This module teaches you how technology fosters meaningful connections and relationships with patients over distances through screens.
What is telemedicine?
Telemedicine or telehealth are terms that are often used interchangeably. However, there are slight nuances to what each category entails. The following section will describe different definitions.
Definition
Telemedicine is defined as digitally supported health services where the citizen (patient) can avoid having to appear at the doctor’s office or at the hospital in cases where a physical appearance is not necessary for the consultation.
Telemedicine does not replace current medical practices but is a response to the challenges facing healthcare today: inequalities in access to care, changes in medical demography, geographical challenges of the system and economic constraints.
Benefits associated with telemedicine
Telemedicine makes it possible to overcome spatial separation between healthcare providers and citizens by offering remote clinical diagnostics, consultations or medical emergency care via data and communication technology. As such, there are great potential gains that can be obtained by utilizing the digital possibilities for performing core tasks in the healthcare system in new and smarter ways. High-quality treatment does not necessarily require a physical meeting. Well-functioning telemedicine solutions benefit the citizens, who can remain in their own homes without having to visit the hospital for frequent but often simple check-ups. At the same time this is expected to reduce costs. Below are some benefits associated with telemedicine:
- The citizen saves time on transportation, parking and waiting at the hospital.
- The citizen avoids the physical strains of transportation and the risk of infection at the hospital or in public transportation.
- The citizen may not need to take a full day off from work for consultations, because he/she only needs time off for the actual consultation/treatment.
- Relatives can participate in the consultation even if they live far away from the citizen and/or the hospital.
Teleconsultations
In the field of telemedicine, teleconsultations, which often include both phone and video consultations, have become one of the most widely adopted technologies.
The Pan American Health Organization (PAHO) describes teleconsultations, also sometimes referred to as remote consultations or telehealth, as “interactions that occur between a clinician and a patient for the purpose of providing diagnostic or therapeutic advice through electronic means.”
Video consultations, a form of teleconsultations, offer the added benefit of closely resembling a physical consultation. This visual interaction compensates for the lack of physical presence, enabling the clinician to gather more information on the patient’s health condition that might otherwise be gathered through visual examination during an in-person consultation.
Given the benefits and increasing prevalence of teleconsultations, it’s critical to understand the factors to consider when integrating this technology into a healthcare organization. This module will guide you through this process. An overview of telemedicine interactions
Questions for reflection
- Does this information change your view of telemedicine?
- Can you think of more benefits associated with telemedicine? For the citizen (patient)? For the healthcare professional?
- What are some possible disadvantages of telemedicine? For the citizen (patient)? For the healthcare professional?
If possible, use examples from your own work experience.
What is telemonitoring?
Another important aspect of telemedicine is telemonitoring. While teleconsultations makes virtual dialogue possible, telemonitoring involves gathering data with the use of home monitoring equipment and communicating that information to a healthcare provider.
Definition
Telemonitoring is defined as the use of information and communication technology to monitor citizens at a distance. It is also known as “remote care assistance” or “remote home monitoring”. It is commonly used for monitoring patients with chronic diseases’ biological parameters such as weight, blood pressure, etc. depending on their condition. The use of the equipment can be used asynchronous without the presence of a healthcare professional, synchronous with an expectation of immediate follow up from a healthcare professional, or in combination with a video consultation with a healthcare professional.
Why is it useful?
Telemonitoring services offer several advantages for citizens, providing them with more options for continued care in the comfort of their own homes. By utilizing telemonitoring, healthcare providers can intervene promptly if the biological parameters measured in the citizen’s home indicate the need for intervention.
Telemonitoring have shown some key advantages:
- Reduced hospital stays: Telemonitoring decreases hospital stays, providing remote care and reducing the burden on healthcare facilities. It enhances convenience and comfort for citizens while avoiding unnecessary hospital admissions.
- Empowerment of citizens: Telemonitoring enables active participation in disease management. By monitoring their health parameters and making informed decisions with healthcare providers, citizens gain a deeper understanding of their conditions, leading to improved health outcomes and a better quality of life.
- Cost savings: Telemonitoring has the potential to reduce health expenditure associated with chronic diseases. It facilitates proactive monitoring, early detection of health issues, and prevention of complications, emergency room visits, and costly hospitalizations. These cost savings contribute to the overall sustainability of healthcare systems.
It’s important to note that the specific benefits and impact of telemonitoring may vary depending on the context and the individual’s health condition. However, overall, telemonitoring holds great promise in enhancing patient-centered care, improving health outcomes, and optimizing healthcare resource utilization.
Which citizens are suitable for telemonitoring?
Stable citizens with chronic diseases like chronic obstructive pulmonary disease (COPD), heart failure and diabetes are well suited to be considered for telemonitoring. These patient groups needs frequent check ups and physical mobility can be limited – which is why they can benefit greatly from telemonitoring. The home monitoring equipment can provide accurate and reliable data that may empower the citizens, influence their attitudes and behavior, and potentially improve their medical conditions.
However, in the improvement or development of telemonitoring systems, it is important that the citizen’s digital competencies and vulnerability are taken into account. See theme 3: Match between Technology and Citizen.
Source / References
Clinical examples of telemonitoring
Here are two examples of clinical uses of telemonitoring.
Case: The TeleCOPD program in Denmark
As mentioned, telemonitoring may be well suited for stable citizens with COPD, heart failure and diabetes. As such, telemonitoring has also most frequently been used in relation to handling these chronic conditions.
COPD is one of the leading causes of morbidity and mortality worldwide, with a substantial economic and social burden on individuals and society. In order to try and facilitate the management of the growing number of citizens with COPD and to reduce pressures on health services, providers have sought to implement telemonitoring for citizens with COPD.
In Denmark, the national program for telemonitoring for citizens with COPD is TeleCOPD. The citizen is provided with a telemedicine equipment package, which includes a tablet for communicating with the healthcare professionals, answering surveys (PRO-data), pulse monitoring, oxygen saturation etc. By answering surveys and using the home monitoring equipment, it strengthens the citizen’s self management. Specially trained COPD nurses will monitor the parameters, and if the measurements worsen, it is possible for them to intervene, before an acute situation emerges. This intervention has lead to fewer symptoms and improvements in the quality of life, while simultaneously leading to reduced COPD aggravations and burdens.
Case: Telemonitoring during pregnancy
An example of the use of telemonitoring is that of pregnant women with complications. As we all know, pregnancy is not a disease, however some women must be monitored more closely than others due to complications. By using telemonitoring, these women may stay in their own homes instead of being hospitalized. Pregnant women with complications such as pre-eclampsia or preterm prelabour rupture of membranes need strong monitoring to survey the state of health for both mother and child. However, due to the sensitivity of the situation, the data collected by the monitoring system is shielded from the citizen, and only shown to the healthcare professionals. (See also theme 2: Tech and ethical dilemmas).
Source / References
Questions for reflection
- Were you familiar with cases with such use of telemonitoring as described in the two examples?
- Do you know of any other examples of clinical uses of telemonitoring? Perhaps from your own work.
Telemedicine: Clinical and communication challenges
Telemedicine, despite its potential advantages and growing adoption, is not without its unique set of challenges. The inherent limitations of telemedicine could increase the risk of misdiagnosis. Clinicians often rely on physical examinations and non-verbal cues, which can be subtle or absent in a virtual setting, leading to potential misdiagnoses. To minimize this risk during implementation, rigorous protocols and guidelines may need to be established for teleconsultations, with clear indications for when in-person visits are necessary.
Limited Scope for Clinical Examinations in Implementation
The inability to conduct comprehensive clinical examinations via telemedicine needs to be taking into account in the implementation. To address this during implementation, certain conditions may need to be earmarked as not suitable for telemedicine or may require a hybrid model where physical examinations are combined with remote consultations. An example is a local nurse visits the patient and facilitates a video consultation with a doctor.
Impacts on Patient-Provider Relationships
Implementation of telemedicine may impact patient-provider relationships. In a virtual environment, fostering a strong rapport as in face-to-face consultations may prove challenging. Non-verbal cues, critical in communication, can be harder to discern, affecting the quality of interaction. This module might bring insights on how healthcare providers can strengthen their virtual communication skills and maintain a strong therapeutic alliance.
Challenges of Technology Adaptation
Adapting to the technology required for telemedicine can be challenging for both patients and providers. Special considerations during implementation must be taken for demographics such as the elderly or those less technologically inclined. Adequate training and user-friendly software design are essential. Additionally, even tech-savvy users may face technical issues, hence the need for a robust technical support system during the implementation phase.
In conclusion, the challenges posed by telemedicine require careful consideration during its implementation. Addressing these issues will ensure that telemedicine delivers safe, effective, and patient-centric care, fulfilling its potential in the modern digital healthcare system.
