I asked Dr Erica Wheeler, PAHO/WHO Representative, some questions about Telemedicine in Trinidad and Tobago

What is telemedicine?

Telemedicine is the use of electronic information and communications technologies to provide and support health care when distance separates the participants. ¹

That is, clinical services – doctor-patient consultations – are delivered remotely.

What are some of the benefits of telemedicine?

• Greater accessibility to health care
• Flexibility for the patient and health worker on managing the patient
• Less of a financial burden on the patient who does not have to travel to the health facility; it also saves time for the patient
• Can help improve patient compliance with health plan as the health worker can more easily follow up on adherence to treatment and share health information
• Patient data collection and management.

What sort of technologies are involved in providing telemedicine?

Mainly ICTs, for example: computer equipment – inclusive of PCs, tablets and lap tops; smart phones; telemedicine kits; television; teleconference software/platforms/apps; data storage applications; internet connectivity.

Do you forsee any challenges with starting telemedicine in Trinidad and Tobago?

Telemedicine is already being used, albeit in a limited manner. Trinidad and Tobago has the necessary infrastructure to expand telemedicine services, i.e. internet access, degree of usage of cell phones, ICT resources and a level of expertise and experience in technology.  The use of telemedicine increased significantly in Trinidad and Tobago – as in other countries – during the pandemic as a means to continue to follow up on patients and to treat them when physical distancing protocols were in place.  The use of telemedicine continues to be relevant, especially as we look at assuring universal health (UH), by increasing access to effective health care.

However, yes, there will be some challenges as the governance framework needs to be put in place to support the further development and expansion of telemedicine.  Thus policy and regulations will be required to guide the use and development of telemedicine services. Some patients may also need more information and guidance to reduce any concerns they may have about the benefits of telemedicine, bearing in mind that it is not meant to be used in all instances as a replacement for in-person consultations. It should be noted that there is tremendous support throughout the health sector and government for the expansion of telemedicine services.

PAHO/WHO is supporting the work in the area through two (2) projects, namely: the  project ‘Bringing High and Low Technology to COVID19 Trinidad and Tobago (HALT), financed by  the India-UN Development Partnership Fund  and Project USA – Pledge: Telehealth for Non-Communicable Diseases funded by the US government.

The Report - Situational Analysis to Implement Telemedicine Services in Trinidad and Tobago Hospitals -  developed under  HALT, identified a number of opportunities for telemedicine locally, such as:

1. The provision of a primary mode of medical communication for patients who are self-empowered to manage their care remotely. 
2. Medical staff can work in delivering telemedicine services from a remote location.
3. Patients can be reviewed on a timely basis by their physicians/clinicall staff to assess their health status and determine their medical needs, irrespective of their location.
4. Increase access to health services, including allied health services such as nutrition and dietetics.

Does telemedicine require legislative or other changes?

Yes, there will be the need for some legislative changes to properly govern the growth of telemedicine.  One of the key areas requiring strengthening locally is in the use and protection of electronic health data.

The World Health Organisation (WHO) notes that "Telemedicine must be aligned with the goal of universal health coverage. This requires taking appropriate steps to ensure the accessibility, quality and sustainability of telemedicine services through effective policy, legislative and regulatory interventions. It should also support the continuity and coordination of care.

A telemedicine governance framework should be put in place with clear lines of accountability and responsibility. … Data collected by telemedicine applications should be secure, private and confidential, in line with data protection and privacy laws, regulations and frameworks, as well as cybersecurity protocols." ²

What minimum technologies would patients be required to have at home?

At minimum, the technology required is phone access; preferably a smart phone to enable visual communication,  but a land line or basic cell phone can also be used.

Is there a difference between telemedicine and telehealth?

Yes, there are some differences between telemedicine and telehealth, although they are often used interchangeably.

"Telehealth is different from telemedicine in that it refers to a broader scope of remote health care services than telemedicine.

Telemedicine refers specifically to remote clinical services, while telehealth can refer to remote non-clinical services." ³ WHO defines telehealth as “the delivery of health-care services using information and communication technology (ICT), where patients and providers are separated by distance…" ⁴

These non-clinical services can include training of health professionals, administrative meetings, health education and consultations between health professionals.

What other forms of health system technologies might we see in the future in addition to telemedicine in Trinidad and Tobago?

Under the project Bring High and Low Technology to COVID-19 in Trinidad and Tobago (HALT) being implemented by the PAHO/WHO, in conjunction with the Ministry of Health, health service robots (HSRs) are also to be introduced in the public health sector.

These HSRs will support health workers in the areas inclusive of patient screening, social engagement, health education, delivery of medication in the COVID-19 health facilities and sanitising of health facilities.

Are we looking at off the shelf software or locally developed software?

Currently, the software to be used is being considered.  

PAHO/WHO is supporting this through Project USA – Pledge: Telehealth for Non-Communicable Diseases which is building a modular platform through the use of an open source platform that will include a Digital Data Tracker to promote the systematic collection and use of patient data; as well as, interoperability, to reduce manual data entry and enable efficient flows of patients to different health providers.

However, final decisions on the use of the software will lie with the Government of Trinidad and Tobago, through the Ministry of Health.

Anything else you would like to add?

Telemedicine would be of particular benefit to those persons who are vulnerable, such as the elderly, persons with physical disabilities and those persons with noncommunicable diseases who may have concerns about being in crowded public spaces. 

¹ Telemedicine: A Guide to Assessing Telecommunications in Health Care. NIH, National Library of Medicine. Washington, DC 1996

² Implementing telemedicine services during COVID-19: guiding principles and considerations for a stepwise approach. WHO, March 2021

³ What’s the difference between telemedicine and telehealth? American Academy of Family Physicians (AAFP), 2022

⁴ Global diffusion of eHealth: making universal health coverage  achievable: WHO 2016