Telemedicine and Covid-19

COVID-19 pandemic greatly affected people’s everyday life. The changes caused by containing the virus were drastic as even to affect social interaction and communication. Governments imposed lockdowns to force people to stay indoors. On rare occasions when a household member is allowed to go out, social distancing is practiced at all times. The rules were stringent to manage the number of people allowed to go outside to buy necessities, like food, medicine, and water. 

The imposed lockdown was detrimental to many livelihoods, businesses, and economies around the globe. Businesses were forced to close, consequently increasing the unemployment rate. It is no surprise that nearly half of the world’s 3.3 billion global workforces lost their livelihoods, forcing tens and thousands of households to be at risk of falling into extreme poverty. Undernourishment is expected to rise. Due to a lack of access to social protection and access to health care, the informal economy workers are particularly vulnerable to the pandemic’s effects. On the other hand, some who managed to keep their jobs were forced to work from home. 

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As the virus spread worldwide, hospitals were constantly packed, and medical professionals have become overworked and exhausted. This is the first time that a health crisis has deeply affected the entire global economy. The pandemic is proof that healthcare is inseparable from the economy and that health care systems around the globe are not designed to deal with a crisis so unpredictable and largescale as to require the urgent mobilization of resources. The increasing demand for care of COVID patients challenged the world’s healthcare system’s capacity to continue delivering essential health services. Despite the impressive advancements in science and massive economic growth over the past decades, disparities in wealth and health have persisted. These disparities have become more apparent as the world scrambles to find security both in jobs and healthcare.

As a response to the challenge posed by the COVID-19 pandemic, telemedicine has stepped into the limelight to assist healthcare providers, organizations, and caregivers. Telemedicine has become the primary tool for healthcare providers and patients to connect as the world faces the pandemic. It has become crucial in giving a better response to the needs infected by the virus and those who seek other medical services amidst the pandemic. A mitigator of the impact of COVID-19, telemedicine has become the go-to type of health and medical service.

What is Telemedicine

The Centers for Disease Control and Prevention disclosed that telemedicine is “the use of electronic information and telecommunication technology to get the healthcare you need while practicing social distancing.” There are numerous channels for delivering these services, but, ultimately, it utilizes the internet.

However, telehealth technologies have a certain limitation when it comes to treating patients during a pandemic. Through telemedicine, medical care is made convenient, low cost, and readily accessible to everyone who utilizes the service. It has become doctors’ first line of defense during the coronavirus pandemic. Healthcare providers can consult and provide services by phone or videoconferencing for mild personal issues while limiting care and supplies for urgent cases.

Telemedicine is not something new. Healthcare providers have been offering this remote service since the 1950s. It was developed some 40 years ago to bring medical diagnoses and care to individuals in remote parts of the world. Telemedicine first began on a landline telephone. It involves using modern technology and telecommunications for doctors to visit their patients virtually, usually over live video or through sending emails used as a reference. Technology has helped telemedicine grow and offer its services in a variety of ways. This includes online portals for remote consultation and through apps managed by companies offering telemedicine services.

How Telemedicine Works

Telemedicine works by utilizing various methods like making a virtual appointment with a doctor or service provider. For example, a patient has a sore throat and undergoes an examination where the doctor determined the problem requires an ENT referral, visit, and treatment plan. Without telemedicine, going to the ENT could mean spending hours stuck in traffic and navigating through your doctor’s clinic. If the patient is not feeling well, this situation is inconvenient. Through telemedicine, the visit to the ENT doctor will be done by video conference to receive an instant diagnosis and treatment. At first glance, this might be a difficult way for treatment. However, there is no need to worry, the doctor or specialist hears the symptoms directly from the patient and makes a diagnosis.

People and even doctors have connected medicine with technology. Through the web, anyone can search for conditions and symptoms. Nowadays, most people can even get prescriptions and supplements delivered. In the past, a patient is forced to wait in a waiting room to see their doctor. Today, technology can make health care convenient. 

There are three types of ways you can avail of telemedicine: interactive medicine, remote patient monitoring, and store and forward. 

Interactive medicine

Interactive medicine is also called live telemedicine. In this type of service, physicians and patients communicate in real-time. There are different ways the patient can utilize this service. The ways include phone, online, and home visits. The process starts with an inquiry into the medical history, consultation about presenting symptoms, and then assessment. It is similar to the one conducted in face-to-face appointments. Teleneuropsychology (TeleNP), telenursing, and telepharmacy are examples of this method. 

Teleneuropshychology

Daniel Smith defines teleneuropsychology as “the administration of neuropsychological tests using remote contact with the patient, typically through video-teleconferencing (VTC) techniques.” It includes remote consultation and assessment with patients that have or are suspected of having a cognitive disorder. Tests follow the instruments’ standardized task instructions except for required equipment changes and the patient and examiner’s interaction. A 2014 study found that this method provides a feasible and reliable alternative to traditional consultations. 

Telenursing

Telenursing is defined as the use of communicative technology “to deliver nursing care and conduct nursing practice.” Like teleneuropsychology, its difference from the traditional nursing services is the use of technology. It only affects the delivery medium and may necessitate competencies related to it. Nurses engaged in this practice conduct, assess, plan, intervene, and evaluate outcomes of nursing care using the internet, computers, telephones, digital assessment tools, and telemonitoring equipment. Through this service, consultations can be made over the phone. There is an upsurge in the number of patients who use this service due to its low cost and high accessibility of its services, particularly those living in remote places. It lessens the burden of patients in hospitals because it can help address minor ailments earlier, and they can ask for advice on whether hospitalization is advised.

Telepharmacy

The Model Act defines telepharmacy as “the practice of pharmacy by registered pharmacies and pharmacists located within U.S jurisdictions through the use of telepharmacy technologies between a licensee and patients or their agents at distances that are located within U.S jurisdictions.” This service allows patients to get pharmaceutical advice when a direct contract with a pharmacist is not possible. It also allows medications to be monitored. Consultations may be done over the phone, and depending on the regulations, patients can receive regular medications when required. 

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Remote patient monitoring

Remote patient monitoring (RPM) is also known as self-monitoring or self-testing. This modality allows caregivers to monitor patients who use mobile medical equipment to collect data like blood pressure and blood sugar level, etc. To get data, this method uses a range of devices to monitor a remote patient’s health and clinical signs. This is commonly used in managing chronic diseases such as cardiovascular disease, diabetes mellitus, and asthma. 

This method is cost-effective and results in greater patient satisfaction because it frequently monitors the patient’s health. However, some are hesitant to use this method because the patients themselves conduct the tests. There is no worry, though. The outcomes are thought to be similar to professional-patient tests. 

As COVID-19 patients go home and recover from the virus, RPM plays a crucial part in their recovery. Complications may arise after a person has been discharged, and with remote patient monitoring, they are safe from returning to high-risk public spaces, especially the hospital. With remote patient monitoring technologies, track and transmit patients’ and users’ vital signs that can indicate real-time information for doctors to evaluate their condition to determine the next steps. We now have wearable tools, like thermometers and pulse oximeters that gather data automatically. Some are available for download on your smartphone but may require manual input. 

RPM technologies are digitally connected and noninvasive but gather accurate data such as blood pressure, temperature, pulmonary function, and other relevant physiology. This is especially important technology after studies have connected COVID-19 to long-term heart and lung damage. With remote monitoring, you can maintain high vigilance during your transition after your bout against COVID-19.

Store and Forward

Sometimes called asynchronous telemedicine, store and forward telemedicine providers can share a patient’s health information such as medical images or biosignals with other health care professionals or specialists. It is asynchronous because the specialist, patient, and primary doctor do not need to communicate at the same time. 

Store and forward telemedicine is an efficient healthcare service. Since a provider, patient, and specialist do not need to be in the same place simultaneously, it facilitates faster diagnosis. This is usually common in the fields of dermatology, radiology, and pathology. This technique saves time and allows medical practitioners to serve the public fully. However, it relies on history reports, documented information, or images that have the risk for misdiagnosis.

What A Telemedicine Service Offers

Getting telemedicine services usually depends on what your doctor offers. The most common way to consult with your doctor through telemedicine is by using a patient portal and virtual appointments. Rapid progression of a patient’s symptoms presents a real challenge to healthcare providers for the whole world. Social distancing measures can help mitigate and reduce the effects of a global pandemic. This is where telemedicine can significantly reduce the burden of patients needing care and healthcare providers wanting to attend to their patients. Telemedicine can have various forms; the most common are the following:

  • Online Consultations or telecare, where patients connect with their primary care providers. Through online consultations, patients can report their symptoms or ask for advice regarding their condition. This also acts as a “forward triage,” where patients are sorted before entering the hospital’s emergency room. 
  • Telemonitoring/screening are devices that collect, transform, and assess a patient’s health data. Data may include blood pressure, respiratory rate, and oxygen level, and transmit them to their care team. Screening for symptoms may be done by letting patients answer specific questions for healthcare professionals to give accurate assessments and diagnoses.
  • Sensors like GPS trackers may be used in remote platforms. GPS or global positioning systems can allow users to conveniently avoid going into dangerous locations where health hazards may be con acquired.
  • Chatbots come very handily for recommendations, getting instant answers for frequently asked questions (FAQs), and connected at-risk patients to an on-call doctor. 

The World Health Organization launched a chatbot on Facebook Messenger, which offers instant and accurate information about COVID-19. It was done to appease the public during the tumultuous time. The chatbot is a similar version of the organization’s Health Alert Platform. Taking advantage of Facebook’s global reach, which made sure that it can accommodate anyone. It runs in English, French, Spanish, and Arabic and can be accessed through the WHO’s official Facebook page

Patient Portal

A patient portal is a product of the introduction of electronic medical records (EMR software) and electronic health records (EHR software). Patient portals have become popular in healthcare organizations. They are used to provide quality care and encourage greater communication between physicians and their patients. This technology allows patients to access their medical information, monitoring their health easier and more convenient. They can check lab results, request prescription refills, update their insurance information, and many more at any time. 

Electronic medical records provide a real-time and modifiable patient list, which can be accessed on-demand. This feature was proven useful during the pandemic, where multiple stakeholders needed to have real-time updates on patients’ isolation status. It can also generate appropriate isolation orders automatically based on COVID-19 order and patient status. Most importantly, it provides automatic alerts to infection preventionists and positive patients, regardless of where an order was placed. This feature has protected nurses, doctors, and other healthcare workers from persons under investigation (PUIs) for COVID-19.  

Patients are protected through a secured online platform. They have their very own username and password they can use to access medical details, send and get emails from their doctors or nurse. Other benefits of having a patient portal include: rapid growth in the industry, increased office efficiency, streamlined workflow, telemedicine promotion, and fewer medical errors. 

Because organizations are offering these portals, there is an increase in the number of patients signing up and actively using the services. According to the National Coordinator for Health IT (ONC), over 90% of hospitals allow patients to access their medical records. Seventy-two percent of organizations give patients full view, download, and can transmit this information. 

Virtual Appointments

Appointments with Doctors are done over the phone or through video conference. These are like “virtual visits” between patients and clinicians through the use of communications technology. Instead of traveling to another city, patients can interact with an offsite medical specialist. Patients can also readily find qualified second opinions through this process. 

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The Benefits of Telemedicine

In the face of battling COVID-19, telemedicine has become a popular alternative. This service helps reduce the risk of infection and decreases contact with healthcare facilities, other patients, and staff. The driving force behind this service is the need for more accessible healthcare. 

The main benefit of telemedicine is just that: more efficient, affordable, and accessible health care. Whether you live in a remote area or keep a busy schedule that makes visiting a physician impossible or inconvenient, it allows the patient to talk to a doctor live, receive and send messages through chat messaging or email, remote monitoring, and reduced time for services, and fewer visits to the clinic. Most, especially patients, can save on transportation costs. Thus telemedicine can improve a person’s overall health and well-being as well as the patient’s finances. 

Access to telemedicine reduces emergency room visits. According to a 2017 study, telemedicine visits average $79 while the conventional doctor visit costs $149. The average trip to the emergency room is $1,734. As the popularity of telemedicine grew, numerous health insurance plans have been offering coverage for these visits. Some states even enacted laws that require health insurance plans to reimburse these telemedicine visits. For example, upon meeting all federal requirements and eligibility, Medicaid offers reimbursement for telemedicine services. It is best to check with specific plans benefits before using telemedicine to understand related financial obligations for more information.  

When to Use Telemedicine?

In these trying times, it is a must that the patient first contact their healthcare provider and ask whether they offer telemedicine visits and ask what technology is needed to have to avail of it. They will advise on health management using telemedicine. Usually, it can be used for follow-up appointments, management of chronic conditions, medical management, and consultation with medical specialists.

Types of Care in Telemedicine?

Telemedicine can be used in delivering a wide variety of health services depending on specialty. For example, a surgeon may use telemedicine to do post-operation check-ups. A psychiatrist may use telemedicine during counseling sessions. 

Your primary care doctor may inform you about and treat these conditions via telemedicine:

  • Allergies
  • Arthritic pain
  • Asthma
  • Bronchitis
  • Colds and Flu
  • Diarrhea
  • Infections
  • Insect bites
  • Pharyngitis
  • Rashes 
  • Conjunctivitis
  • Respiratory infections
  • Sinusitis
  • Skin inflammations
  • Cellulitis
  • Sore throats
  • Sprains and strains
  • Bladder infections
  • UTIs
  • Vomiting

The Center for Medicare and Medicaid Services has a list of medicare-reimbursed telemedicine services. For COVID-19 related services, on the other hand, there are other available services:

  • Screening for COVID-19, testing recommendations, and guidance on isolation or quarantine
  • Prescriptions for medication
  • Nutrition counseling
  • Mental health counseling

However, it should be kept in mind that telemedicine is not recommended for emergencies like a heart attack or stroke, cuts or lacerations, or broken bones that require an x-ray, splints, or casts. Those that require immediate hands-on care should be handled in person.