Athough telepresence and telecare are practices that have been applied in healthcare since the 60s in many countries – mainly to treat sailors who spend months on the high seas or people living in remote places – today the development of telemedicine is a well established discipline. In fact, its potential is always expanding due to increased innovation and implementation resulting from the general shortage of specialists, geographical realities and increased demand, among other factors, at high complexity health facilities. My country, Chile, suffers from this shortage and measures have been taken to address it.
But what is telemedicine? Most people probably think of it as someone sitting in front of a screen with a doctor or maybe a complex robot on the other end. The truth is that telemedicine is a much more extensive concept and refers to all the tools that allow and facilitate remote care to patients.
This means that a relationship between a doctor and their patient does not just have to be via a screen to be called telemedicine, if so, it would only be used to described video calls. In fact, that interaction leads to a series of needs that must be satisfied, especially by the Health IT industry. For example, ensuring that the care is recorded and linked to the patient’s health record, providing a medium by which to deliver and receive tests, and the storage of data that arises from care so that the information can then be managed. In other words it is necessary to deliver added value to communications and make the technology available to do this, without losing sight of the needs and definitions of the providers of the overall ‘teleprocess’, of course.
The search for and delivery of high quality standards for patient care and also the need to make sure that these services are part of other health activities, mean that administrators must quantify, standardize, identify and visualize them as an integrated whole.
So, if we agree upon the need for the integration of clinical activities provided by telemedicine, and the cost that this will imply, we must address the challenge and make it a reality to benefit both patients and general and specialist doctors with the clear objective of providing better quality, more effective and more efficient healthcare.
Still considering the concept of the ‘teleprocess’ – understood as the planning of care processes that involve telemedical action because of the specific characteristics of the situation – these tools should not just bring specialists closer to the most remote parts of the country (or ‘decentralize’ them), but they should also offer the possibility of managing and optimizing time, providing different channels of communication with patients: chat, video-calls, differentiated messages, text messages, etc.
This entire approach is aimed at supporting management of supply and demand as it would be idealistic to believe that the few specialists there are will have time on their schedules to attend all the patients that need them in real time. We must consider the the idea that in many cases telemedicine will be used to confirm diagnoses and this can easily be scheduled in a timely manner that satisfies demand and reduces waiting times.
In Chile the development of telemedicine is being implemented via the application of different tools, depending on the needs of each sector, and today the agenda of health authorities is aimed at extending and strengthening it, both in terms of coverage and complexity, to address – mainly – the shortage of specialists. There can be no doubt that in Chile this is an urgent and important need and thus is an issue that needs to be addressed with an innovative vision in its widest sense.
Telemedicine and Virtual Health
Telemedicine – and all the elements of diagnosis support and full and intensive use of communications technology – creates a space for learning, training and multi-directional communication which must be able to be used for different kinds of relationships: it would thus be useful to use the term Virtual Health to encompass the large number of challenges that telemedicine must face today.
For example, it would include communication between two or more doctors, and also between doctors and specialists; efforts to satisfy demand for care and to create educational spaces for common diagnoses and treatments; and communication between the patient and the doctor, known as Remote Patient Management, which makes it possible to monitor pathologies in patients with chronic conditions or those that require monitoring.
Finally, but just as importantly, Virtual Health can also incorporate communication between patients, making it possible to generate support and advice networks for different pathologies, creating a virtuous, horizontal and dynamic environment of socialization of information that can improve general levels of health and patient care.
