TeleMedicine and Integration of Medical Environment: What Services are Needed to Provide Quality Remote Care?

Given the current intensification of the COVID-19 pandemic, the topic of TeleMedicine is becoming highly relevant. According to Forrester, as of early 2020, only 24% of US healthcare organizations were providing virtual care services. In mid-April, due to the pandemic, the number of encounters via these services was predicted to escalate to over 1 billion by the end of the year (almost a 30-fold increase over the previous period). The validity of this forecast can be assessed by the real growth in the number of encounters via TeleMedicine services, as well as by their insurance coverage this year in no less than 38 US states.

As Laurie Bodenheimer, acting director for healthcare and insurance at the US OPM, emphasized in a press conference on October 14, 2020, “Carriers have been encouraged for both 2020 and 2021 to increase coverage for telehealth services, including waiving cost-sharing in response to the COVID-19 epidemic.” In other words, TeleMedicine is becoming a fairly demanded trend in various areas of health services.

TeleMedicine: what is it and what is it for?

Despite the fact that this technology has not been something new and unknown for a long time, TeleMedicine is often perceived rather superficially: merely as medical personnel serving clients via suitable telecommunication services. A forced measure taken to reduce the quantity of physical contact, as well as to accommodate restricted movement within the framework of national legislation.

However, TeleMedicine can be an effective solution in a variety of situations. It includes care for patients with disabilities, for those who live in rural and hard-to-reach areas, for those who may need urgent help at night (for example, patients with mental illness), for those who are constantly traveling for work or have difficulties with visits for family reasons. There are many more areas where TeleMedicine services are in higher demand than it seems at first glance.

Modern people have such a rhythm of life that it is often more profitable and easier for them to receive many medical services remotely, rather than through classical visits to the clinic. And this refers not only to consultations with specialists but also to diagnostic studies or remote urgent surgical interventions.

Besides, TeleMedicine makes it possible to significantly minimize the infrastructure of communication “clinic-doctor-patient” by:

• reducing the time of waiting for the required specialist,
• efficiently distributing the workload between available physicians who are geographically distant from each other,
• providing information about available diagnostic and treatment facilities,
• minimizing the costs for interaction between medical services and patients, etc.

This, in turn, improves the level of clients’ interaction with medical institutions, increases the quality and quantity of services provided, leads to an increase in the capitalization of companies, a decrease in their operating costs for maintaining the necessary infrastructure, and a reduction in logistic costs.

What services TeleMedicine unites today

The development of TeleMedicine and virtual care requires the integration of many systems that allow for guaranteeing the variety of medical services provided by medical centers and clinics to their patients.

The core of remote care organization is the work with electronic health records (EHRs) – a kind of personal database where information about the patient is accumulated in accordance with the developed algorithms. This allows an authorized specialist to have full online access to information about the patient’s medical history or previous treatment regimens.

The development of this service is mostly hindered by the following factors:

• fragmentation of personal data banks,
• difficulties with transferring information from one system to another,
• potential collisions of diagnostic centers’ software and individual devices with recording formats used by a clinic,
• HIPAA requirements.

An important step in the development of TeleMedicine services is the integration of existing video conference systems or, in exceptional cases, the development of the clinic’s own systems allowing the patient and the specialist to communicate remotely. Many people don’t see a problem in using popular video services (like ZOOM or Skype) to organize such communication as these services are often used for personal communication. However, they have big personal data safety and security issues.

Healthcare employees can either use ready-made HIPAA-certified communication platforms such as Twilio and Vonage or plan to develop and deploy autonomous platforms built into the EHR and compliant with security protocols. But their support, let alone Healthcare software development, often goes beyond the competence of medical companies’ staff.

Further, an important component of service in TeleMedicine software programs is their work with databases that store a lot of important information:

• lists of specialists with their competencies and current statuses,
• up-to-date lists of diagnostic facilities and laboratories,
• statistical data,
• legal base, and much more.

For the development of TeleMedicine services, the availability of up-to-date information about the attending physicians, their competencies and ratings, pharmacies and diagnostic centers closest to the patient, etc. can be a significant auxiliary option for increasing the efficiency of the tasks being solved. Therefore, the development and implementation of such databases is an important step for the creation of competitive services of any organization or company working in the field of healthcare, including TeleMedicine.

An important auxiliary service that provides a means for optimal use of current TeleMedicine services is the RTLS complex – real-time positioning systems. For example, they help to track information on the current location of the client and the possibility of handling a medical emergency, as well as the availability of appropriate free working diagnostic devices or competent specialists nearby.

In addition, these services help to:

1. identify patients and staff who may be susceptible to coronavirus infection by tracking contacts in real-time, putting them in remote assistance mode;
2. send information directly to the EHR without waiting for its manual update;
3. predict bursts of encounters with services based on collected statistics.

Setting up and maintaining such systems is an essential part of the high-quality healthcare services of the future.

A separate mention should be made for services that allow experienced specialists to carry out complex diagnostic studies and surgical interventions via remote communication through robotic systems. These services can be successfully used in TeleMedicine. For example, conducting surgical operations with devices using VR technologies. Or conducting teleradiological examinations of patients and sending data to experienced professionals practicing in various parts of the world.

Here, the effect of treatment is achieved through the introduction of modern communication protocols that make it possible to combine automated devices located in one place and specialists in another into a single system. In these cases, the actions of a specialist are simulated with the help of remote devices, which can be not only applied in cases of emergency surgical interventions but also used for video training of health workers and video consultations. In general, the introduction of such devices and systems is another important step towards the development of integrated TeleMedicine.

Finally, an important component of the TeleMedicine service organization is working with the capabilities of the Internet of Things (IoT): integrated devices allow taking a range of biometric data, such as heart rate, blood oxygenation, blood pressure, etc. For example, the kits developed by the American company Cue Health allow patients to independently diagnose the flu and certain inflammatory responses, determine the level of vitamin D, testosterone, and luteinizing hormone, and then send these results to the doctor via mobile application. Also, IoT technologies allow for remote monitoring of patients and transferring the observation results directly to the EHR for further processing, provided the EHR is integrated with medical devices.

Conclusion

In general, the combination of most of these services into a single system allows medical centers and clinics to remotely provide comprehensive integrated care. This gives the opportunity to improve the capabilities of organizing patient treatment regimens while accordingly minimizing time and logistical costs. Andersen, one of the leading medical software companies, has been in this market for a considerable time, so it has experienced specialists and solid practices to implement and support such solutions.