Telemedicine is the umbrella term for many different forms of medical provision over distance and sometimes also asynchronous.
In general, we differentiate between teleconsultation, being the interaction between a medical professional and a patient (doc2pat), and teleconsult, meaning the interaction between two medical professionals (doc2doc). In radiology, for example, a technician performs the imaging and a (specialised) radiologist performs the appraisal or international multidisciplinary tumour boards (tele-conferencing). It may also be the telephonic or video communication between nursing staff and physicians, nurse-conducted outpatient visits and nurse-led anaesthesia.
History of telemedicine
The first scientific publication of a telemedical consultation was in the year 1879, titled ‘Practice by telephone’ — just three years after Alexander Graham Bell had filed a patent for the telephone. Since then, telemedicine has been a part of the medical profession in one way or another. Many developing countries like India have already embraced telemedicine in various clinical settings decades ago.
Challenges of modern healthcare systems
In countries with long traveling distances to medical facilities and difficult topography, like for example in Australia, Scandinavian countries or even the US, telemedicine is one of the only means to provide professional medical healthcare. And in various European Anglo-Saxon countries telemedicine has developed to be one of the pillars of primary and specialised healthcare in the last two decades. The COVID-19 pandemic in the last two years has lowered many regulatory and/or habitual barriers to telemedicine. In many countries the development of digitalisation in medicine (telemedicine) has been rather slow in comparison to other industries. This mostly due to habits of the population in the way medical services are consumed, regulatory barriers and often missing billable tariffs to be able to establish tele-medical services accordingly.
The telemedical market
The potential applications for telemedicine have reached an inflection point in health care. Mobile smartphone ownership in the US has reached >90 per cent in the 18- to 49-year-old population the same applies for most European countries, mobile computing and cellular phone technology have combined high-fidelity cameras and telecommunication hardware to make video teleconferencing seamless, and patients are more accustomed to interfacing with their healthcare systems via digital telecommunications including e-mail, mobile phone, and electronic patient portals. Recent market analyses project the global telemedicine market to grow to US$130.5 billion by 2025, and yet, anaesthesiology is the specialty least engaged with telemedicine-based clinical work.
Dr. Andrea Vincenzo Braga, MD, MBA
Digitisation boost through COVID-19 pandemic
The COVID pandemic has forced medical institutions to rethink many processes and to push digitisation, especially in patient interaction. Various (medical) processes before and after hospitalisation and/or day-stay interventions can be virtualised. For example, pre-interventional patient history taking end it says your logic premedication consultations, especially for healthy patients can well be done via telephone - or even better - video-consultation. The same thing applies to post-interventional monitoring and follow-up consultations. Here by receipt that there is a very intelligent location of medical/physician resources and time, and it saves patience a lot of unnecessary travel time.
There are of course limitations, especially with multi-morbid patients and patients with limited mental capacities, language difficulties, or inability to operate technical equipment. On the other hand, the consulting physician must be sure that he is able to assess the patient’s condition adequately and concise documentation is mandatory. In case of any doubts that physical consultation must follow.
Telemedicine in anaesthesiology
Anaesthesiologists have had over a decade-long experience with telemedicine for preoperative consultation. Identification of preoperative risk factor and pre-anaesthesia visits are widely accepted as the gold standard of care for elective surgery and are essential for reducing morbidity and mortality.
A boost came with COVID-19 forced public health restrictions thus requiring a careful balance between ensuring best preoperative medical practices and maintaining safety from infection by minimising patient face-to-face attendance in the hospital or clinic. Based on the successful implementation of telemedicine in other medical specialties and its feasibility in the preoperative context, a study with a total of 2,805 patients, which were assessed in the preoperative anaesthesiologic assessment clinic between July 2020 and March 2021 aimed to develop, implement, and evaluate a high-quality virtual preoperative anaesthetic assessment process.
In Switzerland and Austria there have been very good experiences in performing pre interventional telemedical consultations, also known as telemedicine anaesthesia consultation (TCAD), for day-stay and interventions requiring hospitalisation.
Tele-anaesthesia involves anaesthesiologists using technology to provide patient care remotely before, during and after surgeries and procedures, including the management of anaesthesia and observation during patient recovery. This as well for university-level support for rural hospitals as in pre-operative settings for standard operations on healthy patients.
Advantages and limitations of telemedicine
Telemedicine is a vast subject and has many different aspects and challenges: technical, legal, cultural, behavioral, concerning patients, doctors/nurses and institutions. Even though the number of publications about telemedicine, not only in anaesthesia and intensive care settings has dramatically increased, data on the clinical effectiveness and cost-effectiveness of most telemedicine applications is still limited, as are the clear arguments about benefits and drawbacks of telemedicine.
Many potential benefits of telemedicine can be emphasised, especially improved access to information; provision of care not previously deliverable, notably in rural and less developed areas; improved access to medical services and increasing care delivery; improved professional education; and reduction of healthcare costs-increases, and most of all intelligent allocation of medical professional resources, not to forget patients facilitated access to high quality medical services even with limited mobility or other handicaps. Although telemedicine clearly has a wide range of potential benefits, it also has some disadvantages. The main ones that can be envisaged are a potential weakening in the relationship between health professional and patient; a breakdown in the relationship between health professionals; issues concerning the quality of health information; and organisational, legal bureaucratic difficulties, and last but not least, reimbursement uncertainty. On balance, the benefits of telemedicine are substantial, assuming that more research will reduce or eliminate the obvious drawbacks. Face-to-face interactions remain a favourable option of patient-medical professional interaction, where reasonably applicable and possible.
The future of telemedicine
As telemedicine programmes develop within the perioperative arena, it is imperative for institutions to share knowledge, successes, and pitfalls to improve the delivery of care in today’s technology-driven medical landscape.
Moreover, telemedicine may improve access to physicians for patients with mobility problems, such as patients with disabilities, fragile patients, or older patients, and could ideally promote equity of access to healthcare and quick patient engagement at a reduced cost.
As medical resources become scarcer, patients demand rise, high-end technology becomes more accessible and affordable, mobile devices widespread, behavioural change in the population with higher acceptance to engage in medical services using communication technology medical professionals and medical institutions should fathom and embrace the possibilities of widening their service offer to patients reasonably combining virtual and real medical provision to the benefit of a larger patient population.
Further, data-driven studies should accompany telemedical initiatives and services to prove process efficiency, patient safety, intelligent use of medical personnel resources, patient-time and economic value. Investigating benefits by avoiding transport, unclog consultations in hospitals, and avoiding absences from work for traditional consultations are some of the advantages of this new method of consultation can be of further value.
This article appears in the Daily Dose 2023. Read the full issue online today.