The Rise of Telemedicine

The new type of coronavirus pandemic, which started in China in December 2019 and affected the whole world, is the milestone of a new era in many areas with the obligatory lifestyle change it causes. In a period when people had to lock themselves in their homes in order to be protected from the pandemic, human beings had to carry their social, political and economic activities to a new dimension. Many institutions and organizations sent their employees to their homes and employees continued their work online . Again, all universities suspended education and sent all their students to their homes. After a while, the necessary infrastructure was established and the decision was made to continue the trainings online and quickly implemented. Politicians held their meetings and interviews online . Finally, we spent a Ramadan feast away from our loved ones and celebrated the feast of our relatives and friends of our family elders online. It is possible to increase the examples and to list the changes in many different areas. However, as you will notice in the part so far, the word we used the most were the word “online”. This pandemic, which affects all layers of society so much both horizontally and vertically, inevitably caused in-field questions and profound changes in the field of health. Based on this, it can be easily said that this pandemic, which became a pandemic in a very short time, deeply affected the applications and systems of the healthcare. During this pandemic, the troubled situation and crisis in the health services made it necessary to develop new solutions and practices in the field of health. In this article, we will talk about distant health services and telemedicine as an online solution to current problems and problems that arise with the pandemic in the field of health.

In parallel with the rapid development of technology day by day; The field of health, which is one of the most important areas of use of technology in terms of human life, is trying to adapt itself to the needs of the period with new technologies by updating itself within this change and development. One of the pillars of these technological developments is undoubtedly communication technologies. With the rapid development and spread of communication technologies, access to the right information sources has become easier and it has been made possible to reach information available anywhere in the world at any time of the day. In this way, the technological developments that have taken place have normally led to the questioning of the classical patient-doctor communication and interaction and paved the way for the emergence of “online and distant” approaches as a method of patient-doctor interview. Telemedicine, whose origins can be traced back to the 19th century, took its modern form for the first time in the 1960s during military and space studies. The comprehensive realization, spread and adoption of telemedicine applications by the masses took place during the new type of coronavirus pandemic. During the pandemic, hospital health services were restricted to other patient groups due to the extraordinary situation and intensity of hospitals and the increase in hospital-related contamination. Telemedicine applications have become widespread in order to close the healthcare gap emerging due to these reasons and many healthcare professionals have started to serve on online platforms.

According to the definition adopted by the World Health Organization, telemedicine, which can be defined differently, is “the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities”. Let’s try to understand this definition, which seems a bit complicated at first glance, by examining it part by part. First, telemedicine is a form of healthcare service. However, the factor that distinguishes this healthcare service from the conventional hospital type is that there is a spatial distance between the healthcare professional and the patient. However, in telemedicine type healthcare services, this distance problem is overcome by the use of information and communication technologies. The scope of this healthcare service includes all parts of diagnosis, treatment, preventive medicine, research, evaluation and continuing education with the aim of improving the health of individuals and communities, as given in the definition above.

Telemedicine systems vary according to the type of application performed, the type of data to be processed, distance and temporal synchronization. Based on this, it can be said that telemedicine systems operate with three different mechanisms. In the first of these, “store and send” type technologies, previously collected patient information used in non-emergency situations is sent when requested. These types of technologies differ from other technologies, especially in that the patient and the doctor do not need to connect to the server simultaneously. It is frequently used in the fields of teleradiology, telepathology and teledermatology. Another type of “real-time applications” are applications in which sending and receiving information are simultaneously received by the receiver. Generally, when face-to-face consultation is required, it is performed by video conference method. In this type of application, interactive information is provided from patient to physician by using devices such as electronic stethoscope and video otoscope that can be attached to computers. Another type of application, “remote control”, allows the patient to be instantly controlled by the healthcare professional through the devices already attached to the patient. This type of application is rather used in the remote monitoring of critical patients and chronic patients in intensive care units. Wristband units, wireless monitoring devices and wireless glucometers etc. that record the patient’s vital signs in remote control type application. Instant patient information is accessed using many different technologies.

As mentioned before, telemedicine applications have been used for the first time in a modern sense in order to deliver effective healthcare services to places where access to healthcare professionals is limited. The most important of these places are rural areas, space stations and military units, which are isolated and remote from advanced health services and specialists. Later, telemedicine applications were used extensively in the follow-up of chronic patients from home without the need to come to the hospital. For example, these systems can be used in the follow-up of diabetic patients, COPD patients and chronic heart patients. Telemedicine systems eliminate the necessity of spatial and temporal coexistence between patients and healthcare professionals, providing many benefits. Undoubtedly, the most important of these benefits is saving from time and space. However, during the pandemic process that we have recently witnessed, in a situation where hospital conditions are not sufficient for the patients to benefit at the highest level, the benefit of telemedicine in providing effective access to healthcare professionals and patient follow-up is obvious. However, it is thought that telemedicine will make a significant contribution to the elimination of regional differences and inequalities in rural areas with limited access to advanced health services with the elimination of the spatial coexistence requirement. At the same time, telemedicine enables patients to be referred directly to the relevant service or unit without going through hospital emergencies through the remote triage method. Considering that hospital emergencies have a suitable ground for transmission during the pandemic period, it is of great importance to triage other patient groups without coming to an emergency room. Other benefits of telemedicine are the reduction of hospital expenses due to the remote monitoring of patients and the fact that the required patient information can be accessed at any time. One of the advantages of this system is that a specialist can be consulted anywhere in the world and at any time, due to the fact that patient information is in a virtual environment.

With what we have mentioned so far, we have talked about the importance of telemedicine and the benefits it will bring. However, there are some questions and problems that arise with telemedicine. The most important of these is the uncertainty regarding the reimbursement of these services under insurance. The fact that the legal regulations in this area are still insufficient abd this also prepares the ground for this problem. Likewise, the fact that the health professionals who will provide this service are still subject to a certain license is another problem. It can be predicted that this problem can be solved by the health professionals who will provide the service, taking various educational seminar courses and a specific licensing system. Another issue is that access to remote healthcare services requires various infrastructures such as internet and electricity. Although we have previously said that telemedicine health services will reduce regional disparities in access to advanced healthcare services, certain infrastructure services must be delivered to that region for this to happen.

As discussed throughout the article, telemedicine has serious advantages over conventional health services. Especially when considering pandemics or natural disasters, health services that can be provided remotely can provide health services to the required places very quickly and effectively.

Dr. Cihan GOKDEMIR

References:

1- Hollander JE, Carr BG. Virtually Perfect? Telemedicine for Covid-19. N Engl J Med. 2020;382(18):1679‐1681. doi:10.1056/NEJMp2003539

2-Joshi AU, Randolph FT, Chang AM, et al. Impact of Emergency Department Tele-intake on Left Without Being Seen and Throughput Metrics. Acad Emerg Med. 2020;27(2):139‐147. doi:10.1111/acem.13890

3-Lurie N, Carr BG. The Role of Telehealth in the Medical Response to Disasters. JAMA Intern Med. 2018;178(6):745‐746. doi:10.1001/jamainternmed.2018.1314

4- Hasan Aydın ,Telemedicine, http://www.diabetcemiyeti.org/var/cdn/f/4/hasan-aydin.pdf 

Erişim tarihi: 14.06.2020

5-Sibel Ertek, Endokrinolojide Tele-Sağlık ve Tele-Tıp Uygulamaları,Acıbadem Üniversitesi Sağlık Bilimleri Dergisi Cilt: 2  Sayı: 3  Temmuz 2011

6-WHO,Telemedicine, Global Observatory for eHealth series – Volume 2, https://www.who.int/goe/publications/goe_telemedicine_2010.pdf

Erişim tarihi; 14.06.2020