The Psion Organizer II (1986) was one of the first hand-held devices, later referred to as a personal digital assistant (PDA) when Apple launched the Apple Newton (1992). Other important devices that led to today’s ubiquitous smartphone, include the Nokia 9000 Communicator (1996) and the Palm Pilot (1997) . Throughout this time frame many companies and organizations developed medical content to support the use of these devices in medical situations, including physicians’ offices and hospital wards.

Telemedicine? Telehealth? eHealth? Different people and organizations use different terms to describe the same subject. The World Health Organization (WHO) uses telemedicine to describe all aspects of remote health care including preventive care. In Europe, the more general term is eHealth, which is more than just Internet medicine, but almost everything related to computers and medicine. There is a branch of this referred to as mHealth, with a focus on hand-held devices (smartphones aka – in Europe – mobile phones = cell phones). In USA, the operative term is telehealth which also includes non-clinical services. There, telemedicine refers to remote clinical services. Here, the WHO definition is used.

The purpose of this post is to encourage people to engage in a dialogue about telemedicine, generally, but especially with the appropriate authorities where they live. They should let the world know what telemedicine services they need and want … along with additional insights and information, incorporated in the usual questions: Where? When? Why? and How?

Unfortunately, most people do not know very much about telemedicine. Thus as a first step it may be useful to read the Wikipedia article on it.

The pandemic has shown that many things need to be done differently, including health care. No prospective patients should have to travel to a (crowded?) doctor’s office to have a prescription renewed, or blood pressure measured. The first, could just involve a simple e-mail request, the second – an example of remote monitoring – could involve a patient attaching the cuff of a blood pressure monitor to their upper arm at home, in such a way that the device can measure systolic and diastolic pressure, keep track of the results in a home medical journal, and send them onwards to the appropriate health centre, especially if there is an apparent need to adjust medications or discuss lifestyle changes. In general, the advantages of telemedicine are: greater patient satisfaction and cost-effectiveness, with comparable health outcomes.

At the time of writing, Trøndelag county has the lowest incidence of COVID-19 in Europe, with less than 20 infected people per 100 000. Why? First, there are very few immigrants and other foreigners, which means that almost the entire population understands the relevant rules. There have been problems in other areas of Norway because the Norwegian government has insisted in communicating unilingually in Norwegian, and – until recently – has not made provision for translations. This means that immigrants have not been given information, in a language they understand. Second, and more importantly, people have followed the rules. They may not like them. They may complain. Yet, they follow them. Because they are followed, and the COVID-19 infection rates are reduced, there is a lighter touch in terms of regulations, than in many other areas of the world.

Update: 2020-12-08 11:34 (Less than half an hour before this is scheduled to be published). There has been a new COVID-19 outbreak in Trondheim. Maybe our county is no longer best in Europe, I don’t know. However, the outbreak seems to affect many Eritrean immigrants, and the government specifically asked them to get tested. So, even governments are learning how to do things differently.

Why is USA so different from Trøndelag? The answer may lie with Maggy Thatcher, and her good buddy, Ronny Reagan. “There is no such thing as society: there are individual men and women, and there are families,” Margaret Thatcher (1925 – 2013) said, as reported in Woman’s Own, 1987-10-31. Libertarians such as Thatcher, Ronald Reagan (1911 – 2004), Donald Trump (1946 – ), Boris Johnson (1964 – ) and more, don’t seem to believe in society, social norms, or in following rules. When people fail to follow rules in the middle of a pandemic, bad things happen.

Another problem in the US is that so much of the health care is provided by for-profit businesses, that have their own vested interests and approaches to the pandemic. They are not so much interested in reducing/ eliminating the pandemic, as they are in maximizing their profit, or at least reducing their loses. Even in Norway, there has been privitization in the health sector, that has had negative consequences.

For twenty years, or so, I had B12 injections, every three months. For the first twelve years or so, it was possible to make an appointment for an injection. Thus, I would visit the medical centre, wait perhaps five minutes, receive an injection, then leave. Then, suddenly, about the time the municipal run health service became a privately owned one, appointments for injections were no longer possible. Patients just had to take a chance and meet up. Personally, I didn’t appreciate this new system because the time spent waiting increased significantly. The health service no longer valued my time. Then, one August, I discovered that I had failed to receive an injection in May. I had met up, but the nurse was so overworked that I was asked to come back another day. Unfortunately, I quickly forgot about that, and my calendar showed a B12 shot being given. There had been no follow up from the medical centre alerting me to the missed injection. There is no reason for this lack of follow-up. It is very easy to implement in a data system. In fact, I had worked on this very type of problem earlier.

Back in the late 1980s I had worked with HUNT (Helseundersøkelse i Nord-Trøndelag. Now known in English as the Trøndelag Health Study, after the merger of Nord- and Sør-Trøndelag in 2020) and had made a mock hypertext version of their standard procedures for hypertension (high blood pressure) and diabetes. This demonstrated how data-mining of a patient journal could be used to collect data about these two conditions, and alert the patient’s doctor (and ultimately, the patient) when anomalies emerged. In 1991, one of my former students received a grant to start a company InfoTech AS, to make a real-world version of this. The major problem was that the privately-owned providers of patient journals regarded patient data as their own personal property, and would not co-operate. This was, in part, because the Norwegian government had not taken privacy concerns about patient data seriously.

Now, in 2020 in the middle of a pandemic, nobody is allowed to just meet up at a medical centre, for an injection, or anything else. Appointments have to be made for everything. When I had my annual check up with my GP, he looked at my chart, and could see immediately my one and only medication. With a new national change in policy away from B12 injections to B12 tablets, he asked me if I wanted to take B12 pills, instead of an injection? There was no doubt in my mind that I would prefer them, and so it was arranged.

What is irritating about this situation is that there should be absolutely no problem alerting everyone with a B12 deficiency problem (or any other medical situation) about tablets being allowed to substitute for injections, or any other improvement. It is simply that the medical profession is living in the past, and is not aware of the potential offered by data-mining, and similar computing techniques.

It is important for people to keep abreast of new developments, and to reflect over their own needs. They also need to contact politicians and others to make changes that will improve society. Health is important.