COVID-19 pandemic has ravaged all realms of life. Healthcare workers around the country are under enormous pressure to provide the best possible patient care while also protecting their own and their family’s health. With limited resources, healthcare systems are scrambling to find solutions. Our daily existence is shrouded in terror and each day seems to bring terrible news than the last. So, how the healthcare community can find hope or even optimism in the face of this pandemic? Many new technologies will arise during this crisis, just as remarkable medical breakthroughs have evolved from wartime medicine.
Telemedicine is a rapidly growing service aimed at increasing access to the best quality, most efficient and cost-effective healthcare, especially amid the current COVID-19 epidemic. The Public Health Department, NASA, the defense department and department of health have committed time and money to telemedicine research in the 1960s and 1970s. The terms “telehealth” and “telemedicine,” while similar should not be used simultaneously. Telehealth is defined as “the use of telecommunication and information technology (IT) to enable distance access to medical diagnosis, intervention, consultations, supervision and information.” Over the last several decade’s technological advancements have dramatically increased the accessibility and quality of therapy available online. Despite this, telemedicine has struggled to achieve broad adoption due to rigorous regulatory requirements and a lack of acceptable payment structures.
Throughout this pandemic telemedicine has the ability to significantly increase patient access to high-quality, low-cost treatment while maintaining physical separation to keep both patients and doctors safe. Text, email and mobile phone applications, as well as data from wearable devices, can be used to transmit data between patients and doctors in addition to virtual encounters.
The technology transformed the way patients and doctors communicated health information as the eighteenth century progressed. The telegraph was utilised during the Civil War to send information about fatalities and to request medical assistance.
The National Aeronautics and Space Administration (NASA) made a substantial contribution to the creation of modern telemedicine. Physicians were able to monitor astronauts’ vital signs as well as perform exams and treatments while in orbit due to the necessity for medical care during space flight. Telemedicine has become a means of “advance triage” during the COVID-19 epidemic which is when patients are triaged before they visit an emergency department. On-demand telemedicine has become a popular option for people who are self-quarantined to be evaluated.
This approach of triage keeps healthcare workers protected while yet allowing them to provide patient-centred care. Telemedicine has been used to assess respiratory symptoms in people who may have COVID-19 infection which might be part of the virus’s first start. The use of telemedicine has had good impacts in the public health emergency allowing for the fast distribution of large numbers of healthcare workers and the services provided when local hospitals and healthcare facilities are unable to fulfil demand. During this deadly pandemic, telemedicine has been a method of distributing healthcare information to both infected and non-infected people. As a consequence of the greater use of the new telemedicine diagnosing approaches have arisen. Artificial logic flows often known as bots, can for example refer moderate and high-risk patients to nurse-staffed triage lines while also enabling virtual video consultations with physicians to avoid in-person contacts.
The main drawback of telemedicine is that with its growing technology is a lack of consumer understanding about its availability, services and cost. Many consumers are uninformed of the availability of telemedicine services or assume that their health system does not provide them. People in rural and suburban regions in particular are unfamiliar with the services. Moreover, many people who do not have access to essential healthcare may also be unable to use telemedicine. People who are older and live in distant regions and have less education and have more chronic diseases than their peers are less likely to have internet access as compared to their peers. The protection of customer health information is another concern when it comes to telemedicine and mobile health. This is a critical problem when it comes to the broad adoption of online healthcare services since people would be unwilling to utilise mobile health services if they seem unable to obtain or grasp privacy regulations. Furthermore, telemedicine is vulnerable to cybercriminal behaviour because of concerns about the security of sensitive health information exchanged online. Another issue about this is that of acceptability. Our country consists more of a poor and marginal class of people who still find traditional ways of Medicare and assistance to be more reliable because that involves face-to-face interaction with the doctor. Even people in the urban areas feel hesitant to rely on online solutions to consult a doctor and prefer online mediums. This mentality needs to modernize where there is higher acceptability of telemedicine and this norm is normalized. Because, at the time of pandemic when the entire world is halted due to lockdown, telemedicine appears to be the most feasible option out of all. This will be beneficial for both doctors and patients. Doctors can provide one-to-one assistance to COVID admitted patients and pay special attention to them. Patients suffering from any regular ailment can seek assistance through online mode through video consultation thereby saving the time of the doctor, maximizing his/her efforts and fulfilling the purpose of almost every set of patients.
ADOPTION AND REACH
Telemedicine can also provide easy medical access to patients who live in rural communities many miles from good health care. Telemedicine has been widely promoted in countries like the USA, UK, China and Australia. Even with the assistance of past outbreaks, telemedicine appeared to be a fruitful mode. On the other hand, one of the most tech-savvy countries, Italy, does not include telemedicine in the ambit of their National Health Service (NHS). However, they had to adopt this technology when an open call was made for telemedicine and monitoring systems technology proposal made by several authorities including World Health Organization (WHO). This shows that to date, there is a lack of reliance on this technology by till date by certain big countries. But this mindset is slowly changing and countries are willingly adopting this technology and legalizing this advancement in their home countries. Where it was acceptable pre-existing telemedicine law permitted primary care and hospital doctors to employ compensated teleconsultations instead of planned face-to-face consultations with known patients.
Many countries particularly those experiencing crises or outbreaks still lacks a framework that allows them to authorise, incorporate and reimburse telemedicine in their delivery for all patients. Patients can either rely on direct-to-customer telemedicine with private insurance payment corporations or reliance on free solutions through various platforms (like WhatsApp, Facebook, Skype) but they might not respect the national security and data privacy norms. Even though these systems may be beneficial in the early stages of a pandemic they are frequently segregated with national health care systems and do not share data with public health officials for monitoring.
A strategy is essential to swiftly establish telemedicine frameworks to utilise case scenarios, build clinical standards and standardise triage auto quiz and remote patient-monitoring systems for any epidemics on a local, national or global scale. The need of the hour is for a similar strategy and operational plan to guide health care professionals in switching to outpatient teleconsultations and increasing tele-expertise and remote patient monitoring.
A communication toolkit can be formulated by the authorities to educate and inform the authorities regarding telemedicine and its benefits. An efficient data sharing mechanism is required to collaborate telemedicine provider’s databases with that of epidemiological surveillance. Concrete research on telemedicine as a tool still needs to be conducted. Specific funds for research and development can be allocated to understand and assess the impact of telemedicine at times of outbreak.
Regarding the legal and ethical elements of telemedicine, there are numerous concerns. These include the health professional’s responsibilities and potential liabilities, the need to preserve patient records’ security and privacy, as well as the jurisdictional difficulties that arise with cross-border discussions. There’s also the question of compensation for care delivered via telemedicine. Telemedicine permits health information to be transmitted across national borders. Cross-border telemedicine services have begun especially in specialisations like teleradiology although problems of jurisdiction and registration remain unanswered. The implementation, integration and improvement of telemedicine require governments and healthcare organisations to develop rigorous policies, procedures and strategies.
Telemedicine cannot be the answer to all problems, but it can be very important in addressing a vast range of problems.  Telemedicine looks to be more important than ever with physician paucity on the rise our population growing and the current pandemic placing a burden on our healthcare system. When it comes to social distancing and reducing emergency room visits the benefits of telemedicine are obvious but limits to telemedicine services, such as difficulties with accessibility and service coverage prevent widespread use.
During the present pandemic, in the event of unforeseen outbreaks, all groups are recommended to work together to overcome the barriers and develop the safe and evidence-based use of telemedicine. The COVID-19 pandemic acts as a reminder to countries that have not yet completely incorporated telemedicine into their national healthcare systems to do so as soon as possible.
Author’s Name: Vartika Vaishnavi (NMIMS, Mumbai)
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