Telehealth has been crucial during the COVID-19 pandemic to connect patients to their health care systems. It’s impressive that clinicians, regulators, and payers managed to quickly integrate telehealth—and the innovations seem to be catching on permanently. But in the U.S., at least, these accommodations of telehealth were disappointingly limited to reproducing the doctor/patient visit. A comprehensive telehealth strategy is called “connected health.” It focuses on building better behaviors through planning, monitoring, and support.
We are far from a connected healthcare system in most countries, but Let’s Talk Interactive (LTI) is building a solution and reaching out to Latin America. LTI has long offered a wide range of solutions in behavioral medicine monitoring, not just televisits. Elements of LTI’s system (Figure 1) include telehealth software, medical carts, kiosks, and other medical devices, provider networks, HIPAA-compliant web development, cybersecurity, and APIs for integration with other systems.
Understanding the Context
I got a sense of how difficult care in remote areas is from an email message by Juán Carlos Lenz, a board member of Wings of Hope and president of Patrulla Aérea in Colombia, which provides medical aid by air and the Internet to these areas.
“When the people in El Charco, on the Pacific coast of Colombia, need access to specialist doctors or for special diagnoses, they have to go to the nearest high level hospital. This hospital is in Tumaco, about four to eight hours away by boat in the best cases. Sometimes, and for more complex issues, they have to go to Pasto, which is another nine hours by bus. The transportation is very expensive given it is by water, and the trip can be hard on pregnant women and other groups of people, such as the elderly. Travel is also expensive because the insurance covers only the tickets, but there is only one trip per day, so patients have to stay overnight in Tumaco or Pasto. Some of the indigenous people don’t speak Spanish and don’t even have appropriate clothing to withstand the cold from a high-altitude capital like Pasto. Imagine also even thinking of letting your 5 or 7 kids alone at home. Additionally, low schooling levels leave people with difficulties accessing the health system, and interpreting the results they might get, Sometimes the doctor’s advice can be out of touch with their reality.”
Wings of Hope currently flies in specialists to each community once or twice a year for a weekend during which it offers about 800 consultations and 120 surgeries. The organization is currently negotiating a deal with LTI to bring a telehealth infrastructure to that region.
LTI Becomes Embedded
About a month ago, LTI hired Monica Boada as its VP of Global Business Development, to spearhead its growth in Latin America (currently Colombia and Ecuador). I talked recently to Boada and Arthur Cooksey, CEO and Founder of LTI, to learn just how wide of a net they cast.
They are building health care systems from the ground up, starting with providing high-bandwidth Internet access to rural regions. On top of this network, they offer services for connecting to remote clinicians, running teleconferences, sharing patient data securely, and secure payments.
Patient data is secured in an EHR if the provider has one. When using an EHR is not feasible, the patients can store their data in a secure cloud service run by LTI. Through APIs, LTI can integrate the data and services of major EHR vendors.
Currently, patients in areas not served well by a local health care system are patching together a telehealth solution. According to Boada, each step—connection, teleheath visit, and payment—is separate and has to be arranged by the patient and provider. Lacking dedicated health care communication tools, the patient and provider hold visits over a popular social media platform—Facebook Messenger and WhatsApp are most commonly used—and even use WhatsApp to transfer medical information. WhatsApp provides encryption, but it is by no means a secure communications channel by health IT standards.
Thus the six-hour downtime by Facebook services on October 4, which frustrated people in developed countries trying to upload wedding photos, led to a denial of health care for many Latin Americans.
So Where Does the Money Come From?
Funding, of course, lies at the root of a strong healthcare system. In many Latin American countries, governments are recognizing the benefits of a healthy population and are willing to invest not only in medical responses to disease, but in preventative care. LTI is working with both governments and private health care systems to build comprehensive telehealth platforms.
One advantage of telehealth is that a patient can be paired very specifically with a provider possessing the most appropriate expertise. For instance, one can ask not just for a psychologist, but for a psychologist specializing in PTSD.
Remote care—especially in mental health—raises questions of whether a provider can understand the language, dialect, and culture of the patient. We didn’t talk much about this need. Cooksey said that LTI has AI and NLP tools to interpret body language and even analyze the patient’s heart rhythms during a visit.
We can see in the LTI service, as described to me, a model for the oncoming health care platform, not just in Latin America but everywhere. I prefer when services are open protocols shared by multiple institutions, but this is likely the next step to happen if LTI succeeds in their current, bold growth effort.
