COVID-19 Pandemic Triggers Telemedicine Regulation and Intensifies Diabetes Management Technology Adoption in Brazil

We have learned that a pandemic can change overnight our routines, behaviors, society, and world economies with unexpected and unpredictable effects. We still have a lot to learn about this infection and its effects on healthcare systems. However, we already know that people with diabetes mellitus are at a particularly higher risk to be infected and certainly are more prone to present a further severe form of the COVID-19, especially if their glycemia levels are not controlled. Since there is no specific treatment or vaccine for this disease, social distancing is currently the single most effective available measure. Therefore, during these critical days, medical management of patients with diabetes has been struggling with regular in-person appointments, which creates opportunities for the use of technology tools that effectively enables patient-physician relationship.

In Brazil, telemedicine and digital health tools have been used since the early 1990s with an initial frustrated effort over regulation starting in 2002. Besides consistent technology advances and users’ enthusiastic adoption in Brazil in many other industries, such as banking and consumer goods, in healthcare the adoption and sustainable business models development have been discouraged by the restrictive regulation. Along with the COVID-19 pandemic effects and social distancing initiatives countrywide, by the end of March 2020, telemedicine regulation allowed medical doctors to attend and charge patients for virtual consultations, as well as to issue electronically signed medical reports and prescriptions, using telemedicine platforms or any other virtual tool such as messaging and videoconferencing apps. Quickly, hospitals, clinical labs, and healthcare startups started developing digital solutions to ensure healthcare delivery during the COVID-19 pandemic.

The Fleury Group launched a full-scale telemedicine platform—“Cuidar Digital”—which included electronic medical record, access to test results, and a digital prescription interface for all doctors to use free of charge. Sírio-Libanês Hospital has been using telemedicine for physician-to-physician second opinion since 1999 and recently started making digital consultations directly with patients as well, using videoconferencing tools. In diabetes, doctors are now able to assist patients through virtual platforms as long as they are remotely receiving glycemic reports by email or by more dynamic platforms such as GlucoTrends (GlucoGear), thus facilitating the exchange of information and providing clinical feedback based on digital interaction.

Surprisingly, this technological driven environment would not have been considered possible only a few weeks ago and the context of this pandemic helped ignite its use in Brazil. Nevertheless, it still faces several challenges to become a permanent reality, such as the clear definition of a sustainable model for both public and private healthcare. Additionally, it still lacks the business incentives in private medicine that shall direct payers adoption of this technological advances among the listed procedures.

In the foreseeable future, the COVID crisis will leave permanent and profound changes in our society. The depth of these transformations from the standpoint of January 2020 still remains to be determined and may include widespread virtual care environments, along with patients under home monitoring with the aid of wearables and portable, connected medical devices, receiving their medicines through modern logistics, and supported by digital therapeutic tools. In our understanding, the progress will necessarily encompass some time between the two extremes and will involve patient segmentation models that will be able to identify those ones who will be most successfully assisted remotely with the new technologies. Moreover, it is also probable that a combination of physical and virtual components will be best prescribed to a great deal of patients in the next transition years. In this scenario, we can expect that technologies leveraging clinical results and quality of life, as well as enabling economic efficiency, the pillars of value-based healthcare, most probably warrant the new processes to prevail.

It is expected that the pace of such changes will be dramatically accelerated with the new platforms of artificial intelligence. In the context of developing countries such as in Brazil, data-driven decisions have, indeed, the potential to promote a quantum leap toward filling the gap between the sanitary conditions of the 19th century and the tech edge of the years 2000, thus fast-forwarding the whole society to an era of wider access to healthcare. Notwithstanding the fact that the COVID-19 crisis already represents a difficult challenge for our society, it is in the combination of technology and healthcare through collaborative efforts that we may find a path to a digital and healthier nation.