The Paradox of TeleMedicine in Pandemia – beyond the buzzword, an (un)expected reality

To speed-up the development of telemedicine solutions, Dreamix, a partner of Pryv, is developing an OEM modular communication tool which is to be offered to software and hardware companies. Developed on the basis of Pryv.io, the solution would enable secure, instant communication and sensitive data transfers, following highest privacy standards and ensuring full control over the provided information.

Privacy-by-design, embedded consent management, easy data integration, guaranteed data safety, allowing patients to remain aware of how their data is handled following the Swiss DPA, GDPR, HIPAA and other health and personal data protection regulations,  this patient-doctor communication layer will greatly simplify and support the development efforts of clinics, software and hardware healthcare providers which would like to offer trustful, secure, digital communication between doctors and patients.

Request demo of the modular OEM telemedicine communication tool for clinics, software and hardware healthcare providers.

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There have been many expectations towards telemedicine during the last few months. While sanitary measures were rapidly put in place to decrease the spread of the disease, a suitable solution had yet to be found to ensure that sick patients would not be denied access to primary care in the pursuit of containing the epidemic. Telemedicine was expected to address this concern and make it possible for everyone to get medical help in this time of crisis. Is this really what happened though?

TeleMedicine in Pandemia: expectations vs. reality

At the edge of the second wave of the disease, the question as to whether our reality caught up with our expectations is now more relevant than ever. That is, can we say today that telemedicine has made its way to address burning needs arising from current and forthcoming lockdowns and contact minimization policies? While the adoption of tele-solutions has grown significantly in many areas, the same seems still hard to say for the healthcare sector. In Switzerland, particularly, telemedicine appears to be more of a hard pill to swallow than a widely accepted solution.

This reluctance to adopt telehealth innovations at a time of increasing need for medical care and help raises concerns at many levels. In April 2020, cardiologists were already warning about a decrease in consultations for heart disease. In their opinion, it wasn’t that there were less sick patients in this regard, but rather that these patients stayed home due to a confusion with covid symptoms or by fear of going to a hospital. At the same time, care facilities were often advising people with possible covid-related symptoms to stay put in quarantine. For people experiencing a mental health worry, accessing medical support in-person became equally far less straightforward. “So where can people find the trusted help they need?”

TeleMedicine in Pandemia: why the low-rate adoption?

If arguments referring to the complexities of remote consultations were valid at a normal time, they seem hardly convincing when they imply to deny access to primary care during a pandemic crisis. More than ever, we need to push through our fear of change and find solutions that not only “restrict” but are also supportive of the people who need it the most. For example, countries like Germany found a way to recognize “apps on prescription” and to procure doctors and insurers with an up-to-date legislative framework to foster the adoption of digital health solutions. Is this what we lack in Switzerland to make telemedicine a reality?

Either way, given the current situation, to not embrace technology enabled solutions might no longer be an option. Especially considering that adopting telemedicine could help the system absorb the increasing demand for medical help so that more patients can have access to proper treatments, whether in physical, 1-1 consultation or from the comfort of their home. For patients with chronic disease, it could even be life changing. A recent example is the HeartKinetics cardiac monitoring solution that allows patients to easily monitor the cardiac function from home in less than 2 minutes, saving time travelling to the hospital and receiving more frequent analysis.

However, despite all the benefits that such a solution might represent, the low-rate adoption still appears to persist and telemedicine itself  seems to be still perceived as limited in a number of aspects. 

“Collecting information with existing tools and helping patients when they are not physically present is common practice. During the pandemic patients would not come to the office for good or bad reasons, and more often mail photos and call for advice. This actually did grow TeleMedecine while requiring as usual accurate documentation in the existing electronic system. Why then move fast forward to engage with new applications which claim to enable better TeleMedecine? The digital transformation is an engine of economic growth. But at the scale of a general medicine practice for it to be of benefit, there must be incentives that engage the “hearts and minds” of physicians. Two hurdles remain: first, real integration of the single problem solutions, who actually match only part of the many specific needs. Second, to go beyond the digital transformation will always require a humane personal relationship even without the patient being present.”  Pietro Scalfaro, Pediatrician.

TeleMedicine in Pandemia: the privacy dilemma

Another concern that seems to contribute to the reluctance of adopting telemedicine to face the epidemic is the privacy dilemma. While technologies are certainly recognized as a valid solution in the fight against the virus, many say that privacy is a main concern. Still, solutions exist. Since the pandemia, a lot of efforts have been invested into finding privacy-preserving solutions. For example, we at Pryv made our solution available in OpenSource so that anyone can benefit from a free, privacy-by-design, swiss-made software solution on top of which they can rapidly create and build their own digital applications.

In parallel, telemedicine providers like Umana, DTHX, Riva Digital, HeartKinetics provide doctors, patients and care facilities with ready-to-use, proven telehealth solutions, having privacy at their core. Together with our partners Dreamix, Pryv is also working on a new set of module components which will allow any provider willing to launch telemedicine and digital health solutions to be ready to go to market within a few days/weeks only from the start of the project, choosing the components that they need the most while embedding a strong solution for patient consent and privacy-by-design.

Maybe now is the time to turn our expectations into a reality?

Yours,

Stephanie & Evelina

Sources:

https://www.swissinfo.ch/eng/coronavirus–a-turning-point-for-telehealth-in-switzerland/45870678

https://www.rts.ch/info/suisse/11230872-les-patients-noncovid-desertent-les-urgences-inquietude-des-medecins.html

https://www.thehtn.co.uk/2020/10/14/htn-voice-mental-health-apps-must-win-trust-in-how-they-use-data-if-they-are-to-achieve-potential/

About Pryv SA:

Pryv makes health personal data processing as secure and trustworthy as online banking.

Pryv.io is a solid foundation on which you build your own digital health solution, so you can collect, store, share and rightfully use personal data. It comes with must-have consent and auditing tools to keep you compliant with existing and forthcoming regulations. The software has been developed to accommodate rapid integration, allowing you to properly manage your users’ data from day one. It comes with turnkey IoT connectivity, a secure storage vault, fine-grained consent management, and comprehensive auditing capability that radically cut IT risk, development costs and accelerate time-to-benefit while addressing the GDPR and the most stringent data protection requirements.

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Level up: light on the legal and ethical aspects of using gamification in mental mhealth apps

Mental Health has been seen as the “cancer of tomorrow”. The pandemic further strengthened the suppressive force turning this prediction into a reality. As for their part, researchers even show that there is an unprecedented increase in stress, anxiety and depression. And in the blink of an eye, tomorrow suddenly became today. 

In the context of mental illness, there is no “risk group” as it can hit us all – our children, co-workers, family members. The damages and consequences are long-term, life-threatening and life-changing. So, not a surprise, among other digital health applications accelerated during the pandemic, a number of mental health applications got their momentum to deliver on their promise: a click away to mental health and well-being. Is the promise delivered? While there is a robust growth of mental mhealth apps offerings, their usage seems to remain inconsistent.

Do people trust mental mhealth apps? Maybe “not”.

Trust is the very first principle that allows for engaging users in sharing enough data so that they can be given help. Yet today, people may be skeptical to engage with an app that keeps track of their mental health data and rightly so. For these apps to work then, trust needs to be won first. Nevertheless, trust itself isn’t enough – people need to put in the work to get better. This requires consistency and the right amount of motivation to do so.

Do people use mental mhealth apps with consistency? Maybe “not”.

Consistency is key for progress. The problem is: keeping users motivated and consistent while being tied up to their homes, forced into quarantine and limited to zero family reunions or social activities is not a piece of cake. To keep them going, you need them to want to engage with your app, just like they would when choosing to play a video game: because it is fun, not seen as an obligation, and it might even fill them with motivation and a positive mindset… 

So what if winning over mental health could become as entertaining as playing a video game? 

Encouraging consistency in using mental mhealth applications through gamification has become a trend among digital health innovators. 

“Games with purpose”: Embedding gamification into mental health applications

Gamification is used as a tool for influencing behavior modification in many health applications. 

Due to the game elements introduced in the app, users are enticed to be more engaged in their own recovery, which makes it a formidable tool against mental health disorders. When used in this context, it can further help the users develop healthy habits that can reduce stress, anxiety or depression, such as exercising regularly or following treatment instructions.

Video game makers have banded together to promote gaming as a healthy means of physical distancing and social connection amid the coronavirus pandemic. 

One of the reasons it has become so popular in mental mhealth apps is that smartphones are excellent delivery vehicles for gamification in healthcare: easy collection of precious personal data like geolocation, inbuilt accelerometers to monitor activity and external sensors that can capture vital signs such as heart rate and blood pressure are just a few to mention.

Hence, not surprisingly, while the pandemic has inflicted income declines on many industries, video games and digital health are not among them. Nowadays, combining the two might even be the best shape for providing help to the ones who need it the most, “stay at home”-compliant. So is it checkmate? Maybe not. One thing is for sure, embedding gamification in mental mhealth apps does not come that easy.

(spoiler alert: privacy is calling!)

Legal aspects and ethical considerations of using gamification in mental health applications

If mental mhealth apps may feel like a funny game to the users, for the one who designs it, the app is nonetheless a digital therapeutic and personal data collecting tool which needs to comply with a number of regulatory requirements.

For personal data collection, privacy and data protection regulations such as the GDPR, CCPA or any relevant national Data Protection Act (DPA) depending on the business and users locations will have to be addressed. As regards to health data, more specific requirements may have to be added to the list, like the HDS Certification required for health data hosting in France. And if the app is recognized as a medical grade solution within the EU, the new EU MDR might even come into play. On a brighter note, if targeting the german market, you might also consider applying for your app to be prescribed as a treatment and reimbursed by insurance companies. 

Parallel to this, the “influencing the behavior of your users”-part of gamification is not to be taken lightly. Alongside the legal aspects cited above, ethical considerations should be given:

1. Design for Trust:
   • It’s simple: if your users don’t trust you, they won’t provide you with their most sensitive, personal information about their mental health and state. Neither will they feel comfortable enough to use your app with consistency. You need trust for your app to work, so build your app around it – design it for trust.
   • It is not about turning your dev team into the new lawyers to be. But embedding privacy in all aspects of your mental mhealth app so it is trustworthy, lawful, and so that your users know what it is done with their data at every step of the way.
   • Little tip about that: enhancing trust requires rethinking consent.

• Avoid Dark Patterns, unless For Good: 

1. • Be mindful of the impact you have on users’ choices and their behaviour. While it is one thing to motivate your users through games and a user-friendly interface, it is another to get consent over addiction. Even through games, rightfully ask for consent and don’t let the prospect of a quick profit blind you. 
   • Alas, recent studies show that despite the recent upsurge in privacy and data protection regulations (GDPR, CCPA, PIPEDA…), companies still have a hard time going against their own business interests. So is it game over?
   • Maybe not! Take it to the next level: use Dark Patterns for Good.

• Digital Ethics

1. • Respect the moral principles – don’t take the game too far. While gamification can help, it can also have devastating impacts on users, such as inducing depression and crushing attention span. Be careful not to get carried away while “playing the game” and rely on digital ethics to build “games with purpose”.
   • Establish norms dedicated to ensure that the autonomy and dignity of users is respected. It is not all on your development team to understand what “ethics” and “privacy” means technically. Provide them with the tools to implement it “rightly”.
   • Lastly, allow your users to shape the debate and make informed choices.

#tip: Walk the talk and keep on your promises to build long-term engagement.

Play hard, play fair. Respect the rules with Pryv

Stay focused on your core expertise and value proposition and let us turn compliance into your competitive advantage.

Pryv.io is designed to facilitate developers creating privacy-centric digital health applications. Our Swiss-made Personal Data & Privacy Management Software is a ready-to-use middleware specifically designed for personal data and consent management. It comes with must-have consent and auditing tools to keep you compliant with existing and forthcoming regulations.

Our ultimate purpose is to remove barriers to data-driven healthcare innovation by helping digital health innovators rigorously manage personal data and build effective, lawful, patient-centric applications respectful of privacy and seamless digital experiences, faster, at a lower cost and right the first time.

Yours,

Stephanie & Evelina

Additional sources:

• https://mental.jmir.org/2019/6/e13717/
• https://www.businessinsider.fr/us/mental-health-apps-superbetter-happify-gamification-techniques-2019-10
• https://uxdesign.cc/the-benefits-of-gamification-for-mental-health-656f9e4cbcce

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