How a telehealth company delivered vital care in rural Chile
The Covid-19 pandemic has exposed vast gaps in people's experiences of healthcare depending on where they live.
Digital healthcare services have emerged as a way to reduce these inequalities. Telehealth in particular, its usage massively boosted as a result of the pandemic, can deliver doctor consultations remotely, eliminating the need to travel long distances for a face-to-face appointment.
Recently, telehealth company Tyto Care began delivering primary care to the under-served community of San Bernardo in rural Chile. This city, on the outskirts of the capital Santiago, has a population of around 300,000 people, of which almost 23,000 are adults over 65, and about 18,000 have two or more chronic conditions.
In addition, there are about 65,000 people under the age of 18, 85 per cent of whom are below the poverty line, with childhood obesity, possible diabetes, and a considerable increase in heart problems being potential risks.
Almost 80 per cent of Chile’s landscape is made up of rugged mountains, and most of the country's population lives in or near them. However almost 60 per cent of doctors and over 40 per cent of hospital facilities are concentrated in the central part of the country. This makes it a challenge for people to access even basic healthcare services; the lack of human resources and tools required in a medical environment mean that even a simple checkup requires long, harsh travel, and wait times for basic care can exceed 500 days.
The municipality pf San Bernardo decided to invest in the implementation of Tyto Care. Over the course of three days, clinicians visited 100 families using Tyto Care’s handheld remote examination device. Vitaltec, a healthcare provider who represents and distributes Tyto Care products in Chile, helped deliver the care programme.
The device works with AI-driven software to examine the heart, lungs, throat, skin, ears, and body temperature, with earbuds for enhanced audio. Tyto can be used for diagnosing acute conditions like colds, flu, ear infections, bronchitis, and sore throats, as well as monitoring patients with chronic conditions such as high blood pressure, asthma, COPD, and diabetes.
The camera built into the device can photograph skin conditions, rashes, and bites and forward these images to a specialist. Data is stored on a mobile device for later reference, or can be forwarded instantly to a clinician for consultation.
In a trial programme running for three days this past September, the medical teams travelled door to door, making 230 visits to over 300 patients from 100 families in the remote village of San Bernando, and performed much-needed checkups.
The goal was to visit families who had not received medical attention of any kind for over a year. They identified both simple and more serious conditions, sharing them with specialist consultants when necessary to diagnose or treat specific illnesses. They met children who had never been to a doctor, as well as older patients with serious yet treatable conditions who were not getting timely care.
The majority of the diagnoses were for diabetes and cardiological issues, something that was a predictable outcome in a country fighting an obesity epidemic.
The nurses were able, often without further consultation, to reommend adjustments to existing treatments, medical prescriptions, or exercise regimens.
According to David Batikoff, CEO of Vitaltec, “We have a list of 1,689 patients in this region who are registered for home care, but the system simply isn’t able to send clinicians to visit more than once a year. With Tyto, we will visit 100 per cent of the list once a month, spending only about 30 per cent of the total budget. As there are not enough doctors, and expenses are too high to pay them to visit a poor municipality, we will use trained nurses to bring the patients to the doctors, virtually.”
“It was very touching,” adds Batikoff, “To see how the people reacted. The most common response when we knocked on the door was astonishment. They asked what they had done to deserve a private visit. It was hard for them to grasp that as a citizen of Chile, this was their right.”
One of the nurses on the team saw this delight first-hand: “Patients were nervous at first, but as everything went smoothly, patients loved being treated by specialists. They were so accustomed to having to travel for hours - in the best case - and then at the hospital waiting an additional 3-4 hours. Especially for chronic and disable patients, imagine their happiness not needing to travel far from home… and to receive an even better consultation than they were accustomed to!”
Batikoff predicts that, based on the success of the programme, they will see an expansion to other Chilean villages.
“In our community, there are other groups with the same or worse circumstances, so we are eager to begin there and scale this project with Vitaltec and Tyto. We invite to all municipalities and governors to try out the implementation of these devices and leverage telehealth to keep costs down and give citizens the quick attention they need.”
Zoom enters the healthcare market - a timeline
Since the pandemic began Zoom has become an integral part of daily life for people working from home, as well as a vital tool for families and friends to communicate. However it's also been eyeing up the healthcare space since 2017, and following the boom in telehealth the company has been rolling out additional services. Here we chart Zoom's move into healthcare.
2011 - 2013
Zoom is founded in San Jose, California, by Eric Yuan, formerly of Cisco. He got the idea to create a video calling platform from his visits to his girlfriend while he was a student, which would take 10 hours by train.
A beta version is released in 2012, which can host up to 15 participants. In 2013 this rises to 25. By mid-2013, Zoom has 1 million users.
2014 - 2017
Zoom attracts investors, including Sequoia Capital, Emergence and Horizon Ventures. By January 2017, Zoom has a series D funding worth $100 million.
2017 - 2019
Zoom for Telehealth launches, including an integration with EHR system Epic. It has cloud-based video, audio, and content sharing features, a "waiting room" for patients, and can easily be integrated into healthcare provider's workflows.
In 2019 Zoom goes public, with its IPO rising 72% in one day.
As a result of the pandemic, Zoom gains 2.2 million new users, more than in the whole of 2019. On the 23rd of March alone - the day the UK lockdown was announced - the platform was downloaded 2.13 million times around the world.
Share prices rise to around $150, and founder and chief executive Eric Yuan becomes one of the world's richest people, with an estimated net worth of $7.9 billion.
Early security issues are addressed by encrypting data with the Advanced Encryption Standard (AES). By now the the platform allows 99 people to be on a call simultaneously
New features launch, including Zoom Home and Zoom for Chats. Throughout the year the platform is used to replace most kinds of real life events: work meetings, online classrooms, church services and social events.
Renamed Zoom for Healthcare, users can share secured video, audio, and content through desktops, mobile phones, and conference devices. As well as Epic, it can be integrated with Strmr, IntakeQ, and Practice Better.
It can also be used with diagnostic cameras and other point-of-care devices, including digital stethoscopes.
In an interview with Korea Biomedical Review, Zoom Global Healthcare Lead Ron Emerson said: "Our service is not simply a virtual care and telemedicine platform but a multi-purpose platform that can satisfy the needs of healthcare institutions."
"It can be used for administrative tasks, including telemedicine, medical team meetings, recruitment, medical education, employee training, and disease prevention. Analysing electronic records managed by Zoom could provide meaningful insights into patient care."
Phoenix Children's Hospital, Belfast's Hospital Services Limited, Butler Health Services and the global Project ECHO are among Zoom for Healthcare's current customers.