Since the start of the Covid 19 lock-down, which began for me on 23 March, I have had the need twice to talk to medical professionals about health matters – once to my GP and once to a specialist doctor. Both consultations took place on the phone. I realise that this was the beginning of my participation in telemedicine and it made me start to think about how this approach could be useful for older people, not only in the current pandemic, but also in the longer term.
Telehealth
This is the wider concept – it is defined by the Ministry of Health as “the use of information and communication technologies to deliver health care when patients and care providers are not in the same physical location.” Telemedicine includes telecare and telemedicine.
Telecare
This relates to technology that enables patients to maintain their independence and safety while remaining in their own homes. It includes mobile monitoring of vital signs – such as ECG or blood pressure (this may require patients to have their own recording devices but taking a pulse can be easy). Continuous remote monitoring of patients enables the tracking of fluctuation in the medical condition of an individual over time as well as highlighting alerts relating to real-time emergencies.
Telemedicine
Telemedicine, which is what I have been experiencing, involves remote doctor-patient consultations which can enable diagnoses and evaluation of patients; remotely prescribed treatments and medication (or alternations to medication). This may be done over the phone or through a video conference.
A number of different types of consultations can take place using telehealth, from initial assessments to multidisciplinary team meetings and arrangements for therapy/treatment appointments. In my case this involved referral for a radiological procedure.
Telemedicine can also mean two-way, real-time conferencing between providers. It can be used by a physician seeking a consultation from a specialist in another location; tests being forwarded between facilities for interpretation. Taken further, telemedicine could include robotic surgery occurring through remote access and physical therapy done via digital monitoring instruments with live feed.
What are the benefits?
- For patients: Faster access to care and shorter wait times, making consultations more convenient and reducing travel and transfers for older patients.
- Less time spent travelling for doctors; closer working relationship between specialists and primary care, allowing for accessible referrals and second opinions.
- Allied health workers: Rehabilitation and physiotherapy can take place via videoconference, meaning less time and budget spent on travel.
- As well as doctors and patients, patients’ family and whānau can be involved in a telehealth consultation. It is possible for a number of people to take part in video-conferences. For example, a consultant might be with a medical student at one site, while a patient, members of their whānau and a rural nurse specialist are at another site.
How does this relate to the Covid-19 Response?
It has been extremely important to continue to provide health services safely throughout the pandemic, especially for older people, and those who may be especially vulnerable. In the wider view this includes emphasis on the need to keep patient contact information up to date to facilitate contact tracing. A significant amount of information has been found to be missing or out of date.
The Ministry of Health has provided advice to health professionals and also to all users of health services. Uppermost has been the need to keep physical distance from each other as much as possible. This is where telehealth can come in. It provides a way of having an appointment with a doctor, practice nurse and other health providers without seeing them in person. It may involve emailing, texting or having a phone or, where possible, video communication where you can see your health provider and talk about your condition just as you would if you were in the same room. The benefits, in the Covid 19 situation, include:
- removing the risk of catching or spreading germs
- reducing time and costs involved with travelling to an appointment
- not having to leave the house when you are in lock-down or feeling unwell.
The main drawback is that the health professional will not be able to have a hands-on examination. But people can sometimes examine themselves or at least indicate the location of a problem. Sometimes a family member, friend or other health professional can help.
If the consultation is through a private healthcare facility, such as your family doctor/GP, you will be asked to pay for the health professional’s time. This will differ by health professional. I was charged a lesser fee than usual for the telephone consultation with my GP, and was told, in no uncertain terms, that I would be receiving a bill from the specialist.
There seems to be a lot more to say about telehealth for older people, so I will continue in my next blog post.
On Research 