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By Maria Palombini, IEEE Standards Association (IEEE SA)
Today’s typical patients expect 24/7 access to their healthcare providers, and they are using telehealth as a means to meet the demand remotely through now-familiar consumer technologies such as FaceTime and Zoom and regulated platforms such as Teladoc and Doximity. During the COVID-19 pandemic, telehealth became the “life-saver” option to provide patients access for non-critical care situations. However, the challenges with telehealth that existed before the pandemic – barriers to trust, access for all, and security – remained unaddressed. Despite the rapid increase of use during the pandemic, telehealth has not reached critical mass or maturity because the foundational challenges of privacy, security, connectivity and accessibility for all have yet to be resolved. It is critical that all stakeholders – patient advocates, clinicians, healthcare professionals, regulators, hospital administrators, technologists, regulators, and others – begin to collaborate, explore and develop solutions. Stakeholders must build consensus on technical standards and guidance to resolve these challenges if we are to fully realize the potential of telehealth as we move towards the future of mobilized care.
The Rise of Telehealth
The practice of remote health monitoring has been around since the 1960s but gained traction in the last decade or so as more apps and platforms became available. With the distribution of health-related services and information via electronic information and telecommunication technologies, telehealth has the potential to close the gap in reaching those who cannot be reached such as rural communities, immobilized patients, or locations lacking any health service facilities. Despite continuous innovations from medical and wellness smart phone applications and the proliferation of remote monitoring health wearables and implanted devices, the full migration towards telehealth continued to lag until the Covid-19 pandemic. The pandemic urged both patients and healthcare providers to openly embrace a platform out of necessity. A recent survey by Amwell found more than half of consumers plan to use telehealth more after the pandemic than they did beforehand, while 92% of physicians expect to continue providing virtual care. With more people using telehealth, the need for education and protection increases.
Privacy and Security in Telehealth
The healthcare industry is a highly appetizing and vulnerable target for breaches and attacks. Unlike credit card information, once someone’s health data is breached, it cannot be replaced. Telehealth offers an exciting opportunity to close the gaps of legacy healthcare delivery problems while, at the same time, presents new and serious concerns for patient data privacy and overall data security. So, what needs to be done to protect those who use telehealth today and the millions who will eventually have access? The ability to secure the entire telehealth experience is one critical step towards protecting the patient’s privacy and establishing public trust in its use. There is no expectation that only one person, entity or group can solve this challenge. It will take a village of committed experts to develop technical solutions, effective policy guidelines and overall best industry practices to move this forward. Consensus-driven global technical standards will play a key role, and a current project at IEEE Standards Association (IEEE SA), IEEE P2933, aims to establish the framework with TIPPSS principles (Trust, Identity, Privacy, Protection, Safety, Security) for Clinical Internet of Things (IoT) data and device validation and interoperability for remote care.
The Challenges with Telehealth
There are challenges that come with using any form of technology, and telehealth is not exempt. Of utmost concern is managing the added complexities of non-harmonized regulations across geographic regions, such as HIPAA in the United States and GDPR in the European Union. Primary challenges include security, accessibility, privacy, and connectivity for all. The telehealth experience has multiple vulnerable points in the data journey: devices (i.e., smart phones), internet connectivity, platforms, cloud storage, and more. Each of these points have vulnerabilities that require attention. Patients in marginalized populations not only lack access but also lack trust in the technology because of their unfamiliarity with it, which further makes the challenge of connecting them that much harder. Telehealth security has to account for both those who currently have access and those who do not while also encompassing both a robust preventive and reactive response to attacks and breaches. If these challenges are not addressed, the full future and potential of mobilized care will never be fully embraced.
The Future of Telehealth
The way we see telehealth today will look very different tomorrow. Telehealth is at its infancy, yet the challenges are significant in enabling its reliable maturity. The future of mobilized healthcare will heavily rely on a robust, seamless, private, secure, and connected bioinformatics highway, enabling real-time critical and urgent patient care beyond the hospital. As more patients and physicians continue to use telehealth, more focus and efforts must include expanding access and providing a secure experience to everyone. More education and participation in research and development will assist in reaching the unreachable. Telehealth is moving in the right direction, but more remains to be done.
Maria Palombini currently leads the IEEE SA Healthcare & Life Sciences Practice working with a global community of stakeholder volunteers who are committed to establishing trust and validation in tools and technologies that will change the approach to discover therapies, deliver care, and ultimately enable a sustainable and universal quality of care for all. She holds a B.S. and B.A. from Rutgers College and an M.B.A. from Rutgers Graduate School of Business at Rutgers University.
- “Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced,” Cynthia LeRouge, and Monica J. Garfield, December 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881125/