On building the first Romanian telehealth emergency app

Here at RomSoft we’ve been involved in developing various eHealth projects for more than 15 years. The most recent one is eTELEDOC, the first Romanian telehealth emergency app. For RomSoft, developing this product was also another kind of premiere: working exclusively for a Romanian private customer.

The need addressed by this app is pretty straightforward. If you are faced with an urgent medical situation, you can connect to the app any time, day or night, weekend or holiday, in order to enter immediately in a live video call with an emergency doctor. You will receive a professional opinion on the possible diagnosis, advice on first aid steps, advice on first aid medication, and even clarification on whether you should go to the hospital immediately, or, on the contrary, what symptoms you should keep an eye on.

I can see how such an application could save lives, and at the same time save precious resources and reduce the pressure on emergency hospitals all over the country.

Head of R&D at RomSoft Lucian Nita

To gain a little bit more insight into how the application was designed and built, I’ve been talking to Lucian Nita, who is the project manager and head of RomSoft’s Research & Development department, and the best person to tell us more about this project.

Lucian, I understand that you coordinated everything on the software development front, and also you are somewhat responsible for training the doctors who keep joining the application in order to put themselves at the disposition of the patients who use this telemedicine service.

Yes, that’s right.

So, a medical emergency service, in the comfort of your home. What are the main steps to benefit from it?

The onboarding is very easy. You just have to create an account, like with any other web application. Then, you are required to take a few minutes to complete the Personal Data form, and also, the Health Questionnaire.

This is critically important because when you have an emergency there may be no time or you may not be able to go through all the health issues that the doctor should know about you, like chronic illnesses, allergies, and so on.

And then you’re all set. It’s that simple. If you ever find yourself in a situation to use the service, you can do so with one click of a button, which will put you in a direct video session with the first available doctor who is on call at that moment.

Who should use the application?

The application can be used by anybody who has a medical emergency and has no other option to obtain help. Outside working hours, at night, or during weekends, we usually have to rely on our local ER service in order to obtain help. This can make the emergency service and hospitals overcrowded, on one hand.

On the other hand, there are people who postpone calling the ambulance because they aren’t sure if their case qualifies as a medical emergency. Now, you can use the eTeledoc emergency service, to obtain professional advice in all the situations above, even if it is to find out what first-aid steps you can take while waiting for the ambulance.

eTeledoc first emergency telehealth app in Romania

What is the platform not meant to do?

The application is not meant to obtain compensated or recurrent prescription medication. It is to provide emergency professional medical advice whenever you can’t call your own physician.

Can I use eTeledoc for someone else?

Yes, for sure. On your own account, you will have a number of beneficiaries that you can register. Maybe your own kids, or your parents who are not tech-savvy. The number of beneficiaries depends on the subscription type.

In the case of small children, they don’t own a phone number (which is the central element of identification to a user account).  We wanted to come up with a solution for parents who want to use eTeledoc for their children. So we gave them the option to “Create a child account”, based on their phone number and followed by an extension that is the name of the child. In this way, when a user has an emergency about their child, they can make the call from the child’s account, so that the medical data is not mixed.

The fact that I can differentiate between child accounts and adult accounts also gives me the opportunity to redirect the call to a doctor from the secondary line of duty, which is formed mainly of doctors who have a pediatric specialty.

What do you see as the main benefit of the app?

For me, the main benefit is that I can request immediate professional advice, anytime, anywhere. And also, the fact that it’s on video call. I can understand better what the doctor says, and also, the doctor can see some of the symptoms, like the aspect of a wound or allergic reaction.

But there is also the comfort that I don’t have to go to the emergency room for any health scare. A specialist can clarify for me at any time, day and night, if my case is indeed an emergency.

Are there any limitations to the application?

The only limitation that I see at this moment is that you must have a fairly good quality internet connection. But we’re currently working to be able to interconnect via the mobile phone operators’ infrastructure. So this will not be an issue in the near future.

What were the technical challenges so far?

This is a web application, where the doctor’s browser connects to the patient’s browser through a WebRTC library that allows audio-video signal transmission between the two browsers.

The first challenge was to implement the patient-doctor dialogue – connecting the two web browsers. That requested us to rent a service from Toolio, a cloud-based merchandising platform. The complexity is derived from the fact that more patients can call at once, and also, there can be more doctors on call. And this meant that I needed to prioritize and direct these calls so that they didn’t interfere.

Other challenges came from the other modules that needed to be developed on top of the main functionality.

It’s all about flexibility. Nobody can predict how many medical emergencies they will have.

For example, there were some challenges with the e-payments module. The problem we ran into with our first e-payments service provider was that extra payments came into conflict with scheduled payments. They couldn’t coexist. And we needed them to be able to coexist. Let’s take an example.

When you choose a subscription plan, you can opt for recurring monthly payments, and you have a certain number of emergency calls included in that plan. But if you already consumed your entire “credit” of emergency calls, I should be able to give you the opportunity to still use the service when you have an emergency, by allowing you to approve an extra payment, with one click. Due to the fact that I have your payment details saved, all I should need is your approval. But the first e-payments provider didn’t allow us to have these extra payments as well as the recurring ones.

So we had to find another one. It’s all about flexibility because nobody can predict how many times per year they will have a medical emergency, so we need to keep the system as flexible as possible.

These were challenges that I came across on the third-party services side, and to a certain extent due to my lack of previous experience on the e-commerce front. But it was also a great opportunity to learn.

Another challenge was translating the audio signal into text because every patient-doctor dialogue must be saved in the database. But another key requirement is that at any time, these dialogues must be searchable. And you can’t search video files for specific keywords, that’s why every conversation has to be converted into a text file. The solution to this was to use a Microsoft library.

You can’t just discard an entire category of users just because they don’t use a smartphone. You have to treat them all equally.

A problem that I’m still working on – is how to redirect automatically the non-urgent calls. The patient has two buttons in the application. Emergency and Non-Emergency. If a non-emergency call is made during working hours, the call will be directed to the call center, where the operator will open a consultation in the database and will assign it to a doctor.

But if the non-emergency call is initiated outside working hours, I have to redirect the call to the doctor who is on duty at that time.

Redirecting the calls through the call center allows me to solve two problems at once, in fact, because there are also patients who call from a non-smartphone, that is not connected to the internet and therefore browser-to-browser communication cannot be established. And you can’t just discard an entire category of users just because they don’t use a smartphone. You have to treat them all equally.

In both cases, the solution was to write a protocol that allows the application server to connect to the mobile operator server.

What do you think motivates doctors to join in and offer their help?

The main reason – I think – is that they want to add this type of experience to their portfolio. So, curiosity, and wanting to try something new. Also, the idea that telemedicine services will be used more and more in the future.

The good news is that there’s quite some competition – as this is among the very few telemedicine services available in Romania so far.

How fast do they get used to working with the platform?

Usually, one training session is enough. They have to learn how to schedule their shifts, how to answer emergencies and how to follow up on the consultation: to write conclusions, prescriptions, keywords, etc. There is a certain protocol that must be followed in order to maintain data consistency.

A closing thought?

It was a real honor for me to have the opportunity to develop this app. Having worked mostly in R&D projects for so many years, I don’t often get the chance to contribute to a project that is so fast to go to market. I started working on this project in March 2022, and in October I’m already a paying customer on the platform.

Thank you, Lucian. It was a real pleasure talking to you and learning all these behind-the-scenes details on developing this application. I look forward to seeing how the project picks up in the future, but for now, the prospects are looking good.