Telemedicine is the use of electronic communications and software by health care professionals to evaluate, diagnose, and treat patients at a distance. It includes a growing variety of applications and services using two-way video, e-mail, smartphones, wireless tools, and other forms of telecommunication technology. Patient consultations through video conferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education are all considered a part of telemedicine.
During the admission of a patient to a hospital, the patient along with the family members have to bear a lot of expenses like traveling, medicine, and the stay in the hospital till the treatment is completed. Telemedicine provides a means to reduce this expenditure by contacting the doctors through electronic devices from their current location. The doctors can schedule appointments that notify the patient and give guidelines along with additional advice like curbing obesity rate and tobacco use by encouraging them to improve their lifestyle choices. It ensures regular follow-ups, reporting early warning signs even if the patient is in any part of the world. Proper and remote monitoring of the patient can be done along with solving queries to ensure they are on track. When patients are committed to their own healthcare goals, it leads to lower costs and improved health. Some studies also reveal that telemedicine patients score lower for depression, anxiety, and stress and have 38% fewer hospital admissions. In a doctor’s clinic or hospital, there are a lot of chances of transmission of infections or diseases from patient to patient or patient to doctor. By telemedicine, the risk of exposure and infection transmission is reduced.
It is also beneficial for the doctors, especially the primary care ones, to contact specialists irrespective of their location and communicate easily for a second opinion and detailed advice. This benefit provides improved access and consultation for better treatment. Telemedicine comes into play in a clinic setup where the doctor has a lot of overhead expenses like buying a clinic or if rented then paying the rent to the owner, examination beds for patient’s checkup, the need of various types of equipment and staff members for managing the clinic. Through telemedicine, the doctors can reduce this extra cost by attending most of the patients online who do not require a physical approach. This aspect ensures increased patient flow and revenue to doctors and reduced transport expenditure to the patients making it beneficial for both the doctors and the patients.
During the scheduled appointment the patient can have any of their family members present with them. If the age of the patient is 16 years or less, or if the patient has some mental conditions like dementia or physical disability due to an accident, then any one of the authorized family members is required to consult the doctor on the patient’s behalf, irrespective of the patient’s presence. At the time of the virtual visit, the doctor must first ensure the consent of the patient before proceeding with the consultation. Then the patient has to provide the doctor with their medical record, enumerating their present condition and the current symptoms to proceed with the best treatment according to the doctor’s advice. The doctor should evaluate and make a decision regarding the preferable consultation medium. Like in cases of appendicitis complaint physical examination is needed and telemedicine cannot be applied. A complaint of headache or fever may not always require a physical examination or audio-visual approach. But in cases of any allergy or any inflammation like Conjunctivitis, the doctor has to decide if a physical or telemedicine approach is needed. During the telemedicine visit disrobing of the patient is mostly never preferred unless there’s an utmost need or in a case where the patient wants an examination of a visible finding concerning them. In such a situation the patient can click a photo of the visible finding and send it to the doctor for the diagnosis. In a telemedicine setup, the first doctor patient consultation need not be an in-person consultation and the doctors can be contacted by the patients from any state. The doctors giving teleconsultation must be a registered practitioner with a degree of MBBS and above. The displaying of their registration number during all the consultation is necessary especially in cases of emails, Whatsapp messages, prescriptions, and on fee receipts.
If the teleconsultation with the patient does not take place over video, then the doctor cannot prescribe any drugs to the patient other than common over-the-counter medications such as paracetamol, O.R.S. solutions, cough lozenges, etc.
Prescribing drugs for chronic diseases like asthma, diabetes, hypertension should be avoided in telemedicine consultation unless it is an addition to the earlier prescription of an in-person consultation of approximately less than six months ago. If a prescription is necessary then the teleconsultation should be done strictly via video. A prescription can be sent through any electronic medium such as email, Whatsapp as a photo, scan, or digital copy of a signed prescription or an e-prescription.
Telemedicine applications are used for delivering virtual health services from providers to patients. They include all-in-one software platforms to video chat and beyond some of which are widely in talks.
MD Live is an app that provides 24/7 access to doctors, dermatologists, psychiatrists, and counselors who are board-certified with an experience of 15years and above through a mobile app or an online website. Pieces of Advice for routine medical conditions like allergies, common cold, diarrhea, flu are given by well-trained physicians and treatment of depression, anxiety, eating disorders by psychiatrists.
Doctor on demand is being widely used especially in the United States to improve its healthcare system. The main advantage of this is it will reduce the waiting time of the patients who wait for almost 24days and above for the first appointment with the doctor and can connect face to face with doctors and specialists from multiple medical branches. It is free to join and payment is as per consultation which is proven to treat 90% of the common health issues.
Live Health ensures expert medical advice, diagnosis, treatment plans, and prescriptions along with the detailed profile of each doctor giving the choice to choose the doctor of one’s choice according to one’s needs with quite an affordable price.
Talkspace is known for its services to psychiatry and emotionally challenged patients. One can have unlimited talks and also send unlimited messages to your therapist within the privacy of your room and get one to two times messages reply per day. If one needs unlimited chats to get out of their rough times Sibly can also be one’s choice.
Teladoc is said to be ranked at the topmost for telemedicine services in Satisfaction and Customer Service with Direct by J.D. Power. It is also known to be working with 5% of the top-ranking medical specialists. It provides various services like everyday care, behavioral health, dermatology, nutrition, and women’s health doctors, integration with Apple HealthKit, e-Prescriptions, and video conferencing.
Fruit Street especially works on diabetic patients and patients aiming for weight loss. It notifies the patient at the start if they are fit for the program. It is a 12-week program with 26 video chat courses by a registered dietician. Along with the general services of telemedicine apps it has an additional feature of providing a free Fitbit for attending two classes.
Information and Communication Technologies has had a positive impact on the healthcare sector with the innovation of telemedicine in recent times. This impact is not only from a technology point of view but also from a socio-cultural and economic view. The reason lies upon various solutions of day to day challenges such as the demand for healthcare services, population aging, or management of large amounts of information. It is providing a convenient way to deliver and improve access to healthcare for non-emergency issues by saving time and money through online consultation. Thus, telemedicine technology is becoming a viable alternative to an in-person doctor visit.
Pratiksha Baliga, Youth Medical Journal 2020
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