote medical relief. It would be wiser to invigorate the visit-nursing and bolster the currently allowed form of telemedicine as exchanging expert opinions. Permission for direct telemedicine between doctors and patients would increase the burden on hospitals to equip themselves with necessary devices, while alienating the senior citizens unfamiliar with information technology.”

The Korean Pharmaceutical Association reflected the unilateral voice of opposition, saying, “We oppose telemedicine as it will lead to increased medical costs for patients, increase errors in diagnosis and create liability issues for medical accidents. It spawns the need for purchasing expensive devices and inconvenience when getting prescribed drugs.”

Regardless, there have been steady efforts from the government to ease regulations for possible game-changers.

Among the first to benefit from the change is startup Huinno, which was chosen for the Science Ministry’s regulatory sandbox in February 2019. The company is pursuing clinical trials of its watch in collaboration with the Korea University Medical Center.

 “Unlike Huinno’s MEMO Watch, which is being developed as a medical device, Apple Watch and Fitbit remain as wellness devices,” said a Huinno official, asserting that while the smart devices could help wearers lead a healthier lifestyle, they cannot support their medical conditions. 

Categorized as a medical device, Huinno’s MEMO Watch is authorized by the Food and Drug Ministry to collect personal medical data and transmit them to the doctor. 

Their role is to connect patients with heart conditions who have been receiving medical support from this hospital to remotely check in with their KUMC doctor.

The MEMO Watch and MEMO Patch use biosensors for a cardiograph, marking down the data in hardware and transmitting them through a smartphone Bluetooth application. The data then is retransmitted through Wi-Fi or cellular service to a cloud server that computes the information using an artificial intelligence algorithm before it sends the analysis to a monitor at the medical facility. 

If the patient’s condition is deemed to require a visit to the hospital, an alert is sent. 

Huinno said it is further sharpening its algorithm with more patient data from Seoul National University Hospital, Seoul National University Bundang Hospital, Korea University Medical Center, Konkuk University Medical Center and Sejong Hospital. 

Yoon Sung-roh, head of the Presidential Committee on the Fourth Industrial Revolution, is participating in developing Huinno’s AI solution as a member of the company’s scientific advisory board. Yoon is a professor of electrical and computer engineering at Seoul National University. 

In the long term, Huinno seeks to target overseas markets such as the US, where wearable ECG technology is more common. In this case, the company would be setting itself up as a rival to Apple Watch for the early detection of an irregular pulse and the prevention of atrial fibrillation, which causes stroke.

Huinno is also preparing for clinical trials in Vietnam with the military hospital system there. 

  
‘COVID-19 may accelerate Korean telemedicine market’

NH Investment & Securities said in its report in late March that the age of telemedicine has arrived because of the coronavirus pandemic. 

Korea’s globally touted example of drive-thru testing centers is, in a form, telemedicine, the report said, while also including the case of state-issued smartphone applications that facilitate self-quarantining patients’ stay-at-home checkups.

Remote health care will help root out blind spots of the existing health care system, with the assistance of the widespread reach of communications networks and wearable devices, the report said. 

The trend is global. Line Healthcare in Japan, Teladoc in the US and Ping An Good Doctor in China have become prime examples of online health care in their respective countries. The continuing accumulation of CT images will only add to enhanced accuracy of remote AI diagnosis. 

Renewed importance is being given to health care big data companies spearheaded by Japan’s M3, which has close to 50 percent coverage of the total 12 million global doctors.

It will be some time before a line is drawn to separate the role of wearable medical devices and wearable wellness devices, however, as the notion is confusing to consumers. 

An increasing number of consumers are drawn to wearable devices that track their steps and heart rates, but that is different from the serious monitors of heart conditions that can be identified as instruments of medical decision-making.

Still, worldwide end-user spending on wearable devices will total $52 billion in 2020 -- an increase of 27 percent from 2019 -- according to the latest forecast from Gartner in October 2019. 

Gartner predicted that end users will spend the most on smartwatches and smart clothing, with spending growing 34 percent and 52 percent in 2020, respectively.

 The trend is also toward wristbands being replaced by smartwatches, with the revenue of wristbands forecast at $3 billion in 2021, and smartwatches to $27.3 billion 2021, the Gartner report said.

“While brand leaders, Apple Watch and Samsung Galaxy Watch, command premium pricing in the smartwatch segment, lower-priced players such as Xiaomi and Huawei will counterbalance high-priced smartwatches with lower cost products,” Ranjit Atwal, senior research director at Gartner, said in the report.

“We expect average selling prices of smartwatches to decline 4.5 percent between 2020 and 2021.”

By Lim Jeong-yeo (kaylalim@heraldcorp.com)