OpinionAbstract
Opinion
The term “Telemedicine” was first used in the 1970s, meaning
“healing at a distance. In fact, the use of this concept was mentioned
as early as in 1960’s. One such example was the provision
of telemedicine to astronauts on space missions in National
Aeronautics and Space Administration (NASA) [1]. Later in 1998,
World Health Organisation (WHO) adopted the description as “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”[2]. With the introduction of internet and
advance in technology, telemedicine has become more user-friendly
and many trials have been done to assess its effectiveness on health
care and its impact on patients and healthcare professionals. A
Cochrane database review on telemedicine was published in 2015,
including 93 trials and about 22000 patients [3].
Most of these studies were to provide monitoring of chronic
illnesses, treatment or rehabilitation, education and advice on selfmanagement,
real time assessment of clinical status, screening,
and specialist consultations for diagnosis and treatment decisions.
Regarding impact on health care outcomes, the review found that
telemedicine may improve glucose control in diabetics. Some
studies showed lower blood pressure in patients with hypertension
via monitoring of telemedicine, and some studies looked at the
effect of telemedicine on patients with mental health and substance
abuse problems and did not find any differences in the effect of
therapy given via video-conferencing when compared to face-toface
delivery. One study in 2017 showed that the evaluation time
by dermatologist was markedly shortened from 70 days to 0.5 day
after the use of tele dermatology [4]. As majority of patients in
primary care have chronic illnesses such as hypertension, diabetes
mellitus and mental health problems, the results from these studies
support the use of telemedicine in primary care. Not only could it
improve healthcare outcomes of those with chronic illnesses, but
it could also help to reduce referral rates and waiting time. Indeed,
telemedicine should be one of the ways for future development in
primary care if we have to manage the increasing volume of patients
due to the ageing population.
Due to COVID, many schools have been closed and their
teachings have been switched to web based. This also applies to
seminars, meetings, or overseas conferences for our healthcare
professionals. In fact, to our surprise, such online teachings via
Google meet, Zoom, Webinar have been welcome by many due to
lack of limitations due to geographical reasons and time saving in
travelling. In the past, the contingency plan, in case of bad weather,
would be to cancel the seminar or lecture. But now, the contingency
plan can be to convert to online teaching without wasting the effort
from the speaker or the organizing team. Using internet system for
direct video consultation between patient and doctor has certainly
marked its importance in healthcare provision. Future advanced
technology should focus on better electronic health record system,
data accuracy and information integration between patients and
our healthcare system. For instance, direct entry of their home
blood pressure or histix readings into their electronic clinical records, thus allowing doctor to easily monitor their control, would
be essential in enhancing the efficiency in primary care.
However, one must bear in mind that advanced technology
alone cannot improve the healthcare outcomes. The success of
telemedicine should comprise of careful planning in management
and well written protocols, with accurate reminders or prompting
for patient and health care providers so that timely intervention
can be carried out. In primary care settings, part of the therapeutic
effect would be based on the trustful relationship between the
family physician and the patient. So, one must not forget that
such relationship should be established professionally before
responsible telemedicine service is to take place [5]. As physicians,
we should also be aware of the ethical issues related to the use of
telemedicine such as personal data privacy and confidentiality. In
this current tough time, while we are all busy and tired in fighting
against the coronavirus, we, as healthcare professionals, must stay
positive and grasp each opportunity to learn and create new way to
care for our community.
Acknowledgement
None.
Conflict of Interest
None.
References
- History of telemedicine. Md Portal.
- WHO (1997) A health telematics policy in support of WHO’s Health-For-All strategy for global health development, report of the WHO group consultation on health telematics, 11-16 December, Geneva, 1007, Geneva, World Health Organisation, 1997.
- Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S, et al. (2015) Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 9: CD002098.
- Carter, Shauna Goldman, Kristen Anderson, Xiaxiao Li, Linda S Hynan, et al. (2017) Creation of an internal teledermatology Store-and-Forward System in an existing electronic health record. JAMA Dermatol 153(7): 644-650.
- Daniel H, Sulmasy LS (2015) Policy recommendations to guide the use of telemedicine in primary care settings: An American College of Physicians Position Paper. Ann Intern Med 163: 787-789.
