The in-person delivery of medical care is imbued with inefficiencies, where patients endure unpredictable wait times, are hindered by their geography and limited by social inequities.
The COVID-19 pandemic has further exacerbated these challenges especially as strict social distancing measures and patient’s heightened infection concerns have led to the reduced presentation to medical facilities. This pandemic has reiterated the limitations of the traditional in-person delivery of care and has propelled the healthcare system to rapidly embrace Telemedicine. Therefore, it is important to have a clear understanding of what Telemedicine entails.
Firstly, the clarification of terminology is helpful to avoid confusion. Telemedicine is often used interchangeably with Telehealth and refers to the electronic communication of medical information, from one location to another, with the goal of improving the patient’s health. However, some sources make a distinction between the two, such that Telemedicine specifically refers to the medical consultations over an electronic medium (e.g. telephone, email, videoconference); whilst Telehealth broadly refers to the use of digital solutions to improve healthcare. When used in this manner, Telehealth encompasses the use of technology to manage data (e.g. electronic medical records), to optimise clinical decision making (e.g. treatment algorithms) and to consult with patient from afar (e.g. Telemedicine).
Historically, technological limitations constrained Telemedicine to the military, prison and remote settings, and was primarily used to manage acute conditions, such as stroke. However, the recent ubiquity of the internet and smart phones have increased the scope of Telemedicine, and has been shown to confer benefits to patients, medical practitioners and the healthcare system. The advantages to patients are manifold and is exemplified by the opportunity for rural patients to have improved access to specialist care with decreased travel time to distant facilities. Moreover, vulnerable patients, such as the elderly or the immunocompromised, can continue to receive care from their general practioner without the increased exposure to infectious pathogens in waiting rooms. Likewise, medical professionals experience safety benefits from the decreased risk of infectious contact and are better able to incorporate multi-disciplinary team approaches to their patient care. The healthcare sector also benefits, as the delivery of virtual healthcare is relatively inexpensive compared to expensive overhead costs and hospital services. Therefore, the uptake of Telemedicine by general practitioners are critical at reducing the burden on emergency departments.
In order to support general practitioners to integrate Telemedicine into their practice, the Royal Australian College of General Practitioners have published guidelines to assist with nuances of this mode of delivery. These resources have outlined situations where Telemedicine are suitable, such as routine chronic disease check-ups, when prescriptions need to be written, in the provision of mental health support, and when medical certificates are required. There is also guidance around situations where Telemedicine is not suitable. This includes situations where the patient presents with high-risk symptoms that require a thorough physical examination or when patients have difficulty communicating online. It is critical to remember that the quality of a virtual physical examination will inevitably be inferior to that of an in-person consultation. For example, the signs of an acute abdomen can be difficult to assess over a screen, subtle neurological symptoms is easily missed (e.g. hemiparesis in stroke) and the vital signs obtained by untrained patients is inaccurate. Therefore, professional judgement should be used when assessing a patient’s suitability for a Telemedicine consults, so that sinister outcomes can be minimised.
Ultimately, the expansion of Telemedicine presents profound opportunities for the future of healthcare. It is clear that this is an efficacious solution to the geographical and social inequities of traditional in-person healthcare and has the added benefit of allowing patients to access care from the comfort of their own homes. As clinicians integrate Telemedicine into their practice and work through some of the challenges, the health care sector can embrace the potential of this mode of delivery to enhance the patient experience of care and improve the health of populations.
Dorsey, E. R., & Topol, E. J. (2016). State of telehealth. New England Journal of Medicine, 375(2), 154-161.
Moffatt Jennifer J., Eley Diann S. (2010). The reported benefits of telehealth for rural Australians. Australian Health Review 34, 276-281.
Oh, H., Rizo, C., Enkin, M., & Jadad, A. (2005). What is eHealth?: a systematic review of published definitions. World Hosp Health Serv, 41(1), 32-40.
Telehealth, RACGP. Retrieved from https://www.racgp.org.au/running-a-practice/technology/clinical-technology/telehealth
Telehealth (2015) The Department of Health. Retrieved from https://www1.health.gov.au/internet/main/publishing.nsf/Content/e-health-telehealth
Tuckson, R. V., Edmunds, M., & Hodgkins, M. L. (2017). Telehealth. New England Journal of Medicine, 377(16), 1585-1592.
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