The Medical Service Act amendment to institutionalize telemedicine recently passed the National Assembly. Telemedicine, which was operated temporarily during the COVID-19 period, has been incorporated into the formal system and is about to be fully implemented. North America has used phone- and video-based remote care as routine medicine for decades. We visited sites in North America to look at how it actually operates. [Editor's note]
Stroke, caused by a ruptured or blocked cerebral blood vessel, is the No. 2 cause of death worldwide, killing 6 million people every year. Stroke progresses quickly, and missing the golden time can lead to aftereffects such as hemiplegia and aphasia. Overseas, if a stroke patient appears and there is no attending physician available, remote co-treatment with another hospital is possible.
On the 28th of last month (local time) at Victoria Hospital (London Health Sciences Center) under LHSC in London, Ontario, Canada, LHSC executive vice president for medical and academic affairs Adam Dukelow said, "We can remotely prescribe thrombolytic agents to stroke patients (in another hospital)."
By administering a drug that dissolves the clot blocking a cerebral blood vessel, patients can be treated quickly. This offers lessons for Korea's medical system, where patients are often bounced around emergency rooms.
◇ Stroke golden time is 4.5 hours; respond remotely
In Korea recently, a 10-year-old child who lost consciousness and collapsed in Busan was refused transfer by 12 hospitals and went into cardiac arrest. According to fire authorities, the 119 ambulance contacted hospitals to transfer the child, but acceptance was refused, citing the lack of a specialist. This does not happen only in Busan. Even after a patient arrives at an emergency room, they are frequently transferred because the hospital says it cannot provide treatment.
In Canada and the United States, in such cases physicians conduct remote co-treatment. The golden time for most stroke patients is 4.5 hours. If a patient reaches a hospital with no available treating physician and moving to another hospital will take a long time, they would rather respond remotely. It is possible to share CT (computed tomography) and X-ray test results or prescribe medication remotely. That reduces the risk that the patient's condition becomes severe or that sequelae remain.
Frank Myslik, LHSC chief medical information officer, said, "Patients don't have to spend time on the road," adding, "That enables faster action."
MedStar Washington Hospital Center in the United States provides remote medical consultation to 33 MedStar Health Urgent Care centers in the community. Urgent care centers are visited by patients with mild symptoms such as colds or tonsillitis.
If a patient with a severe injury or a life-threatening condition visits, specialists affiliated with MedStar Washington Hospital Center can provide telemedicine. It serves as a backstop for care.
A MedStar Washington Hospital Center official said, "Orthopedics, cardiology, ophthalmology and pediatrics specialists provide consultations."
Remote co-treatment helps regional, essential and public health care. According to the Korea Institute for Health and Social Affairs (KIHASA), outside the capital area there are only 0.46 essential medical specialists per 1,000 people. Instead, there are about 3,600 public health centers, branch health centers and community health posts nationwide.
Among these, 794 medical institutions, including public health centers and private hospitals and clinics, are participating this year in the Ministry of Health and Welfare and the Korea Health Promotion Institute's remote co-treatment project. Regional public health centers can closely assess patients' conditions. As remote co-treatment is strengthened, the level of care can improve and patients' trips to big-city hospitals can decrease.
◇ Place caregivers next to patients — Korea should take note
Canada and the United States share a common feature: even with telemedicine, they place caregivers next to patients. This is significant for Korea.
As full-scale telemedicine is set to begin late next year, discussions are underway on how to help older adults who find smartphones difficult.
In Canada, social workers linked to hospitals help with Wi-Fi connection and laptop camera setup where patients live. Some U.S. hospitals run programs in which nurses ensure that telemedicine proceeds smoothly in the homes of patients in their 80s.
In Korea, there are prospects to link with local government caregiving programs. A Ministry of Health and Welfare official said, "You can get help from regional public health centers or use smart senior centers." Instead of going to a hospital, patients could meet physicians via laptop or tablet at a neighborhood senior center. If the senior center has health management devices, they could check blood pressure or blood sugar.
Overseas prescription delivery is also worth referencing. In Canada and the United States, patients can choose to pick up medication at a pharmacy or receive it by courier. Temperature-sensitive drugs can be shipped refrigerated, and patients' signatures may be obtained to prevent delivery mishaps. In Korea, as proxy pickup is limited, experts advise that identity verification and other procedures are needed when delivering medication.
Meanwhile, concerns have been raised that telemedicine may be less effective than in-person visits. That is because physicians cannot physically examine the affected area and must look through a camera or ask and answer questions about symptoms. This is also why the Medical Service Act amendment allows telemedicine mainly for follow-up patients.
Even so, experts note that the advantages of telemedicine outweigh the drawbacks.
Ann Mond Johnson, CEO of the American Telemedicine Association, said, "Because patients living in rural areas can receive care (frequently) at home without going to big cities, it can actually reduce hospital admissions or emergency room visits."
Victoria Hospital psychiatrist Lee Jae-heon said, "In Canada, if a patient is in danger during virtual care, the physician can fill out a form to request police dispatch," emphasizing, "In any situation, misdiagnosis is not tolerated."