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TELEMEDICINE: During & ahead pandemic

Telemedicine can be defined as a rapidly developing application of clinical medicine where medical information is transferred through the phone or the web and sometimes other networks for the aim of consulting, and sometimes remote medical procedures or examinations .Telemedicine could also be as simple as two health professionals discussing a case over telephonic communication, or as complex as using satellite technology and videoconferencing equipment to conduct a real-time consultation between medical specialists in two different countries. Telemedicine generally refers to the utilization of communications and informational technologies for the delivery of clinical care.

Types of Telemedicine practiced on the basis of two concepts:

  • Real-time (synchronous)
  • Store-and-forward (asynchronous)

Real-time telemedicine

Real time telemedicine can be as simple as a telephone call or as complex as robotic surgery. It requires the presence of both parties at a similar time and a communications link between them that allows a real-time interaction for taking place. Video-conferencing equipment is one among the foremost common sorts of technologies utilized in synchronous telemedicine.

Peripheral devices can be attached to computers for the video-conferencing which can assist in an interactive examination. For instance, a tele-otoscope allows a remote physician to ‘see’ inside a patient’s ear; a tele-stethoscope allows the consulting remote physician to hear the patient’s heartbeat.

Store-and-forward (asynchronous)

Store-and-forward telemedicine is collecting clinical information and sending it electronically to a different site for evaluation. Information typically includes demographic data, medical record, documents like laboratory reports, and image, and video and/or sound files. The health care provider may use a personal computer or a mobile device, like a smartphone to collect and send the data. Information is transmitted by email correspondence, uploaded to a secure website, or uses a personal network.

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Benefits of store-and forward consultations include:

  1. The patient, GP and specialist don’t need to be available at an equivalent time , improving efficiency and convenience ,they do not got to travel as participants are often located anywhere waiting times are reduced
  2. Specialist reports are often received within a couple of hours of the request second opinions are often quickly obtained outpatient appointments are freed up for patients that require them most unnecessary prescriptions and surgical procedures are minimized.
  3. The most common application of telemedicine is “teleradiology”. It can be defined as the process of sending CT scan, x-ray or MRI scans (store and forward images). Nowadays, many radiologists are installing appropriate software in their home so that they have easy remote access to the diagnosis scans, saving their unnecessary visit to clinics/hospitals.

Impact on telemedicine during pandemic

Telemedicine is most beneficial for populations living in isolated communities and remote regions and is currently being applied in virtually all medical domains. The COVID-19 pandemic shifted telemedicine from an outlier to a necessity almost overnight, and doctors say they cannot see ever going back to their old model of care. “It’s hard to imagine us going back to doing everything within the office,” said Joe Kvedar, MD, president-elect of the American Telemedicine Association in Arlington, Virginia, “It’s more convenient, patients are happier, we get the knowledge we’d like , and that we can open up more slots for other patients.” Specialties that use telemedicine often use a “tele-” prefix; for example, telemedicine as applied by radiologists is called Teleradiology. Similarly, telecardiology, practiced by cardiologists, is another example of telemedicine.

Pandemic has accelerated telemedicine

The recent rise in telemedicine has been partly fueled by the temporary lifting of several medicare restrictions on the kinds of and eligibility for telehealth service reimbursement during the pandemic; the relief of HIPAA privacy laws that allow the utilization of smartphones, video conferencing platforms like Zoom, and messaging services like WhatsApp; and therefore the ability to supply care across state lines in 48 states. “This is particularly important for people of age 65 years and older, since virtually all are at greater risk of becoming seriously ill if they’re infected with the new coronavirus that causes COVID-19,” said Juliette Cubanski, PhD, MPP, MPH, deputy director of the Program on Medicare Policy at the Kaiser Family Foundation in San Francisco.

Telemedicine ahead of the Pandemic

Telemedicine is additionally useful as a communication tool between a physician and a specialist available at a foreign location. Telepathology is another common use of this technology. Images of pathology slides could also be sent from one location to a different for diagnostic consultation. Dermatology is additionally a natural for store and forward technology (although practitioners are increasingly using interactive technology for dermatological exams). Digital images could also be taken of skin conditions, and sent to a dermatologist for diagnosis.

The other widely used technology, two-way interactive television (IATV), is employed when a ‘face-to face’ consultation is important. The patient and sometimes their provider, or more commonly a nurse practitioner or telemedicine coordinator (or any combination of the three), are at the originating site. The specialist is at the referral site, most frequently at an urban center. Video conferencing equipment at both locations allows a ‘real-time’ consultation to require place. The technology has decreased in price and complexity over the past five years, and lots of programs now use desktop video conferencing systems. There are many configurations of an interactive consultation, but most typically it’s from an urban-to rural location. It means the patient doesn’t have to visit a populated area to check a specialist, and in many cases, provides access to specialty care when none has been available previously. Almost all specialties of drugs are found to be conducive to the current reasonable consultation, including psychiatry, general medicine, rehabilitation, cardiology, pediatrics, obstetrics and gynaecology and neurology. There are many peripheral devices which may be attached to computers which may aid in an interactive examination. For instance, a tele-otoscope allows a physician to ‘see’ inside a patient’s ear; a tele-stethoscope allows the consulting physician to hear the patient’s heartbeat.

With the digitization of healthcare, different forms of telemedicine have emerged and have opened a new way of healthcare delivery. Though it has some limitations, but as quoted beautifully “Change is Hard at the Beginning, Messy in the Middle and Gorgeous at the End”, this new normal will bring in better solutions for us in the long run.

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