Towards Telemedicine Adoption in Korea: 10 Practical Recommendations for Physicians

Telemedicine Experiences of People Living with Amyotrophic Lateral Sclerosis at Home in South Korea

PURPOSE

Telemedicine is advantageous in providing medical care to patients with mobility difficulties. This single-center study aimed to report on the provision of video televisits to people living with amyotrophic lateral sclerosis (pALS, ALS) who were registered with a home-based medical care (HBMC) team in a tertiary hospital in South Korea.

MATERIALS AND METHODS

A retrospective cross-sectional study was conducted for pALS provided with video televisits by the HBMC team between July 2020 and February 2023. The patients' demographics, disease status, mobility level, and supportive care equipment were investigated. The main issues discussed at televisits were investigated.

RESULTS

During the 32-month study period, video televisits were provided to 69 (81.2%) of the 85 pALS registered with the HBMC team. Their median (interquartile range) age was 66 (57-71) years, and 66.7% were aged 60 years or older. At the time of the televisits, 71.0% were non-ambulatory and 27.5% were at an assisted ambulatory level. Furthermore, 82.6% were receiving nutritional support with a nasogastric or gastrostomy tube, and 78.3% had received either non-invasive positive pressure ventilation (43.5%) or tracheostomy invasive ventilation (34.8%). Common issues addressed on televisits were disease-related symptoms (100%), management of supportive care equipment (92.8%), acute health issues (52.2%), and advance care planning (ACP) including goal of care discussion (14.5%).

CONCLUSION

Video telemedicine is feasible for pALS, including older adults with limited mobility due to muscle weakness or reliance on various supportive care equipment. Video televisits allow for a variety of discussions, ranging from acute health issues to ACP.

Expert Consensus on Developing Information and Communication Technology-Based Patient Education Guidelines for Rheumatic Diseases in the Korea

BACKGROUND

This study aimed to identify key priorities for the development of guidelines for information and communication technology (ICT)-based patient education tailored to the needs of patients with rheumatic diseases (RDs) in the Republic of Korea, based on expert consensus.

METHODS

A two-round modified Delphi study was conducted with 20 rheumatology, patient education, and digital health literacy experts. A total of 35 items covering 7 domains and 18 subdomains were evaluated. Each item was evaluated for its level of importance, and the responses were rated on a 4-point Likert scale. Consensus levels were defined as "high" (interquartile range [IQR] ≤ 1, agreement ≥ 80%, content validity ratio [CVR] ≥ 0.7), "Moderate" (IQR ≥ 1, agreement 50-79%, CVR 0.5-0.7), and "Low" (IQR > 1, agreement < 50%, CVR < 0.5).

RESULTS

Strong consensus was reached for key priorities for developing guidelines in areas such as health literacy, digital health literacy, medical terminology, user interface, and user experience design for mobile apps. Chatbot use and video (e.g., YouTube) also achieved high consensus, whereas AI-powered platforms such as ChatGPT showed moderate-to-high agreement. Telemedicine was excluded because of insufficient consensus.

CONCLUSION

The key priorities identified in this study provide a foundation for the development of ICT-based patient education guidelines for RDs in the Republic of Korea. Future efforts should focus on integrating digital tools into clinical practice to enhance patient engagement and improve clinical outcomes.

Satisfaction Survey of Medical Staff for Telemedicine after the COVID-19 Pandemic: A Comparison Between the COVID-Pandemic and Post-COVID Pandemic Periods

Introduction: The role of telemedicine should be reassessed in the post-COVID-19 pandemic era. This study aimed to evaluate the perception and satisfaction of medical staff with telemedicine after the COVID-19 pandemic and compare these findings with those during the COVID-19 pandemic. Methods: Between January and February 2023, a questionnaire regarding the utilization, safety, and satisfaction with telemedicine was administered to 200 medical staff members (100 doctors and 100 nurses). Additionally, open-ended questions were included to gather insights on the strengths, weaknesses, and prerequisites of telemedicine. The satisfaction levels of the medical staff were compared with those from a previous study conducted during the COVID-19 pandemic. Results: The response rate among medical staff was 60.0% (50 doctors and 70 nurses). Concerning patient safety, 83.3% of respondents indicated a risk of worsening symptoms in chronic patients, and 68.3% expressed concerns about emergencies related to patient safety. Eighty-two percent of doctors preferred in-person visits over telemedicine, while 48.6% of nurses reported equal or greater satisfaction with telemedicine (p = 0.003). The reported strengths of telemedicine included the convenience of outpatient clinics (67%), while its primary weakness was the incomplete assessment of patient conditions (73%). The likelihood of partial substitution of telemedicine for in-person visits was significantly higher in the post-COVID-19 pandemic period compared to during the pandemic (71.7% vs. 49.0%, p < 0.001). Conclusion: In the post-COVID-19 pandemic era, telemedicine continues to offer significant benefits in enhancing patient access to medical care. However, medical staff remain concerned about its safety and show lower satisfaction compared to in-person visits. In response to these concerns, an effective telemedicine platform and legal standards, including practical guidelines, should be developed.

Temporary Telemedicine Policy and Chronic Disease Management in South Korea: Retrospective Analysis Using National Claims Data

BACKGROUND

Since its introduction, telemedicine for patients with chronic diseases has been studied in various clinical settings. However, there is limited evidence of the effectiveness and medical safety of the nationwide adoption of telemedicine.

OBJECTIVE

This study aimed to analyze the effects of telemedicine on chronic diseases during the COVID-19 pandemic under a temporary telemedicine policy in South Korea using national claims data.

METHODS

Health insurance claims data were extracted over 2 years: 1 year before (from February 24, 2019, to February 23, 2020) and 1 year after the policy was implemented (from February 24, 2020, to February 23, 2021). We included all patients who used telemedicine at least once in the first year after the policy was implemented and compared them with a control group of patients who never used telemedicine. The comparison focused on health care use; the medication possession ratio (MPR); and admission rates to general wards (GWs), emergency departments (EDs), and intensive care units (ICUs) using difference-in-differences analysis. A total of 4 chronic diseases were targeted: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and common mental disorders.

RESULTS

A total of 1,773,454 patients with hypertension; 795,869 patients with DM; 37,460 patients with COPD; and 167,084 patients with common mental disorders were analyzed in this study. Patients diagnosed with hypertension or DM showed increased MPRs without an increase in GW, ED, or ICU admission rates during the policy year. Moreover, patients in the DM group who did not use telemedicine had higher rates of ED, GW, and ICU admissions, and patients in the hypertension group had higher rates of GW or ICU admissions after 1 year of policy implementation. This trend was not evident in COPD and common mental disorders.

CONCLUSIONS

The temporary telemedicine policy was effective in increasing medication adherence and reducing admission rates for patients with hypertension and DM; however, the efficacy of the policy was limited for patients with COPD and common mental disorders. Future studies are required to demonstrate the long-term effects of telemedicine policies with various outcome measures reflecting disease characteristics.

The Use of Mobile Health Care Among Medical Professionals in the Sichuan-Chongqing Region: Cross-Sectional Survey Study

Background

The emergence and integration of mobile health care technology have fundamentally transformed the health care industry, providing unprecedented opportunities to improve health care services and professional practice. Despite its immense potential, the adoption of mobile health care technology among health care professionals remains uneven, particularly in resource-limited regions.

Objective

This study aims to explore the use and influencing factors of mobile health care among health care professionals in the Sichuan-Chongqing region of China and make recommendations.

Methods

Convenience sampling was used in a cross-sectional study conducted from November 8 to November 14, 2023, to survey frontline clinical health care professionals at 5 district-level secondary public hospitals in the Sichuan-Chongqing region. A web-based questionnaire was used to investigate the use of mobile health care and its influencing factors among the participants. Descriptive analysis and logistic regression analysis were used in the study.

Results

A total of 550 valid questionnaires were completed. Among the surveyed health care professionals, only 18.7% (103/550) used mobile health care, with a satisfaction rate of only 50.5% (52/103). Around 81.3% (447/550) did not use any form of mobile health care. The age group of 30-39 years was found to be a significant factor influencing the use of mobile health care by health care professionals (P=.03). The main reasons for not using mobile health care among health care professionals were lack of appropriate technical training and support (266/447, 59.5%), lack of suitable management-specific apps (204/447, 45.6%), and concerns about increased workload (180/447, 40.3%). There were significant differences in the single-factor analysis of the reasons for the nonuse of mobile health care among health care professionals from different specialties (P=.04). Logistic regression analysis indicated that age was the only significant factor influencing the use of mobile health care by health care professionals (P=.04).

Conclusions

The utilization rate of mobile health care among health care professionals in the Sichuan-Chongqing region is low. Age is a significant factor that influences whether health care professionals use mobile health care. Providing appropriate technical training and support may help improve the enthusiasm of health care professionals in using mobile health care.

Telerehabilitation: lessons from the COVID-19 pandemic and future perspectives

The coronavirus disease 2019 (COVID-19) pandemic has had an enormous effect on healthcare, notably rehabilitation for neurological, rheumatological, musculoskeletal, and cognitive diseases. Telerehabilitation provides rehabilitation services via multiple modalities, such as real-time chats, computerized consultations, and distant evaluations, emphasizing assessment, diagnosis, and intervention. While the use of telerehabilitation had restrictions before COVID-19, regulatory changes have accelerated its adoption, broadening therapy provision beyond traditional healthcare settings. Telerehabilitation has been examined for its effectiveness in a variety of health concerns, including stroke, traumatic brain injury, Parkinson's disease, musculoskeletal disorders, and rheumatic diseases. Despite the constraints of the COVID-19 environment, telerehabilitation settings, which include patient and therapist aspects, have emerged to ensure optimal treatment delivery. Key themes include home-based rehabilitation initiatives, wearable gadgets, and the integration of analytics and artificial intelligence. The growing acceptance of telehealth and telerehabilitation is expected to drive further progress in this discipline.

Trends in telemedicine utilization for mental illness during the COVID-19 pandemic: an analysis of a nationwide database in Korea

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has worsened mental health and reduced access to mental health services. During the pandemic, the demand for telemedicine has increased and related laws have been enacted. This study aimed to investigate telemedicine use for cases of major mental illnesses during the COVID-19 pandemic and to compare the characteristics of patients who received telemedicine service with those of patients who received in-person care.

METHODS

This population-based, cross-sectional, observational study was based on health insurance claims data, and included 2,749,872 patients who received outpatient treatment for mental illness from February 24, 2020 to June 30, 2022. Logistic regression was performed to assess the relationships between patient characteristics and telemedicine service use. Patients who received telemedicine services were analyzed in subgroups of each mental illness.

RESULTS

During the study period, 80,157 patients (2.9%), with an average age of 63 years, received at least one telemedicine treatment. There was a predominance of women and medical aid recipients. The lowest proportion of telemedicine treatments was for depression (2.1%), and the highest was for dementia (6.7%). The proportion of patients receiving telemedicine in long-term care hospitals was high (22.6%), with the highest odds ratio (OR) (5.84), compared with that in tertiary or general hospitals, followed by that in psychiatric hospitals and clinics. The proportions were high in the departments of internal medicine, neurology, and psychiatry. Patients aged > 80 years received most telemedicine treatment (OR: 1.23) across all diagnoses. Cases of dementia and other mental disorders had higher ORs (2.60 and 2.36, respectively) compared with cases of depression. Except for dementia and behavioral/emotional disorders, hospitalization increased the probability of telemedicine treatment. Comorbidities were positively associated with telemedicine treatment.

CONCLUSIONS

Older people and people with other physical illnesses were more likely to use telemedicine treatments temporarily provided during the pandemic. Telemedicine maintained continuity of treatment for patients with dementia and severe mental illnesses. Telemedicine can be useful for filling the medical gaps for vulnerable populations other than those with mild mental illnesses. This aspect should be considered for the future establishment of telemedicine systems.

National and regional trends in the prevalence of type 2 diabetes and associated risk factors among Korean adults, 2009-2021

Disproportionate impact of COVID-19 on socioeconomic and behavioral variables may have impacted the prevalence of diabetes. We utilized nationwide long-term serial study from the 2009 to 2021 Korea Community Health Survey (KCHS). We explored national and regional prevalence and trends of diabetes according to the socioeconomic and behavioral factors before and during the pandemic. Also, we interpreted which groups became more vulnerable to the prevalence of diagnosed diabetes during the pandemic. A total of 2,971,349 adults aged (19 to 39, 40 to 59, and ≥ 60 years) were included in the analysis. The prevalence of diagnosed diabetes increased slowly during the pandemic (11.6% [95% CI 11.5-11.7] in 2020 and 12.4% [95% CI 12.3-12.6] in 2021), compared to the pre-pandemic era (7.9% [95% CI 7.8-7.9] in 2009-2011 and 11.3% [95% CI 11.3-11.4] in 2018-2019). Also, women, low-income group, low-educational group, and infrequent walking group showed less prevalence of diagnosed diabetes than the others. The diabetic population increased slowly than expected during the pandemic. The pandemic seems to contribute to an unanticipated increase in under-diagnosis of diabetes among the already minority. This study may suggest reinforcing access to healthcare services among the minority during the pandemic.

The Direction of Neurosurgery to Overcome the Living with COVID-19 Era : The Possibility of Telemedicine in Neurosurgery

OBJECTIVE

Due to the implementation of vaccinations and the development of therapeutic agents, the coronavirus disease 2019 (COVID-19) pandemic that started at the end of 2019 has entered a new phase. As a result, neurosurgeons should reconsider the way they treat their patients. As the COVID-19 situation prolongs, the change in neurosurgical emergency patients according to the number of confirmed cases is no longer clear. Outpatient treatment by telephone was permitted according to government policy. In addition, visits to caregivers in the intensive care unit were limited.

METHODS

The electronic medical records of patients who had been treated over the phone for a month (during April 2020, while the hospital was closing) were reviewed. Meanwhile, according to the limited visits to the intensive care unit, a video meeting was held with the caregivers. After the video meeting, satisfaction was evaluated using a questionnaire.

RESULTS

During April 2020, 1021 patients received non-face-to-face care over the telephone. Among the patients, no critical medical problem occurred due to non-face-to-face care. From July 2021 to December 2021, 321 patients were admitted to the neurosurgical intensive care unit and 107 patients (33.3%) including their caregivers agreed to video visits. Twice a week, advance notice was given that access would be made through a mobile device and the nurse explained to caregivers how to use the mobile device. The time for the video meeting was approximately 20 minutes per patient. Based on the questionnaire, 81 respondents (75.7%) answered that they agreed, and 26 respondents (24.3%) answered that they strongly agreed that was easy to communicate through video meetings. Fifty-two (48.6%) agreed and 55 (51.4%) strongly agreed that they were easy to understand the doctor's explanation. For overall satisfaction with this video meeting, three respondents (2.8%) gave 4/5 points and 95 respondents (88.8%) gave 5/5 points, and nine (8.4%) gave 3/5 points. Their reason was that there was not enough time.

CONCLUSION

In situations where patient visits are limited, video meetings through a mobile device can provide sufficient satisfaction to caregivers. Telemedicine will likely become common in the near future. Health care professionals should prepare and respond to these needs and changes. Therefore, establishing a system with institutional support is necessary.

Normalization of photoplethysmography using deep neural networks for individual and group comparison

Photoplethysmography (PPG) is easy to measure and provides important parameters related to heart rate and arrhythmia. However, automated PPG methods have not been developed because of their susceptibility to motion artifacts and differences in waveform characteristics among individuals. With increasing use of telemedicine, there is growing interest in application of deep neural network (DNN) technology for efficient analysis of vast amounts of PPG data. This study is about an algorithm for measuring a patient's PPG and comparing it with their own data stored previously and with the average data of several groups. Six deep neural networks were used to normalize the PPG waveform according to the heart rate by removing uninformative regions from the PPG, distinguishing between heartbeat and reflection pulses, dividing the heartbeat waveform into 10 segments and averaging the values according to each segments. PPG data were measured using telemedicine in both groups. Group 1 consisted of healthy people aged 25 to 35 years, and Group 2 consisted of patients between 60 and 75 years of age taking antihypertensive medications. The proposed algorithm could accurately determine which group the subject belonged with the newly measured PPG data (AUC = 0.998). On the other hand, errors were frequently observed in identification of individuals (AUC = 0.819).

Traditional Korean Medicine Home Care for the Older Adults during the COVID-19 Pandemic in South Korea

Objectives: The aim of this study was to examine the status of community care services regarding traditional Korean medicine (TKM) for older adults and raise awareness on current opinions and services of TKM institutions. Methods: The National Development Institute of Korean Medicine conducted a survey of 16 local governments by sending official letters through an electronic document system from October 2020 to November 2020. The survey items included basic demographic information and information about TKM service. Results: Eleven (68.8%) of the 16 local governments provided TKM home care services. A total of 136 TKM clinics provided home care services for 598 older adults with musculoskeletal disorders. The number of TKM services provided in five or more local governments were cupping 11 (100.0%), acupuncture 11 (100.0%), education and consulting 10 (90.9%), and moxibustion 9 (81.8%). Moreover, pain (recorded on visual analogue scale) and quality of life significantly improved following TKM services (p < 0.001). Conclusions: Covered under medical policy, TKM homecare services could function as a viable alternative for continued medical care disrupted during the coronavirus disease 19 pandemic. In addition, standardisation and legalisation of these services could ensure and improve their efficiency.

Survey for Government Policies Regarding Strategies for the Commercialization and Globalization of Digital Therapeutics

PURPOSE

This study was conducted to build a direction for government policies regarding strategies for the commercialization of digital therapeutics in Korea, as well as its globalization.

MATERIALS AND METHODS

The study included 37 participants from the Korea Digital Health Industry Association (KODHIA). The data was based on a survey conducted in 2020 targeting employees of companies engaged in the digital health industry in Korea. Participants were asked about their involvement in product development of digital therapeutics and their opinion about the growing motivator for digital therapeutics in Korea and the global market.

RESULTS

According to our data, among subjects not involved in making digital therapeutics products, the main reason for not being involved was the lack of experts (73.9%) and difficulty in licensing (73.9%). Responses concerning the priority area in need of national support were R&D funding (43.2%), and the next was licensing guidance and simplifying regulations (24.3%). Possible difficulties of overseas market expansion were the unfamiliarity in digital therapeutics technology verification and licensing structures of foreign countries (73%), and concerns regarding the level of recognition of clinical trials and technology in Korea from overseas (70.3%). Overall, respondents were hesitant in starting a related business due to the lack of government support and the complexity of the regulation process. Moreover, concerns about global market entry were similar. Being unfamiliar with the novel process and worrying about the achievement despite existing challenges were the biggest drawback.

CONCLUSION

For the digital therapeutics industry to evolve domestically and internationally, government support and guidance are essential.

Impacts of the COVID-19 pandemic on sleep center operations and sleep apnea treatment in Korea: A multicenter survey

ABSTRACT

The coronavirus disease-2019 (COVID-19) pandemic has not only changed the lives of people around the world but also affected all areas of the healthcare system, including sleep medicine. However, no studies in Korea have investigated the status of domestic sleep centers and their challenges during the pandemic.An online survey was performed from December 2020 to January 2021. Hospitals that belonged to sleep-related academic societies and were considered well managed were included in this survey. The questionnaire focused on changes in sleep center operations, infection control policies, and patient treatment since the start of the COVID-19 pandemic. Telemedicine and future directions for sleep medicine services were also investigated.Of the 20 sleep centers that responded, 80% were at university hospitals with more than 500 inpatient beds. During the third wave of the COVID-19 pandemic in Korea (November-December 2020), the routine operating schedule of the sleep study room was reduced in 30% of the sleep centers compared to November-December 2019 (before COVID-19). The number of type 1 polysomnographies performed decreased in 85% of the sleep centers. In contrast, in-lab positive airway pressure (PAP) titrations decreased in 40%, remained unchanged in 35%, and increased in 25%. With respect to prescriptions, 30% of the sleep centers increased the number of prescriptions for auto-titrating continuous PAP. However, 60% of the sleep centers reported no change in the rate of fixed continuous PAP and auto-titrating continuous PAP prescriptions. All sleep centers that participated in this survey agreed that the need for documented infection control regulations will continue after the COVID-19 pandemic. Since the beginning of the pandemic, 30% of the centers have tried telemedicine. However, respondents expressed concern about telemedicine, citing a number of practical issues.Compared to countries where the COVID-19 pandemic was severe, Korea had less impact of COVID-19 on the sleep center operations and sleep apnea treatment. Infection and quality control in the sleep study room are important and inevitable issues, and regulation within each institution is necessary. Further research and discussion are needed regarding telemedicine and home sleep apnea test in Korea.