At a glance, South Korea looks ripe for widespread adoption of telemedicine, which enables doctors to treat patients remotely by means of videoconferencing and other forms of telecommunication. The small but densely wired nation boasts high internet speeds and smartphone penetration rates, and has proved willing to leverage new technologies to shake up traditional systems, as seen in its spirited embrace of mobile-first retail and the launch of one of the world’s first nationwide Internet of Things networks.
But telemedicine between doctors and patients is currently prohibited under the South Korea’s Medical Act, and a recent government attempt to legalize it was met with a wall of opposition from medical professionals and activists. Tensions over the bill resulted in a doctors walkout in 2014 and will likely intensify in the months leading up to this year’s vote in the South Korean National Assembly.
Telemedicine has already been rolled out in the US and Japan, and a number of European countries are now at varying stages of experimentation or implementation. In South Korea, one of few countries where it is still illegal, telemedicine could benefit an estimated 5.8 million people, including the geographically isolated and elderly patients with chronic conditions burdened by constant trips to the doctor.
Yet there are many anxieties about its adoption. Promoted alongside other healthcare reforms like the introduction of for-profit hospitals, telemedicine is intertwined with fears that a lucrative market for “smart” health technologies will benefit only those who can afford them. While South Korean tech companies stand to profit greatly from the legalization of telemedicine, many fear that the hidden costs will be foisted onto small community clinics and the ordinary South Koreans who rely on them.
With a plateauing smartphone market, SK Telecom, South Korea’s largest wireless carrier, is one of a handful of companies scrambling to reposition itself as a leader in the growing market for telemedicine. The tech conglomerate already has telemedicine projects underway in China and Saudi Arabia, with further plans to tap into the South American market. Others, like smartphone makers Samsung and LG, are undertaking similar initiatives.
“Videoconferencing is actually just a small part of telemedicine,” says Lee Kyung-ho, a professor at Korea University’s Graduate School of Information Security. “The real focus is data, such as pulse, heart rate, blood glucose levels or any other types of patient information that can be collected remotely using equipment.”
But dangers arise when vast tranches of patient data enter privately owned digital networks. South Koreans also know better than anyone what’s at stake, given the threat of cyberattacks by an increasingly capable North Korea.
As occupational health physician Lee Sang-yoon notes, the exposure of personal medical data can lead insurance companies to discriminate against patients based on their records. Worse, failure to maintain accurate data—due to a technical malfunction or cyberattack—could lead to medical accidents. In other words, data security in telemedicine can be a matter of life and death.
This has been a major stumbling block for the government’s telemedicine pilot program, which has been experimenting with telemedicine in select clinics across the country. The program, which wrapped up its second round of trials last year and is now facing a third, has already been plagued by serious failings in data management.
In 2015, the Korean Medical Association (KMA), the nation’s largest representative physicians’ body, commissioned Lee as lead researcher in a field study on the state of cybersecurity at clinics trialing telemedicine. His findings ran the full gamut of known security and technical flaws, from a lack of proper encryption of sensitive medical data to the use of vulnerable passwords such as “1111.” In one instance, Lee found an onsite bluetooth blood pressure monitor application could be hacked, its data left susceptible to theft or tampering.
The real wake-up call came last August, when the National Police Agency’s Cyber Bureau discovered the first instance of a North Korean cyberattack on a medical institution. Assailants gained access through a Seoul university hospital’s software security contractor and took control of the hospital network, going undetected for eight months. While the bureau speculated that the purpose of the attack was “to prepare for an act of cyberterrorism,” rather than steal data, it was a sobering reminder of the vulnerability of digital medicine.
Domestically, too, corporate interests intervene between physicians, patients and valuable medical data. SK Telecom was forced to shut down its electronic prescription program in 2015 amid allegations of unauthorized patient-data harvesting. According to the prosecutors’ investigation, the company had illegally collected and sold off the private prescription data of more than 70 million patients to pharmacies for a 3.6 billion won (roughly $3 million) profit during the course of the program.
Instead of reining practices like this in, South Korea’s government has recently announced that it is looking to ease regulations (link in Korean) on commercial use of consumer health data, believing that it will bolster the country’s services economy. Similarly bullish on telemedicine’s soaring global profile, the government has also made ambitious promises that it will revitalize a moribund economy, create jobs, and increase exports into the Chinese and South American healthcare market.
But it’s dangerous to think that telemedicine will lift all boats, says Chung Hyung-jun, rehabilitative physician and strategic director of non-profit Association of Physicians for Humanism. “It’s hard to be competitive in digital health care without a tremendous amount of capital. Big hospitals can afford something like a telemedicine program but smaller clinics don’t have that kind of money. It will inevitably lead to a monopoly dominated by the biggest and best-funded,” says Chung. “The biggest beneficiaries will be medical equipment companies and telecommunications providers.”
This is partly why the government has failed to gain the crucial support of the KMA, which represents about 100,000 of South Korea’s doctors. The KMA threatened a six-day strike in 2014 and has conspicuously been boycotting the government’s trials. “Community clinics and small and medium regional hospitals depend on geographic proximity to operate and will almost certainly go out of business, ” the KMA said in a statement, cautioning that this widespread collapse of primary care clinics would ultimately erode in-person healthcare access for those who need it. The KMA has also decried the government’s opacity with pilot program data, the dearth of safety and policy research, and disregard for physician input in such a radical rethinking of healthcare.
“Civic groups like us have been following the technology for a while and really want to see what good telemedicine and digital healthcare can do, but the evidence just hasn’t come out yet,” says Chung. “There needs to be some revolutionary change before it’s feasible.”
For those like Chung, that means implementation that is rigorously pragmatic rather than radical and aspirational. While the government insists the current run of practical difficulties will be worked out over the course of the pilot programs, medical professionals remain unconvinced, calling instead for a slower, more collaborative plan of attack that establishes safety protocols and smart regulatory oversight. That might mean South Korea will stay behind the curve for a little longer—but without the cooperation of those who would administer it, telemedicine would otherwise be destined to fail.