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Table of Contents
REVIEW ARTICLE
Year : 2020  |  Volume : 17  |  Issue : 3  |  Page : 217-220

COVID-19 and the role of telemedicine in delivering health care


1 Southport and Ormskirk NHS Trust, Southport, UK
2 Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India

Date of Submission25-Jun-2020
Date of Decision25-Jun-2020
Date of Acceptance25-Jun-2020
Date of Web Publication01-Aug-2020

Correspondence Address:
Karthikeyan P Iyengar
Southport and Ormskirk NHS Trust, Southport, PR8 6PN
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_62_20

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  Abstract 

As the COVID-19 pandemic spread across the world, there has been an urgent need to devise and identify new models of delivering care to the needy individuals to avoid “face-to-face” consultation between clinician and patient, thus reducing the risk of disease transmission. The medical community had to re-think and reconfigure a way it could deliver continuity of care to its patients during the pandemic. Information technologies such as telemedicine have traditionally been used in patient care supported by various digital platforms. However, telemedicine's development, application, and revolution have accelerated during the COVID-19 pandemic and are bound to play a significant part in the future delivery of health care when the pandemic stabilizes.

Keywords: Coronavirus, COVID-19, health care, pandemics, remote consultation, telemedicine


How to cite this article:
Iyengar KP, Jain VK. COVID-19 and the role of telemedicine in delivering health care. Apollo Med 2020;17:217-20

How to cite this URL:
Iyengar KP, Jain VK. COVID-19 and the role of telemedicine in delivering health care. Apollo Med [serial online] 2020 [cited 2020 Oct 24];17:217-20. Available from: https://www.apollomedicine.org/text.asp?2020/17/3/217/291313


  Introduction Top


The World Health Organization (WHO) formally declared the new coronavirus severe acute respiratory syndrome-coronavirus-2 outbreak a pandemic on March 11, 2020.[1] Being a highly contagious disease spread by droplet transmission, it causes a spectrum of respiratory illness and may lead to serious pneumonia requiring hospitalization.[2]

To prevent the spread of this disease, various new modes of delivering care had to be identified to avoid “face-to-face” consultations.

COVID-19 has affected all medical specialties. “Lockdown,” social-distancing strategies, and infection control measures have meant that the delivery of “face-to-face” services had to be avoided except for treating urgent medical conditions and obligatory injuries. In this dilemma, a major challenge has been to ensure that patients and health-care staff are at safe distance while providing patients an effective continuity of care.

Information and communication technologies (ICTs) have great potential to address some of the challenges faced by both developed and developing countries in providing accessible, cost-effective, high-quality health-care services. Telemedicine uses ICTs to overcome geographical barriers and increase access to health-care services.[3] Telemedicine has appeared to be a logical solution to address the challenge of providing a continuity of care. Current and evolving telecommunication technologies play a key role in the exchange of valid information for the diagnosis and management of diseases and injuries.[4] Medical consultations performed by either telephone or video platforms do have limitations but can provide a safe channel to consult and advice patients in appropriate situations, especially in the current pandemic.[5] Recent advancements in, and the increasing availability and utilization of ICTs by the general population have been the biggest drivers of telemedicine over the past decade, rapidly creating new possibilities for health-care service and delivery.[3] Telemedicine is playing a vital role in the current pandemic in managing acute and chronic medical conditions.[6] Telemedicine is expected to play a crucial role as the world emerges from the pandemic and elective services resume, forming a keystone in managing health care in future.[7]


  Telemedicine Top


Telemedicine, a term coined in the 1970s, literally means “healing at a distance.” The WHO defines telemedicine as “the delivery of health-care services, where distance is a critical factor, by all health-care professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of health-care workers, with the aim of advancing the health of individuals and communities.”[1]

Telemedicine versus telehealth

Some distinguish telemedicine from telehealth, with the former restricted to service delivery by physicians only and the latter signifying services provided by health professionals in general, including nurses, pharmacists, and others. However, for the purpose of this report, telemedicine and telehealth are considered synonymous and used interchangeably. Telehealth refers to health-care interactions that leverage telecommunication devices to provide medical care outside the traditional face-to-face, in-person medical encounter.[8]


  Types and Modes of Telemedicine Top


Modes

  1. Tele-audio using telephone, audio applications, or voice-over-internet protocol
  2. Live video – laptop or mobile device apps, for example, Skype, Zoom, Microsoft Team, Facetime (iPhone), and Cisco-Webex
  3. Text based – Chat boxes; chat-based telemedicine applications; short messaging service; and chat platforms such as WhatsApp, Google, Facebook Messenger, electronic mails (emails), and fax transmissions
  4. Remote patient monitoring
  5. Mobile health.


Subtypes

  1. Synchronous communication which is continuous – video/audio/text
  2. Asynchronous which is stored and forward – emails and text messages.


Types according to consultation purpose in health care

  1. Triage purposes – To assess the priority of patient and decide whether face-to-face appointment is needed (e.g., new-onset chest pain or exacerbation of preexisting asthma)
  2. First consultation –First referral for a clinical condition (e.g., new-onset diabetes)
  3. Follow-up appointment – To convey blood or imaging results and advice.
  4. Telerehabilitation for neurologic and musculoskeletal conditions (e.g., following recent stroke or brain injury recovery exercise regimens)
  5. Monitoring of chronic medical conditions (e.g., diabetes care, chronic obstructive pulmonary disease [COPD]).



  Telemedicine Picture in India and Esanjeevani Top


Telecommunication technology has improved in leaps and bounds in India with low-tariff providers and support from the Government of India to develop telemedicine. Recently, telemedicine or delivery of health-care services using information or communication technology is evolved in India due to COVID-19. The Government of India has recently launched the e-Sanjeevani OPD, a national tele-consultation service, as mandatory for health-care providers. Through e-Sanjeevani OPD, patients can get medical advice through audio and video. With this service, people living in the remotest areas will also be able to get their health-related consultation.[9] Telemedicine applications have been applied in specialties such as diabetes, oncology care, and chronic pulmonary conditions [Table 1].[6],[10],[11] In the wake of the COVID-19 pandemic, the Ministry of Health and Family Welfare, Government of India, and the Medical Council of India (MCI) have recently come forth with telemedicine practice guidelines that clearly state the role and limitations of teleconsultations.[12] Telemedicine is playing an important role in delivering care in the current COVID-19 pandemic with applications of MCI guidelines and is expected to be pivotal in the post-COVID-19 recovery phase when elective traditional services resume.[6],[7]
Table 1: Telemedicine applications in delivering health care

Click here to view



  Face-To-Face and Telemedicine Consultations Top


It is acknowledged that “face-to-face” clinical consultation is the gold standard in assessing a patient's clinical condition and planning a “shared decision” management. However, though telemedicine consultations have limitations, they can provide a safe channel to consult and advice patients in appropriate situations especially in the current pandemic [Table 2].[4],[5],[6]
Table 2: Differences between telemedicine and face-to-face consultations relevant to COVID-19

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Telemedicine has many advantages. It allows interaction with a clinician in situ ations when a patient is not able to attend the setting or if the system does not permit face-to-face consultation (e.g., the current coronavirus outbreak). This can reassure a patient.

It also allows health-care professionals to determine which patients need a face-to-face consultation and can help in “risk stratification,” for example, a patient who reports his/her exacerbation of his/her COPD or asthma. These patients should have arrangements made for an urgent clinical face-to-face review and plan further management.

Telephonic consultation does not allow full assessment of the patient with absence of visual clues and facial expressions, thus failing to address the problem.[5] Video consultations (VCs) are complementary to telephone remote consultation and the next step on the ladder during the current pandemic, but introducing VC can be a complex organizational change.[13] It has to be used in appropriate situation with appropriate technology setup bearing in mind the limitation that some elderly patients may not be comfortable or have knowledge about digital platforms.[6]


  Pitfalls in Telemedicine Top


As telemedicine becomes an integral part of patient's clinical care now and in future, it has to be acknowledged that telemedicine technology should be applied in appropriate settings and situations. Common risks associated with telemedicine include miscommunication or inadequate communication, delayed diagnosis, poor documentation, and inadequate medical advice. The MCI and General Medical Council have published telemedicine practice guidelines enabling registered medical practitioner/s to provide health care.[12],[14] As such appropriate training and following telemedicine good practice principles, enhanced documentations, communication, and observing information governance guidelines will go a long way in avoiding pitfalls associated with consultations.[15]


  Conclusion Top


COVID-19 has made doctors move rapidly from the traditional face-to-face appointments to telephone or VC in challenging circumstances. Telemedicine technology is a key factor in the delivery of health care in future including monitoring of chronic diseases and telerehabilitation services. As with any technology, we need to ensure that telemedicine is explored to its fullest potential bearing in mind its limitations and ensuring good practice to avoid complaints and medico-legal issues associated with them.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. Regional office for Europe. WHO Announces COVID-19 as a Pandemic. World Health Organization; 2020. Available from: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic. [Last accessed on 2020 Jun 25].  Back to cited text no. 1
    
2.
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33.   Back to cited text no. 2
    
3.
World Health Organization. Telemedicine: Opportunities and Developments in Member States. World Health Organization; 2010. Available from: https://www.who.int/goe/publications/goe_telemedicine_2010.pdf. [Last accessed on 2020 Jun 25].  Back to cited text no. 3
    
4.
Iyengar K, Vaish A, Toh E, Vaishya R. COVID-19 and remote consulting strategies in managing trauma and orthopaedics. Postgrad Med J 2020;96:438-9.  Back to cited text no. 4
    
5.
Iyengar K, El-Nahas W. A brief guide to telephone medical consultation. Br J Healthcare Manag 2020;26:4, 1-3.  Back to cited text no. 5
    
6.
Ghosh A, Gupta R, Misra A. Telemedicine for diabetes care in India during COVID-19 pandemic and national lockdown period: Guidelines for physicians. Diabetes Metab Syndr 2020;14:273-6.  Back to cited text no. 6
    
7.
Iyengar KP, Jain VK, Vaish A, Vaishya R, Maini L, Lal H. Post COVID-19: Planning strategies to resume orthopaedic surgery -challenges and considerations. J Clin Orthop Trauma 2020;11(Suppl 3):S291-S295.  Back to cited text no. 7
    
8.
Tenforde AS, Hefner JE, Kodish-Wachs JE, Iaccarino MA, Paganoni S. Telehealth in physical medicine and rehabilitation: A narrative review. PM R 2017;9:S51-8.  Back to cited text no. 8
    
9.
Government of India. Available from: https://esanjeevani.com/. [Last accessed on 2020 Jun 25].  Back to cited text no. 9
    
10.
Banerjee M, Chakraborty S, Pal R. Teleconsultation and diabetes care amid COVID-19 pandemic in India: Scopes and challenges. J Diabetes Sci Technol 2020;14:714-5.  Back to cited text no. 10
    
11.
Goldstein RS, O'Hoski S. Telemedicine in COPD: Time to pause. Chest 2014;145:945-9.  Back to cited text no. 11
    
12.
Ministry of Health and Family Welfare, Government of India. Telemedicine Practice Guidelines; 25 March, 2020. Available from: https://www.mohfw.gov.in/pdf/Telemedicine.pdf. [Last accessed on 2020 Jun 25].  Back to cited text no. 12
    
13.
Greenhalgh T, Wherton J, Shaw S, Morrison C. Video consultations for COVID-19. BMJ 2020;368:m998.  Back to cited text no. 13
    
14.
General Medical Council. Good Medical Practice. Available from: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice. [Last updated on 2019 Apr 29; Last accessed on 2020 Jun 20].  Back to cited text no. 14
    
15.
Iyengar K, Jain VK, Vaishya R. Pitfalls in telemedicine consultations in the era of COVID-19 and how to avoid them. Diabetes Metab Syndr 2020;14:797-9.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2]



 

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  In this article
Abstract
Introduction
Telemedicine
Types and Modes ...
Telemedicine Pic...
Face-To-Face and...
Pitfalls in Tele...
Conclusion
References
Article Tables

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