Technology can connect people over distance but can you establish relations with a citizen through a screen? Hopefully, you will find yourself equipped to do exactly that after the learnings of this theme.
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.
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.
In the field of telemedicine, one of the most emergent technologies is the use of teleconsultations, which often both includes phone and video consultations. Therefore, the module has been developed on what to consider when integrating video consultations in the organization.
PAHO describes teleconsultation (also sometimes referred to as remote consultation or telehealth), as:
“Interactions that happen between a clinician and a patient (citizen) for the purpose of providing diagnostic or therapeutic advice through electronic means.”
Video consultations have the added benefit, that they closely resembles a physical consultation. The video function overcomes the lack of visual information, that can be used in the examination of the citizen, to gauge the state of the citizen’s health.
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.
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.
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
Telemonitoring during pregnancy
Another good use for telemonitoring is of pregnant women with complications. As we all know, pregnancy is not a disease, however some women must be watched more closely. 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 ethical dilemmas).
Why is it useful?
Telemonitoring services offer more options to citizens and allow continued care at home. It also allows proper intervention if the biological parameters measured in the citizen’s home dictates it. Systematic reviews have shown that with telemonitoring, hospital stays for citizens are reduced and citizens are empowered to play an active role in the management of their disease. It can also reduce health expenditure related to the chronic disease.
Clinical examples of telemonitoring
Here ara 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.
Source / References
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).
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.