EXPLAINER: What is Telehealth

  • Telehealth is a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies.

  • Telemedicine only applies to clinical services and is a subset of telehealth.

When can it be used?

  • Initially – to treat patients located in remote places with no ready access to medical professionals and/or health facilities, or patients with limited mobility.

  • Now – can be a tool for day-to-day medical care (i.e. not necessarily in emergency).

  • The emergence of wearable medical tech and simple home-use medical devices leads to the need to respond to the anomalies in their signals (blood pressure, glucose monitors, etc).

Benefits

For Patients

  • Access to medical care – virtual visits.

  • Speed – reduced or eliminated wait to get access to a specialist and especially a primary care provider.

  • Price advantage – telehealth is cheaper to the consumer due to cost savings at service delivery.

  • Better engagement with their doctor – higher frequency of contact builds more trust and makes patients more engaged in their care.

  • Constant monitoring – in person or via connected medical devices – and faster response to medical concerns or emergencies.

For Medical Care Providers

  • Outsourcing of special cases (teleradiology: the examination and the analysis are made by two different people, who may not even know each other) to niche specialists. Said niche specialists can take on more cases as a result.

  • Lower cost of service delivery, including taking certain measurements in a more timely manner.

For Both

  • Reducing problems of medication non-adherence (i.e. the patient forgets or refuses to take medication at the right time).

  • Reduces unnecessary emergency room visits.

  • Reducing risks of infection for both the patient and the doctor.

Complexities

  • Doctors often need to perform physical patient examination, which is not possible to do remotely. Telemedicine is OK for follow-up visits, but oftentimes – not for the first one.

  • Service delivery requires extensive training.

  • Picking a random doctor each session to answer questions or to monitor patient condition doesn’t lead to care continuity and trust, so achieving better outcomes requires less efficiency from assigning doctors from the available pool.

  • Lack of unified approach in billing reimbursement: most insurers don’t cover services delivered via telemedicine; hence the visit becomes a question of cost/urgency.

  • Electronic prescriptions (especially for scheduled drugs) may not have a proper legal status to be useful. Cross-country and cross-state rules may differ, too, as people needing telemedicine may be away from their normal place of residence. Telepharmacy (below) maybe the answer for certain types of medication.

  • Supposedly the rate of medical errors will increase without an in-person contact (ignoring non-obvious subtle clues about a patient) as well as the quality of doctors participating in the telemedicine programs may be lower.

  • Certain treatments may require in-person administration and waiting for the body reaction before proceeding.

  • Technology problems (quality of consumer device, network issues) may render the service useless.

  • When and how to obtain patient consent?

Useful Applications of Telemedicine

  • Teleradiology – X-Ray, ultrasound, CT scans, etc. can be sent for analysis and review to specialists from other clinics [technically – even other countries if the laws allow this]. Lots of readings can be made by computers/AI with at least the same quality as by the trained practitioner.

  • Telephychiatry – expand access to behavioural health services [MK: especially helpful with managing emotional health in the COVID era]

  • Teledermatology – checking and treating skin conditions not requiring tests. Sending a photo of a mole, rash, wart or another anomaly may be all that’s needed to receive the diagnosis and a treatment plan.

  • Teleophthalmology – diagnosing and treating eye infections.

  • Telenephrology – between doctors to discuss the patient’s kidney disease.

  • Telenutrition – discussing the patient’s diet based on their eating logs and body measurements, weight and health goals

  • Telepharmacy – drug therapy monitoring, patient counselling, prior authorization and refilling of existing medications. For controlled substances and scheduled drugs this will require a visit to a pharmacy or a medical facility and a video bridge with the prescribing doctor. Would love to see the medications to be delivered directly to the patient via drones.

  • More can be found on Wikipedia

The Main Types of Telemedicine

Asynchronous (store and forward)

  • Doctor and patient don’t need to communicate to each other in real time. Usually this is in relation to tests, images, videos, records, etc.

  • If not urgent, this works for the doctor-doctor communications, too.

  • If the requests are queued properly, the time it takes to analyse a set of results is minimal.

Remote Patient Monitoring (telemonitoring)

  • Doctors or their software can monitor a patient’s vital signs remotely and raise an alarm if the signs are abnormal.

  • Very useful for chronic care management.

  • That’s where wearables can come in very handy, especially for older patients.

Synchronous (real-time)

  • A live interaction between a patient and a doctor.

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