Telehealth and telemedicine: how the digital era is changing standard health care Yasser El-Miedany King’s College, London, UK Abstract: The revolution in digital technology has transformed our lives, and electronic advances are expected to expand. At the same time, personal attitudes toward technology developments and digital health care are also changing positively. Younger generations and older adults have started to enjoy the outcomes of the recent technology progresses. Soon, smart gadgets are expected to play an important role in health care and day-to-day management of the patients, and hence will be able to renovate medical services and facilitate real improvement in the patients’ self-management. The challenge is how to make most of these technical advances patient friendly, and explore ways to avoid the risks, particularly in regard to privacy. This article discusses the growing role of telehealth in standard health care, the facility and impact of using digital technology in day-to-day patients’ management and the best evidence available from those using digital technology on the front line. Keywords: telemedicine, telehealth, e-PROMs, e-comorbidity, rheumote, electronic medical record, e-health

Health care professionals' perception of security of personal health devices Brian Ondiege, Malcolm Clarke Department of Computer Science, College of Engineering, Design and Physical Sciences, Brunel University London, UK Abstract: With the rapid advances in the capabilities of telehealth devices and their increasing connection to the Internet, security is becoming an issue of major concern. Therefore, the perceptions of the health care professionals regarding security are of interest, as the patients trust them to make informed decisions on issues concerning their privacy, data, and health. Eight health care professionals were interviewed to determine their perceptions and knowledge of security in health care. The research further examines one specific aspect of security which is considered of significant concern: the authenticity of a device being from the actual manufacturer and not a counterfeit. This research proposes device registration together with digital signatures and one-time passwords to address the issue of counterfeit remote patient-monitoring devices and identify and authenticate the user of the device. Keywords: telehealth security, health care professionals’ perception, personal health device, authentication

Patient perception of smartphone usage by doctors Georgina Kerry,1 Shyam Gokani,2 Dara Rasasingam,2 Alexander Zargaran,3 Javier Ash,2 Aaina Mittal2 1College of Medical and Dental Sciences, University of Birmingham, Birmingham, 2Faculty of Medicine, Imperial College London, London, 3Faculty of Medicine, St George’s University of London, London, UK Abstract: Technological advancements have revolutionized modern medicine and smartphones are now ubiquitous among health care professionals. The ability to look up information promptly is invaluable to doctors and medical students alike, but there is an additional contiguous benefit to patients. Queries can be answered more accurately through fingertip access to evidence-based medicine, and physicians have instant access to emergency care protocols. However, is consideration always extended to the patient’s perception of the use of smartphones by doctors? Do patients know why we use smartphones to assist us in their care? What do they think when they see a doctor using a smartphone?An independent question, conducted within a wider service evaluation (ethical approval not required, full verbal and written electronic consent provided by all patients) at St. Mary’s Hospital, London, indicated that although the majority (91.0%) of patients owned a smartphone, many (61.6%) did not agree that the use of smartphones at work by doctors is professional. This highlights the potential for damage to the doctor–patient relationship. There is a risk that these patients will disconnect with care services with possible detriment to their health. Additionally, it is notable that a larger proportion of those patients aged >70 years found the use of smartphones by doctors at work unprofessional, compared with patients aged <70 years.Adequate communication between the doctor and patient is critical in ensuring that doctors can make use of modern technology to provide the best possible care and that patients are comfortable with this and do not feel isolated or consider the doctor ignorant. It is suggested that moves are made to educate patients of the importance of the use of technology by doctors and to ensure that patients are aware of the reasons for which doctors use smartphones at work. Keywords: telehealth, smartphone, doctor–patient relationship, patient self-determination act

Business models for telehealth in the US: analyses and insights Francis Pereira Data Sciences and Operations, Marshall School of Business, University of Southern, Los Angeles, CA, USA Abstract: A growing shortage of medical doctors and nurses, globally, coupled with increasing life expectancy, is generating greater cost pressures on health care, in the US and globally. In this respect, telehealth can help alleviate these pressures, as well as extend medical services to underserved or unserved areas. However, its relatively slow adoption in the US, as well as in other markets, suggests the presence of barriers and challenges. The use of a business model framework helps identify the value proposition of telehealth as well as these challenges, which include identifying the right revenue model, organizational structure, and, perhaps more importantly, the stakeholders in the telehealth ecosystem. Successful and cost-effective deployment of telehealth require a redefinition of the ecosystem and a comprehensive review of all benefits and beneficiaries of such a system; hence a reassessment of all the stakeholders that could benefit from such a system, beyond the traditional patient–health provider–insurer model, and thus “who should pay” for such a system, and the driving efforts of a “keystone” player in developing this initiative would help. Keywords: telehealth, business model framework, stakeholders, ecosystem, VISOR business Model

Telehealth has the potential to improve access and outcomes for patients and to reduce health care costs across a wide range of health conditions and situations. The wide adoption of telehealth requires, however, a strong legal and financial foundation. In this article, we compare the evolution of American and Brazilian telehealth legislations and reimbursement schemes. The detailed analysis in this article shows many differences between these two countries that help to explain why telehealth in the USA has a much faster adoption rate than that in Brazil.

Telecare technologies involve the remote monitoring of patients who have health, rehabilitation or social needs. These technologies, although deployed unevenly in developed countries, represent a shift in the ways in which care is practiced. Research on the consequences of this shift away from more traditional ‘hands-on’ care has focused primarily on quantitative measurement (for example cost savings) with less attention paid to how recipients themselves experience these new care practices. This paper discusses two aspects of telecare technologies which are under researched; the potential for isolation which may arise as a result of the use of these technologies, and the ethical issues raised by this. The primary locus of the discussion is the United Kingdom, where a major public policy shift towards telecare is under way and where telecare research has been particularly well funded by government. The discussion concludes that isolation raises the potential for loneliness – which is increasingly recognised as a significant factor in overall health and well-being – and is not being sufficiently considered, in part because the ethical frameworks in use do not adequately address the issue of loneliness itself, given their bio-medical, rather than relational focus.