TELEMEDICINE
History of telemedicine
The origin of telemedicine is indissolubly-related to telecommunications; i.e., sending
information over long distances by means of electromagnetic signals. The arrival of
the telegraph at the beginning of the 19th century allowed for communication over long distances. The telegraph was used by
telemedicine in military scenarios as a result of its transmission speed. The telegraph
was used during the Civil War, in the United States, to ask for medical supplies,
and to report deaths and injured soldiers on the battlefield. It seems likely that
the telegraph could have also been used to ask for medical advice.
By the end of the 19th century, Bell patented the telephone, but it was not until the early 20th century that ordinary people could gain access to it on a massive scale. Back then,
doctors and patients could talk directly on the phone. Medical providers could also
speak on the phone with other physicians in order to ask for their expert opinion
or to exchange information.
The first notion of telemedicine - as we know it today — was introduced in a Radio
News Magazine edition from April 1924, which featured a futuristic illustration of
a machine with a microphone and a television, which enabled patients to get in touch
with their doctors. The device also included the use of temperature and heartbeat
indicators. However, the first uses of telemedicine to broadcast videos, images, and
complex medical data occurred in the late 1950s and in the early 1960s. In 1959, the
University of Nebraska used interactive telemedicine to broadcast neurological exams.
Such technology was originally developed to connect patients living in remote areas
with physicians residing in urban areas.
Radiology was the first branch of healthcare to fully embrace telemedicine with the
purpose of digitally broadcasting radiological images. Over the 1960s and 1970s, telemedicine
was strongly boosted thanks to NASA research programs, since astronauts were not able
to travel with a doctor by their side.
With the Internet booming, in the 1990s, there was an outburst of information. There
was a true revolution in telemedicine that included patient education, broadcast of
medical imaging, real-time audio and video medical consultations, and vital sign measurements.
An overview of telemedicine
After having reviewed the report on mHealth, the 71st World Health Assembly urges member states:
To assess their use of digital technologies for health, particularly in health information
systems in the national and subnational levels, in order to identify areas of improvement,
and to prioritize, when appropriate, the development, evaluation, implementation,
extensions, and greater use of digital technologies, as a mean to promote fair, affordable,
and universal access to health for everyone, as well as the special needs of groups
that are vulnerable in the context of digital health;
To consider, when appropriate, how digital technologies could be integrated into existing
health system infrastructures and regulations, to reinforce national and global health
priorities by optimizing existing platforms and services, to promote people-centered
health and disease prevention, and in order to reduce the burden on health systems;
To optimize the use of resources by means of developing health services alongside
the application and use of digital technologies in health systems development and
reforms;
To identify priority areas where normative guidance, technical assistance and advice
on digital health would be beneficial, including, but not limited to: gaps in research,
evidence-based standards, implementation and extension support, funding and business
models, content, evaluation, cost-effectiveness and sustainability, data security,
ethical and legal issues, the re-use and adaptation of existing digital health tools
and other relevant ones as well;
To work towards and support the compatibility of digital technologies for health by,
among other options, promoting the use of international and open standards as an affordable,
effective and easily adaptable solution;
To spread, when appropriate, the best practices and successful examples of digital
health architecture, programs, and services, in particular effective policy designs
and practical implementations, among the international community, including through
WHO, bilateral, regional, cross-regional and global networks, digital platforms and
hubs;
To strengthen public health resilience and to promote opportunities, when appropriate,
through the use of digital technologies, which includes improving access to, and monitoring,
sharing and the use of, quality data, direct citizen, health care workers and government
engagement, and to build the capacity for rapid response to disease incidents and
public health emergencies, leveraging the potential of digital information and communication
technology to enable multidirectional communications, feedback loops and data-driven
“adaptive management”;
To build, especially through digital means, capacity for human resources in digital
health, when appropriate, across both the health and the technology segments, and
to communicate areas of specific need to the WHO in order to receive appropriate technical
assistance;
To improve the digital skills of all citizens, in particular by working with the civil
society to build public trust and support for digital health solutions, and to promote
the enforcement of digital health technology in benefit of, and with access to, everyday
health services;
To develop, when appropriate, the legislation and/or data protection policies around
issues such as data access, sharing, consent, security, privacy, compatibility and
inclusivity consistent with international human rights obligations and to communicate
these on a voluntary basis to the WHO;
To develop, when appropriate, and in coordination with existing and emerging regional
hubs and support mechanisms, effective partnerships with stakeholders from across
all sectors in the use of digital health[1 ].
Current legal framework applicable to the telematic activity in Argentina
A study performed by the Argentina’s Ministry of Health, in 2015, about the distribution
of physicians in Argentina described that, in spite of the fact that our country has
a number of physicians per capita comparable with central countries, the distribution
of physicians is highly unequal[2 ].
Telehealth is a broader concept, which entails managing public health, medicine, health
education and research. Such management is issued by communication and information
technologies[3 ].
As a result of the pandemic it was held that “telecare and/or teleconsultation” were
to be interpreted as any remote consulting and/or assistance service by means of suitable
technologies which guarantee service provision in a timely manner and subject to proper
quality conditions, thus ensuring the prompt intervention in a health crisis context.
Current applications of telemedicine
Reality and problems before and after the pandemic in Argentina’s telemedicine has
shown a reduction in the number of people going to hospitals and emergency rooms in
person, and in the costs, which result from such visits. The remote monitoring of
patients reduces the number of unnecessary visits to hospitals and enhances communication
among healthcare professionals, in addition to defining new roles of “experts in telemedicine”.
Not only do these advantages impact on patients and on their caregivers, but they
also impact on healthcare professionals and on management.
However, in spite of its potential advantages, it was slowly implemented before the
COVID-19 pandemic, and it has found many “barriers” on its way. In order to understand
this topic, it is necessary to analyze the standpoint of each “participant” that takes
player” part in a telemedicine program.
There are only a few assignments that assess the opinions of healthcare professionals
about the drawbacks they find in telemedicine, even though they all agree on the excessive
workload as the main hindrance to overcome[4 ]. There are also some difficulties related to health funders issues to acknowledge
the health services delivered, to invoicing the services rendered, and thus to the
resulting loss of earnings, and the request of tests by these means.
The COVID-19 pandemic has introduced many necessary changes in the healthcare system,
and telemedicine is one of the most important tools for communication, patient care,
organization of virus testing scenarios, and patient isolation, expert consensus meetings,
education and training, in relation to this serious situation that is affecting the
entire world.
Healthcare professionals implemented such technology over the last few months as an
essential tool for daily work, but it is highly probable that it may be here to stay
in society as a big contribution to the current situation and face a future condition
that may entail significant changes.
Patients had to learn to use this tool as their sole option to gain access to an outpatient
consultation system during confinement. Patients started to adapt, and adhere, to
the tool. The physician and his or her team prescribe a treatment to their patients,
and they will have to suggest this key tool to improve remote follow-up and adherence[5 ]-[7 ]. The benefits of ongoing communication need to be explained in detail to the patients.
The studies conducted came to the conclusion that telemedicine is more profitable
than standard care, and that patients are less satisfied with the doctor-patient relationship
(DPR)[6 ],[7 ].
It is particularly important to provide patients with support when they start using
TM, because TM is obviously different than traditional care in person. The first teleconsulting
appointments will be the hardest to accept, until the appointment and monitoring paradigms
change.
Informing patients of the benefits of this tool, where patients do not need to spend
any waiting time for their medical appointments or pay for any travel allowances and
sustain any loss of earnings in order to dismiss any doubts or to find solutions to
any short-term treatment disadvantages.
There are TM implementation helpers. Evidence-based medicine states that patients
with amyotrophic lateral sclerosis (ALS) and their caregivers and/or families show
a positive attitude toward the use of telehealth[6 ],[7 ]. This may be the result of the benefits obtained by patients (for example, a better
qualification sense, a reduction in trip frequency and clinic load), and of good fulfillment
with the use of TM (that is to say, easy-to-use devices, feeling comfortable with
using technology, and providing caregivers with assistance). A positive attitude towards
patients and caregivers acts as an implementation facilitator, because it increases
system acceptance and positively impacts on the attitude of healthcare professionals.
There are some barriers to the implementation of TM. Some studies suggest that healthcare
professionals have a more negative attitude towards telehealth, in spite of the fact
that they have a positive outlook on communication through this tool. Most healthcare
professionals reported barriers such as technical problems, lack of contact to make
physical examinations, and problems with performing comprehensive medical evaluations.
A negative attitude by healthcare professionals generates resistance to the system.
This is something that has become a barrier when it comes to the application of implementing
TM.
There are two very important telehealth implementation facilitators, which have positively
influenced users’ attitude: training and continuous support. Customizing telehealth
encourages patient involvement and it demands adjusting the monitoring frequency,
scheduling visits with the treatment team, and providing care and information.
It is highly important that the healthcare team gets ready for telemedicine in order
to enhance remote monitoring and the usage of monitoring data for research purposes.
Standardized outcome measures (SOMs) must be set, and patients must take part in deciding
which are the relevant measures[8 ],[9 ]. In order to create healthcare teams in the field of telemedicine, it is necessary
to reassign staff roles, increase the statistics and follow-up of patients’ safety,
and to make the companies, which provide treatments with positive pressure devices
to get involved.
Telemedicine and sleep apnea
Obstructive sleep apneas (OSAs) are characterized by repetitive episodes of apnea-hypopnea
caused by a collapse of the pharynx during sleep, causing desaturations and arousals.
As these events become associated with a series of signs and symptoms, they amount
to an obstructive sleep apnea-hypopnea syndrome (OSAHS)[10 ]. Nevertheless, a significant number of patients with OSA do not necessarily show
any symptoms. Sleep apnea is a pathology with mortality and mainly cardiometabolic
comorbidity. Mortality and life quality reduction are positively affected by the treatment
with CPAP devices (positive airway pressure)[11 ],[12 ].
The use of this technological resource provides for:
Sleep medicine uses the exchange of data with patients in order to better manage the
disease. Data are conveyed over the Internet or over smartphones with specific applications
considering the availability of feedback with the patient using the same resources.
Telemedicine (TM) is useful for sleep apneas in all respects: from its detection to
its treatment compliance by means of:
Remote polysomnography/polygraph tests subject to occasional distant controls by a
technician;
Doctor-patient consultation;
Training on the use of devices for videoconference purposes;
Remote CPAP titration;
Video conference follow-up and compliance monitoring.
Telediagnosis
The main goal is to obtain good quality records outside the sleep lab, to avoid long
waiting lists at laboratories[13 ].
Polygraph tests (RP): the use of home-based devices allowing for deferred data transmission
is a possibility. Borsini et al. (2016)[14 ] showed a 4 to 12% failure rate and the need for lab tests. This has shown that it
is possible to deploy a decentralization strategy and to receive data promptly after
recording. Always keeping in mind that type III studies, as RPs have a 64 to 100%
sensitivity and a 41 to 100% specificity. Depending on the device, these features
will enable us to set limitations to the method[15 ].
Polysomnography (PSG) tests may be performed in patients’ homes or in any remote area,
and they involve continuous or intermittent monitoring. Gagnadoux et al. (2002)[16 ] performed a remote monitoring test in the care sector of peripheral hospitals and
in patients’ homes by providing the nursing staff with training to correct any sensor
placement mistakes. The fault percentage ranged from 11% to 23%, the latter pertaining
to studies performed at home, and that therefore, they may be less monitored studies.
A work group in Belgium performed PSG tests with a device that had been specifically
designed for telematic broadcasting purposes, added to the polysomnograph in order
to transfer records to the sleep lab where technicians remotely monitor the tests.
They communicate with patients via Skype to correct the position of any sensors, which
may have shifted from their proper recording position. The SLEEP box device and the
contact thru Skype made it possible to obtain 90% of good-quality signals[15 ].
In a (maybe) near future, home-based polysomnography and polygraphy devices through
telematic data transmission will be used, as well as smartphone-based breathing and
environmental sensors, records of data collecting devices which gather information
over several days, and contactless data transmission devices[16 ],[17 ],[18 ] ([Figure 1 ]).
Figure 1 OSA Telediagnosis Flowchart. OSA: obstructive sleep apnea, PSG: polysomnography,
RP: respiratory polygraphy, ORL: otorhinolaryngology, CPAP: continuous positive airway
pressure, MAD: mandibular advancement device.
Teleconsultation
Teleconsultation is a useful tool to explain the diagnosis and therapy follow-up of
patients who have recently been evaluated over the Internet or by video conference
call.
As it arises out of the work performed by Coma-del-Corral et al. (2013)[19 ], the adherence to therapy had no significant differences in patients with a confirmed
diagnosis who held a personal interview, as opposed to patients evaluated through
teleconsulting, following the way of diagnostic information to CPAP titration.
Treatment with CPAP devices
Beginning of the treatment with telemonitored CPAP
The first step in the treatment segment would consist of providing training on the
device features, on the right use of the interface; and on how to use and manage the
thermal humidifier, if it was prescribed to the patient. This telematic procedure
could be supported by surveys addressed to patients in order to assess the patients’
level of understanding and the need to reevaluate actions.
An assignment describes remote CPAP titration by means of a telemetry unit on the
CPAP device, which would prevent any probable calibration failures[19 ]. Remote calibration testing has not been set for the devices available to us[20 ], except in delayed mode. See [Table 1 ] steps in the use of telemedicine in sleep-related breathing disorders and treatment
with positive airway pressure devices.
Table 1
Steps in the use of telemedicine in sleep-related breathing disorders and treatment
with positive airway pressure devices.
Teleconsultation (First visit Follow-up)
The Epworth Sleepiness Scale, the STOP-BANG Questionnaire, and the Berlin Questionnaire
are to be filled out by patients and uploaded to the platform. They may be sent before
the teleconsultation session so that they are available during the first video visit.
Neumonology TM Template: set on the teleconsultation platform.
Telediagnosis
Polygraphy (PR) tests conducted at patients’ homes and compressed data transmission
by staff trained on data management for uploading purposes on a central server or
platform to count on the studies for processing purposes. The file storage system
is available even on different polygraphy devices. Patients will be able to receive
a video that shows how to use the device to simplify its placement.
Polysomnography (PSG) may be conducted as out-of-laboratory tests, and up to this
date, there are no devices featured to transfer data on line. Two different suggestions
can be made, as with PR tests: In the first place, remote recording demands that a
technician place the sensors. Data collection may be performed on the following day.
The data collected is zipped and sent to the platform. Another option to consider
is to use an online centralized control with both computers being connected thru Team
Viewer, which enables remote access to the record-taking and monitoring screen. A
simple call can indicate anybody accompanying the patient how to correct any sensor
positions[30 ].
CPAP Telecalibration
A calibration study can be performed in any patient's home after having conducted
the relevant training in person or by video visit and delivery of the devices to the
patients to be used over 3 nights and according to each Laboratory's indications.
The use of devices such as the Airsense (Resmed) or the Dreamstation (Philips -Respironics)
provides access by means of specific software solutions, which allow for the assessment
of cloud data or through a special segment for data transmission. Therefore, this
allows access to fulfillment, pressures, and leak levels throughout the time of calibration.
It would be ideal to access the data obtained from the cable-download monitoring devices
or card-monitoring devices, which could be informed by the very patient by file transfer—via
e-mail, for instance—to be thereafter downloaded to be interpreted in the Sleep Lab.
In the latter case, were it not possible on these devices, the patient attendance
in person would be required.
Telemonitoring
As it has been described in the previous section, 30, 60, and 90-day monitoring may
be performed on the basis of the usual recommendations. At this point, it is worth
stating that a personal visit may be scheduled, depending on the patients’ needs,
and on the patients’ relationship with the relevant device and interfaces. Notifications
may also be scheduled from the platform to be sent by e-mail or phone applications
with consistent reminders on the use of the device in order to improve adherence,
considering the possibility of separating patients with adaptation difficulties as
opposed to those who can easily adapt.
Telemonitored assessments may proactively contribute in the early detection of any
adaptability difficulties.
Tools for patients
Medical device suppliers have designed specific applications for patients: My Air
(Resmed) and Dream Mapper (Philips) would improve adaptability parameters if available,
and provided that patients were able to use them.
Provide for the access of patients to the platform so that they may upload or transfer
their compliance data.
Data
It must be possible to store:
1. Questionnaires: Epworth - Berlin - STOP-BANG
2. PR and PSG with zip data in the platform or in a related server with access to
the studies performed by means of each operator’s password
3. Spreadsheets that show data obtained from the results of studies and calibration
data with breakdown to be specified
4. Access to the data spreadsheets to export them and create bases for research developments.
Treatment follow-up
It is worth remembering the definition of adherence to therapy: 4 hours of nightly
CPAP usage for 70% of the nights is considered adequate adherence to therapy. However,
CPAP use above 6 hours/night contributed in reducing blood pressure and drowsiness[21 ].
The early implementation of telematics strategies may be of essence for patient care
and adjustment and such strategies currently allow for device programming.
The considerations to be evaluated are: adaptability and adherence, leaks, residual
apnea index, and effective pressure. It has been found in studies assessing CPAP use
for less than 4 hours per night or with leaks exceeding 0.5l/sec., telemonitoring
outweighed traditional monitoring to restore efficient use time parameters[22 ] ([Figure 2 ]).
Figure 2 Commencement of OSA Treatment and Follow-Up Flowchart. CPAP: continuous positive
airway pressure, PSG: polysomnography, RP: respiratory polygraphy, AHI: apnea hypopnea
index.
It is also interesting that telemonitoring has further reduced the time for a first
intervention by improving adherence in a short period of 3 weeks (5.7 as opposed to
4.2h/night). In that aspect, it is essential to have access to the data in order to
be able to properly monitor compliance by patients with any difficulties to adapt
over short periods of time and in the long term, and those patients who have easily
adapted may be monitored with more time available[23 ].
The repeated educational incentive by messages sent by email on days 1, 7, 14, 30,
and 90 as opposed to a communication on the phone after 90 days derived in differences
in the adherence to the CPAP therapy[24 ].
Mobile phone apps provide patients with information on the daily use and patients
may therefore access the information on the use of their device. The Spanish sleep
group (Grupo Español de Sueño ) has recently developed the Appnea-Q app, which generates questions (a total of 10), combining different aspects of treatment:
CPAP use and effectiveness, common unfavorable effects, general topics such as: exercise,
diet, and weight assessment. Patients receive tips, and encouraging messages[25 ],[26 ].
Telemedicine and hypoventilation syndromes
Telemedicine for monitoring patients with non-invasive ventilation (NIV) support
Telemedicine in patients with alveolar hypoventilation subject to home-based non-invasive
mechanical ventilation demands monitoring efficiency and adherence in non-dependent
patients. In the case of dependent patients, teleassistance is additionally required
for ventilation start-up, optimization of mechanical ventilation, and telesurveillance.
When we reviewed evidence-based telemedicine and its impact on respiratory diseases,
we found randomized controlled clinical trials, as the trail performed by Pedone et
al. (2013)[27 ] which showed a drop in exacerbations and hospitalizations in older adult patients
with COPD, using a multiparameter monitor by means of a cell phone with (SaO2 , FC, T°ax) measurement.
Johnston et al. (2013)[28 ] found a reduction in COPD severe exacerbations by using a software for the smart
reporting of symptoms by telephone. Halpin et al. (2011)[29 ] performed a randomized controlled trial of the effect of the automated interactive
calls, combined with a health risk prognosis on the frequency and harshness of exacerbations
in patients with clinically assessed COPD and using the EXACT PRO questionnaire.
Borel et a. (2015)[30 ] showed that the software data from the NIV device could predict the onset of an
exacerbation of COPD. They have also proved that the changes in the respiratory frequency
and in the percentage of activated breathing transmitted via wireless connectivity
were related to the onset of exacerbations in COPD.
In the context of the studies performed and pulmonary rehabilitation programs required
to optimize NIV, we found that as per Marina et al. (2018)[31 ], telemedicine represents a useful cost-effective tool, whose quality and effectiveness
have been verified over time to perform quality telespirometry tests where considered
necessary (distant healthcare centers without a specialist or in the patient’s home).
As regards the pulmonary tele-rehabilitation (PTR) of patients with COPD, Hansen et
al. (2020)[32 ] proved that the PTR did not outweigh the conventional pulmonary rehabilitation (CPR)
in the 6-minute march test, and they did not find any differences among the groups,
or as to the respiratory symptoms or life quality or physical activity or muscle function
of lower limbs in patients with COPD and forced expiratory volume (FEV)1 <50% in outpatients for day care facilities.
According to Paganoni et al. (2019)[33 ], video televisits are possible visits, and they may be a useful tool to supplement
the multidisciplinary care of patients with amyotrophic lateral sclerosis on non-invasive
mechanical ventilation during sleep, video televisits provide considerable savings
in adjusted costs for patients and institutions. Pinto et al. (2010)[34 ] has managed to telemonitor the ventilators’ graphics in patients with amyotrophic
lateral sclerosis, and to remotely modify the parameters, thus showing a reduction
in the number of admissions to hospitals due to exacerbations and equal clinical progress.
Fernández-Granero et al. (2015)[35 ] found that 75.8% of exacerbations in patients with COPD were early diagnosed by
using an electronic stethoscope, which transfers auscultation sounds 5±1.9 days before
the actual medical care, in average.
A study performed by Mansell et al. (2018)[9 ] showed the optimization of non-invasive mechanical ventilation. The information
concerning Tv (tidal volume), leak, FR respiratory rate, MV (minute ventilation),
patient-triggered respirations, pressures reached, and patient’s adherence to therapy
was downloaded via telemedicine and cards. Telemonitoring proved higher adherence
and hours of ventilator use. The use of ventilator data downloading helped an early
and objective assessment of the leaks and changes in ventilator parameters.
Through teleconsultation and telemonitoring, together with interrogation, questionnaires
and oximetry, they allow to start non-invasive ventilation, optimize it, achieve adherence
and carry out its follow-up monitoring ([Figure 3 ]).
Figure 3 Telemedicine Flowchart for Non-Invasive Ventilation Support. NIV: noninvasive ventilation,
AHI: apnea hypopnea index, RF: respiratory frequency, Vol: volume, hs: hours.
The data obtained from the software of non-invasive mechanical ventilators are stored
in smart cards or they may be read on the cloud through telemedicine. For instance,
the apnea-hypopnea index recorded by the ventilator is safe and useful in order to
optimize remote patient ventilation[36 ],[37 ].
The parameters set out below are the most widely used data downloaded via telemedicine
or card to optimize home non-invasive mechanical ventilation:
Tidal volume;
Respiratory rate;
Leaks due to inadequate interfaces or pressurization failure;
Individual adherence with home NIV (residual AHI, average use hours per night, and
leak);
% of ventilator triggering by the patient.
The objectives for patients in NIV
There are clinical improvement and reduction in daily PCO2 , SatO2 >90% 90% of time, minimal fluctuations in SatO2 , monitoring in the NIV cloud, adherence, and fragmentation of ventilator use.
When these objectives are achieved, it is decided to continue with the same NIV parameters,
otherwise unintentional leaks by the clinic in telemonitoring or data in the cloud
must be ruled out.
When there instability in the airway, an increase in EPAP is indicated, when suspected
persistent night hypoventilation PCO2 or tidal PtcCO2 , increase in IPAP or tidal volume and when there is suspicion of asynchronies and/or
central events we indicate a polysomnography[38 ] ([Figure 4 ]).
Figure 4 Optimization Flowchart. PCO2: partial pressure of carbon dioxide, SatO2: arterial
oxygen saturation, NIV: noninvasive ventilation, PtcCO2: transcutaneous carbon dioxide
pressure, EPAP: positive pressure in the airway at the end of expiration, IPAP: positive
inspiratory pressure in the airway, PSG: polysomnography.
It is highly important that these diagnoses, adherence to therapy, follow-up, and
telesurveillance parameters may be monitored and recorded by using telemedicine.
BMI, Epworth daytime sleepiness scale, life quality questionnaire, and respiratory
insufficiency questionnaire (SRI);
Blood gases, end-tidal CO2 capnography, and transcutaneous pressure of CO2 ;
Sleep study: AHI, oximetry (T90), IDO - I, II, III, and REM sleep phases;
Interfaces: nasal, oronasal, total face, nasal pads, oral and mouthpiece;
CPAP: pressure, autoCPAP: maximum and minimum pressure;
NIV: modes S, S/T, PC, AVAPS. Parameters: IPAP, EPAP, RF, Tv, inspiration time (I/T),
OXY monitoring, end tidal CO2 , PtCO2 ;
Leak, res AHI, Hs use/night, E Tv, inspiratory flow.
DISCUSSION
According to the Pan American Health Organization (PAHO), it is estimated that one
out of four individuals in America suffer from a non-communicable disease (NCD), including
cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases, which
are the leading causes of death and disability in the world[39 ].
Pursuant to recent surveys conducted by the World Health Organization-Pan American
Health Organization (WHO-PAHO), from 31 to 53% of the NCD treatment services have
been suspended - in whole or in part - in America, while primary healthcare services,
which address 80% of health needs have been reduced by 20 to 30%.
In addition to that, 60% of diagnostic and medical practices have been canceled. On
the basis of such data, the need arises to implement new innovative healthcare system
models, which need to be explored in order to provide for uninterrupted medical care,
including telemedicine, thus reducing stress in healthcare provision facilities.
The use of telemedicine technologies is a way to ensure the timely provision of medical
services based on proper quality conditions. Within the framework of the current circumstances,
healthcare professionals have no choice but to retrain on digital health in record
time.
Telematic channels started to be used before the pandemic; however, the mobility crisis
triggered by the pandemic clearly caused such channels to be used on a regular basis.
The access mechanisms, the type and quality of communication, and the reconversion
to person-to-person appointments, under specific circumstances must be ensured. Furthermore,
from the legal standpoint, as any medical services, virtual medical appointments must
be registered. Accordingly, follow-up mechanisms must be ensured and written indications
and must be sent.
It is specifically with respect to sleep medicine that telemedicine developments enable
access to diagnosis and treatment control, and the latter is a key option in performing
the follow-up of home-ventilated patients. Based on the advantage that telemedicine
had been developed prior to the health crisis, the pandemic provided for a faster
and smoother implementation of telemedicine than in other medical areas.
Patients face many difficulties, such as long distance traveling, workload, loss of
earnings, board and lodging costs, and family organization issues, among other factors,
in order to be able to arrange medical appointments[40 ],[41 ].
In addition to those hindrances, there are other key advantages consisting in evading
reduced mobility difficulties caused by disabling diseases. Confinement scenarios
have currently extended such circumstances to the people at large, which have clearly
benefited from a telematic access to non-urgent medical care.
Another important aspect that is worth mentioning, as far as medical practice is concerned,
is the organization of the remuneration system by healthcare providers - in the particular
case of private medical care providers -, which should have modified the payment for
teleconsulting, drug and test prescriptions.
Data confidentiality and access to e-files must also be strictly monitored, and access
codes must be generated for healthcare professionals at all times.
