Editor’s note: Telehealth, and telemedicine, are often used interchangeably and cover a broad category of solutions in the healthcare sector, relating to providing healthcare from a distance. For the purposes of this article we will be using ‘telemedicine’. This describes, in general terms, telemedicine as the clinical application of technology.

Telemedicine has been tried and tested for some years in the UAE. Nothing seems to have set the sector on fire, but in the last eight months three new startups have launched patient-doctor consultation services, believing that now Emiratis might be ready for it.

The new startup, Health at Hand, will offer video consultations, cutting down on the time a person has to spend going to the doctor’s, waiting at the doctor’s, and collecting prescriptions.

This very small scene includes recent additions Heydoc! and Smart Seha.

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Investors have clearly held hopes for the industry, with Etobb, Altibbi and Alemhealth receiving investments over the last few years, but it has so far failed to prove itself. It’s an issue than the current crop of entrepreneurs say is actually in line with global norms, but that’s cold comfort for the health authorities and businesses that have been throwing money at the industry.

Tele-what?

If telemedicine doesn’t seem like it’s really taking off in the region, it’s not that unusual because it’s not fully integrated anywhere, yet.Across developed and developing countries the barriers to adopting telemedicine are generally the same - a misconception about the costs of implementing the services. According to the World Health Organisation, developing countries lack the technical skills, while developed countries are hesitant around the legal issues of privacy and perceived lack of demand.

Brian de Francesca, CEO of Ver2 Digital Medicine, said part of the slowness in adoption in the region was down to the lack of regulations and policies surrounding telemedicine.

At the start of 2016, Dubai Health Authority and the UAE telco Du launched a pilot, which didn't go any further yet. Alemhealth moved to Singapore and Silicon Valley. Uber did announce a partnership with Altibbi in February to cover up to 50,000 drivers with telehealth services and it is currently operational in Saudi Arabia, Jordan and Egypt. People obviously want access to the service and the information these people provide - Altibbi's managing partner, Jalil Allabadi, says they've gained 35,000 active subscribers in less than a year, and that the platform has been growing at 35 percent month on month. 

The Economist report Enabling Telehealth: Lessons for the Gulf, said despite spending on e-health services and telehealth in the region rising and the GCC countries leading this phenomenon, there needed to be more consideration of efficient licensing to enable patients to access telemedicine services.

De Francesca said there was no shortage of examples of how telemedicine could save money and improve care in the UAE. “We have known this for over a decade.”

However, the challenge to greater telemedicine adoption was that there were many players that must be aligned, these being the care providers, patients, government regulators and the payers.

Growing demand

The proliferation of chronic diseases is global and the rising cost of healthcare is putting a strain on governments.

One of these high cost areas is the use of unnecessary trips to hospital emergency rooms (ER).

Stephen MacLaren, of insurers Al Futtaim Willis, said on Linkedin last year that Emirati residents were using outpatient, and typically ER, services at hospitals around 12 times a year. This is one of the highest in the world. He wrote that “experts” put this frequency down to various things “such as prescription renewals, pre-marital screenings, and a UAE culture of thinking (as long as we’re insured) that doctors are at our beck and call whenever we need them”.

Not only is this putting a strain on insurance companies in a country where health insurance is mandatory, but there is the the cost to the hospitals spending time on non-urgent cases, to employers who are losing staff to doctor visits, and to people spending time and money to visit the doctor.MacLaren estimated that the average cost of these ER visits per person in the UAE, annually, was $1,200.“Estimates for the amount of this money that is wasted on unnecessary visits vary, but even if we take the conservative estimate of around 10 per cent, this leaves us with an unnecessary spend of $120 per resident. In a country of nearly 10 million, that adds up,” he wrote.

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Heydoc! cofounder Ahmad Al-Hidiq said there was definitely a desire for telemedicine services, as patients and doctors created informal telemedicine channels. “Most people in our region (unlike Northern America, Europe and the UK) don’t know that the concept of telemedicine exists,” Al-Hidiq said, “or that they can get an advisory from a doctor via an app.” But while working in the healthcare sector before setting up Heydoc!, he found that doctors were getting calls and Whatsapp messages from patients, seeking everything from an appointment to a second opinion.

The startup is set to officially launch at the end of April. So far over 1,500 users have signed up since a beta launch September 2016. They have since found that over 85 percent of the consultations solved the patient’s problem, with no hospital visit necessary. It currently just offers a text and media sharing service (you can send photos of that strange rash to the physician) but they expect to introduce video and voice notes as part of the next step. They charge $40 per consultation.

Creating awareness is a big part of Heydoc!’s market-making mission to help people understand what telemedicine is, in addition to how and when they can benefit from it.

Where telemedicine is already working

“Compared to other countries, we are actually moving faster as is the case with anything in Dubai,” said Sameer Mankani, VP and founder at Smart Seha. “But it is worth keeping in mind that we got a late start as well and are fortunate to have the advantage of better telecom infrastructure, availability of equipment (e.g., everyone has a smart phone) and generally a more accepting attitude towards technology from the general public.”

Indeed his uptake has been fast. Since launching earlier this year they have 20,000 “committed members”.

In the UAE the Dubai Health Authority’s Dubai Robodoc initiative was piloted in 2016 and is reportedly being rolled out in hospitals and health centers across the city. It will also be available to patients in the home where a nurse visiting the patient can dial in for teleconsultations.

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Both Dubai’s and Abu Dhabi’s health authorities have created tele-consulting and tele-counselling guidelines.

There are also, according to the Khaleej Times, ‘consult stations’ popping up in public areas where patients will be able to conduct their own health checkups and up to 18 different kinds of tests, including blood glucose and hearing tests. At the end of April there will be two installed for beta testing at the DHA headquarters and a Dubai mall, said the Times.

However, we’ve not found any evidence of this scheme beyond the Times article.

And in 2014 the Abu Dhabi Telemedicine Centre launched a round-the-clock telephone service that connects patients to nurses and doctors throughout the region.

It is a joint venture between the Abu Dhabi government’s investment arm, Mubadala, and Medgate, a Swiss telemedicine provider. They say their return rate is about 30 percent. Most patients are parents with small children, and the second most popular group is the 20 to 40-year-old age group.

What has been surprising for the centre is the adoption of the service by Emirati nationals. CEO Mina Hamoodi said initial market research forecast that it would be largely expats opting for the service, but instead 80 percent of the users were UAE nationals.

There are 25 full time staff at the centre who are specially trained in telemedicine. The drawback to their service is that you have to be insured through Daman, a Abu Dhabi-government health insurer.

Unity Stoakes, president of New York digital healthcare investor Startup Health, said he was surprised by the slow of adoption of telehealth, considering the many benefits, from cost saving to efficiency to experience. “But also we’ve seen with many tech innovations the pace of adoption often seems slow in the near term and radical over a ten year period. We are still very early and expect to see a leap forward over the coming 2 to 3 years globally.”

Startup Health was one of Alemhealth’s first investors.

Startups such as Health at Hand are hoping they are hitting a market that is finally ready for them, and an ecosystem that has the capacity to support the new commercial medical sector that is slowly arising, mostly out of the UAE.

Health at Hand's Charlie Barlow sees the work of Dubai Future Accelerator and Dubai 100 as a step in the right direction here.

But it will take time to find out in which parts of the region telemedicine really takes off, and when.

Feature image via Publicdomainpictures.net