Telemedicine

HEALTH INFORMATION

Telemedicine

‘The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.’

TELE-HEALTH

‘The delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies.’

TECHNOLOGY USED AND MODE OF COMMUNICATIONS:-

Multiple technologies can be used to deliver telemedicine consultation.

There are 3 primary modes:Video, Audio, or Text (chat, messaging, email, fax etc.).Each of these technology systems has their respective strengths, weaknesses and contexts, in which, they may be appropriate or inadequate to deliver a proper diagnosis.

It is therefore important to understand the strengths, benefits as well as limitations of different technologies. Broadly, though telemedicine consultation provides safety to the RMP from contagious conditions, it cannot replace physical examination that may require palpation, percussion or auscultation; that requires physical touch and feel. Newer technologies may improve this drawback.

STRENGTHS AND LIMITATIONS OF VARIOUS MODES OF COMMUNICATION

MODE STRENGTH LIMITATIONS
I)VIDEO:- Telemedicine facility, App, Video on chat platforms, FaceTime,etc 1)Closest to an in person-consult, real time interaction 2)Patient identification is easier 3)RMP can see the patient anddiscuss with the caregiver 4)Visual cues can be perceived 5)Inspection of patient can becarried out 1)Is dependent on high quality internet connection at both ends, else will lead to a sub optimal exchange of information 2)Since there is a possibility of abuse/ misuse, ensuring privacy of patients in video consults is extremely important
II)AUDIO: Phone, VOIP, Apps etc. 1)Convenient and fast 2)Unlimited reach 3)Suitable for urgent cases 4)No separateinfrastructurerequired 5)Privacy ensured 6)Real-time interaction. 1)Non-verbal cues may be missed 2)Not suitable for conditions that require a visual inspection (e.g. skin, eye or tongue examination), or physical touch 3)Patient identification needs to be clearer, greater chance of imposters representing the real patient
III)TEXT BASED: Specialised Chat based Telemedicine Smartphone Apps, SMS, Websites, messaging systems e.g. WhatsApp, Google Hangouts, FB Messenger 1)Convenient and quick 2)Documentation & Identification may be an integral feature of the platform 3)Suitable for urgent cases, orfollow-ups, second opinions provided RMP has enough context from other sources 4)No separate infrastructure required, 5)Can be real time 1)Besides the visual and physical touch, text-based interactions also miss the verbal cues 2)Difficult to establish rapport with the patient. 3)Cannot be sure of identity of the doctor or the patient
IV)ASYNCHRONOUS: Email Fax, recordings etc. 1)Convenient and easy to document 2)No specific app or downloadrequirement 3)Images, data, reports readilyshared 4)No separate infrastructurerequired 5)More useful when accompaniedwith test reports and follow up and second opinions 1)Not a real time interaction, so just one-way context is available, relying solely on the articulation by the patient 2)Patient identification is document based only and difficult to confirm 3)Non-verbal cues are missed 4)There may be delays because the Doctor may not see the mail

BENEFITS OF TELEMEDICINE :-

  1. It increases timely access to appropriate interventions including faster access and access to services that may not otherwise be available.
  2. Saving of the cost and effort especially of rural patients, as they need not travel long distances for obtaining consultation and treatment.
  3. It would also also reduces the inconvenience/impact to family and caregivers and social factors. Telemedicine can play a particularly important role in cases where there is no need for the patient to physically see the RMP (or other medical professional), e.g. for regular, routine check-ups or continuous monitoring.
  4. Telemedicine can reduce the burden on the secondary hospitals.
  5. With telemedicine, there is higher likelihood of maintenance of records and documentation hence minimizes the likelihood of missing out advice from the doctor other health care staff.
  6. Conversely, the doctor has an exact document of the advice provided via tele-consultation. Written documentation increases the legal protection of both parties.
  7. Telemedicine provides patient’s safety, as well as health workers safety especially in situations where there is risk of contagious infections. There are a number of technologies that can be used in telemedicine, which can help patients adhere better to their medication regimens and manage their diseases better.
  8. Disasters and pandemics pose unique challenges to providing health care. Though telemedicine will not solve them all, it is well suited for scenarios in which medical practitioners can evaluate and manage patients.
  9. India’s digital health policy advocates use of digital tools for improving the efficiency and outcome of the healthcare system and lays significant focus on the use of telemedicine services, especially in the Health and Wellness Centres at the grassroots level wherein a mid- level provider/health worker can connect the patients to the doctors through technology platforms in providing timely and best possible care.

Emergency consult for immediate assistance or first aid etc.

  1. In case alternative care is not present, tele consultation might be the only way to provide timely care. In such situations, RMPs may provide consultation to their best judgement. Telemedicine services should however be avoided for emergency care when alternative in-person care is available, and telemedicine consultation should be limited to first aid, life-saving measure, counselling and advice on referral.
  2. In all cases of emergency, the patient must be advised for an in-person interaction with an RMP at the earliest.