Ready for the cladogenesis of traditional healthcare?

As the numbers continue to grow, healthcare providers are constantly inventing new ways to lower these costs without negatively impacting the quality of care. Telemedicine – including "remote patient service" – is one of these. But change usually happens slowly, especially when personal data and politics are involved.

2020: the beginning of a new normal?

COVID-19 has taken attention away from chronic diseases but confirmed and exemplified that digitalising healthcare is the key to progress.

Although the pandemic has triggered some legal changes, making remote access to physicians and medicine easier, CE and SEE countries are still cautious about the digitalisation of healthcare. Most of them still prefer analogue systems.

Poland is a pioneer! Polish law has explicitly allowed the provision of remote health services since 2015. Patients can receive a diagnosis without having to personally visit the doctor's office. In Poland, telemedicine has proven useful in diagnosing and monitoring the health status of patients with chronic diseases such as asthma, cardiovascular disease, diabetes, mental illness and stroke.

Bulgaria is one of the few countries in CEE that legally allows the execution of prescriptions filled by doctors from other EU Member States, even those signed with an elec-tronic signature. This is not the case in the Czech Republic. However, an amendment of the Czech Medicines Act will enter into force in April 2021 allowing the adoption of electronic prescriptions by other EU Member States. Also in 2021, Poland will join a cross-border e-prescription programme, which currently includes Finland and Estonia only.

Austria introduced its ELGA system in 2012. It establishes an "electronic health file" for every participant, but is still not fully up and running. Nevertheless, e-prescription and remote patient service have experienced a boom, albeit out of necessity. Patients can now simply call their doctor before heading straight to the pharmacy to pick up their digital prescriptions.

Legal fiction

Legislation is being adopted to better meet patients' needs and respond to the challenges of the pandemic and our faster lifestyles. But calling a physician for a consultation or ordering drugs online or by e-mail is hardly innovative.
Now imagine yourself on holiday or simply at home not needing to spend valuable time going to your doctor for an examination, whether routine or for an illness. Imag-ine just plugging yourself into a device from the comfort of wherever you are. Or imagine the ER doctors and paramedics receiving your blood type and medical history while traveling to save you or awaiting your arrival. The technology is available right now!

TytoHome is a handheld device that can measure people's vital signs, examine their lungs, ears, skin and throats with special adapters, and videoconference with a doctor to monitor the patient's metrics in real time. Omron HeartGuide is a blood pressure monitor that looks like a wristwatch – perfect for monitoring cardiovascular health. The Pelebox smart locker allows registered patients to pick up prescriptions from kiosks with a onetime text message code.

This is not sci-fi, but reality… in Estonia! They address real healthcare problems, such as a lack of trained doctors and a healthcare system overburdened with paperwork. Meanwhile, members of the Austrian healthcare system do not want prescriptions sent to pharmacies by e-mail after the pandemic because it is too difficult…
The Estonian eHealth system is one of the most ambitious in the world. Already over 95 % of the data generated by hospitals and doctors are not only digitised but system-atised. This facilitates patients' access to the most appropriate health professional, and improves the cost-effectiveness, sustainability and efficiency of healthcare. It also enables the transition to preventive medicine, supported by blockchain technology as a keyway to ensure the integrity and security of patient data.

Twenty-two Member States are now part of the EU eHealth Digital Service Infrastructure and are expected to exchange ePrescriptions and Patient Summaries by the end of 2021. Estonia, Finland, the Czech Republic, Luxembourg, Portugal, Croatia, Malta, Cyprus, Greece and Belgium may start these exchanges by the end of 2020.

So, the question is not whether adaptation is possible, but how willing we are to explore new ways.

cladogenesis = an evolutionary splitting of a parent species into two distinct species. It usually occurs when environmental changes cause several extinctions, opening up ecological niches for the survivors.

authors: Iliyana Sirakova, Elena Todorova