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The Disruption Series: Telehealth Adoption During and After COVID

How the pandemic is accelerating telemedicine integration

This is the fifth piece in the Lionbridge Disruption Series, a collection of commentary from life sciences experts on how the industry is changing as a result of the COVID-19 crisis.

Although the technologies enabling telemedicine have been in use for many years, its adoption has until recently been slow and uneven. But the COVID-19 pandemic has forced us to reexamine almost all aspects of how we live and work. Just as we have witnessed a once unimaginable mass migration to remote working – with even world leaders now routinely logging in to Zoom meetings – even the most conservative of our global health institutions are reevaluating the role of communications technology.

What is Telemedicine? Why Do We Need It?

Telemedicine and telehealth remain unfamiliar concepts to many, even among the clinicians and researchers scrambling to respond to the current crisis. Recognizing this, the World Health Organization has adopted a broad definition, using the terms to describe the use of information and communication technologies not just in diagnosis and treatment but also in research and evaluation – indeed, in any activities that are “in the interests of advancing the health of individuals and their communities”.

This broad vision is now being realized all around us, with governments and public health agencies turning to mobile technology solutions for what was once thought of as “shoe leather epidemiology”, the vital work of symptom reporting and contact tracing. The research community, too, has recognized the urgency of the discussion. During a panel discussion at DIA in March, clinical trials experts reflected on how governmental controls imposed in Wuhan had affected vital clinical trials. They cited the worrying example of a study in which 80% of participants had declined to attend an investigation center in spite of holding government permits to do so.

What is Changing as Telemedicine Becomes Necessary?

Even regulators, institutions whose very existence is dedicated to risk-aversion, now acknowledge the need for adaptability. In its recent guidance on the management of clinical trials during the pandemic, the European Medicines Agency framed the challenge in stark terms. While stressing that patient safety remains paramount and that changes in practice must be proportionate and based on sound risk management principles, the EMA nonetheless calls for “extraordinary measures” – including telemedicine contacts – to be contemplated as investigators balance continuity of oversight against the new imperatives of social distancing and infection control.

As these changes gain acceptance, sponsors and trial administrators will face new challenges of their own. While innovations like ePRO – using electronic means to facilitate the reporting of patient outcomes – are now in relatively common use, the coming transformations may be much more radical.

For investigators within a single site or jurisdiction, moving to electronic contacts may not be hugely problematic. However, as promising therapies progress to larger scale trials, new complexities are likely to emerge. Incorporating telemedicine technologies may help protect participants and enable a vital acceleration of evaluations, but crucial principles such as informed consent will still be pertinent. This means services like over-the-phone interpretation (OPI) and video remote interpreting (VRI) may also become a large part of the emerging clinical landscape.

What is OPI (Over-the-Phone Interpretation) and VRI (Video Remote Interpreting)?

These interpretation modalities, also referred to as telephone interpreting and video remote interpreting, allow the benefits of communication help from native language speakers while skipping some of the logistical struggles with on-site and in-person interpretation. The remote nature of this approach also protects all three parties from unecessary person-to-person contact.

Language is the primary element of personalization. That doesn't change simply because a clinical trial or doctor visit is suddenly remote.

Is the Change Permanent?

As many commentators have pointed out, it’s much too early to tell what the “new normal” will look when the COVID-19 pandemic eventually recedes. What’s clear, though, is that we are witnessing transformations of historic proportions from which no industry will emerge entirely unchanged. Predictions have never been more difficult to make, but the adoption of telemedicine and telehealth seems likely to substantially and permanently accelerate because this crisis. Even technologies once considered niche in healthcare – like wearable monitoring devices and interactive home assistants – may seem no more unfamiliar than the boxes we talk to when we want to check the weather or cue up a show on Netflix. We may not see an all-remote delivery model for healthcare anytime soon, but a remote-first model no longer seems a wholly unlikely prospect.

To support your team during the crisis and start planning for the new normal, reach out to our life sciences team to see how we can help you maintain momentum.

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Mark Aiello
Mark Aiello