Sign Up
For the best experience, choose your profession & state.
You are not currently logged in. Please log in to CEUfast to enable the course progress and auto resume features.

Course Library

Telemedicine

2 Contact Hours
CEUfast OwlGet one year unlimited nursing CEUs $39Sign up now
This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Nursing Student, Registered Nurse (RN)
This course will be updated or discontinued on or before Monday, January 4, 2027

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


Outcomes

≥ 92% of participants will understand the role of telemedicine in modern medical care.

Objectives

After completing this continuing education course, the participants will be able to meet the following objectives:

  1. Define telemedicine.
  2. Describe the different protocols of telemedicine within telemedicine systems, telemedicine specialty care, telemedicine consultation centers, and telemedicine care delivery packages.
  3. Explain how telemedicine works between the care provider, through the network, and to the patient.
  4. Identify the advantages of integrating technology with medicine while adopting the product as a method of healthcare delivery.
  5. Compare and contrast the general merits and demerits of telemedicine in disease prevention, patient monitoring, health communication, and public health.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Last Updated:
To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Jassin Jouria (MD)

Introduction

Modern technological advancement has massively increased its influence across the different facets of life as we know it. From the production market, to finance, retail, entertainment, and medicine, labor-intensive manual processes required for repetitive procedures are now replaced with robotics and other latest inventions of technology. In medicine, the narrative is arguably nobler. Advanced two-way audiovisual communications systems have revolutionized the primitives of medical care. This concept, referred to as Telemedicine, involves the delivery of healthcare protocols including surgery, consultation, and counseling across long distances via remote electronic interfaces.

By offering a technology-based virtual platform, telemedicine has been demonstrated to improve the reach of modern medicine by remodeling the processes involved in diagnosis, radiological imaging, consultation, laboratory investigations, psychiatry care, addictions therapy, and disease prevention. Not only does telemedicine provide expert care in rural communities, but it also reduces the frequency of in-person hospital visit, optimize the index of care delivery and provide precision-driven medical care in terminal illnesses. This course is designed to examine the protocols of telemedicine as a healthcare delivery option, with a direct focus on its potential and its role in furthering the objective of modern healthcare delivery. It also provides a succinct view of the operational principles of the telehealth packages while recommending different plans for the implementation of telemedicine as a care protocol across the globe.

Case Study

Mowat Al-Firsan resides in the suburbs of Andoabat, a relatively busy city in the Southern part of Egypt. As a country man, Mowat, a 75-year-old male, had traveled around the country in his youth, living his life as a Consulting Auditor for top banks, consulting firms, and public financial institutions. Now in his older age, he lives a sedentary life enjoying retirement in his birthplace. Two months until his 63rd birthday, Mowat was diagnosed with coronary artery disease by a cardiologist in Cairo. His diagnostic profile also shows a high risk of multiple cardiovascular diseases. For his routine checks, he travels an approximate distance of 56 kilometers two times a week. Seven months after his first diagnosis, Mowat was rushed to the emergency department of a local clinic in Andoabat after suffering a myocardial infarction.

On stabilization, he was referred on ambulatory support to the cardiology team in Cairo. A month later, under inpatient care, Mowat suffered multiple episodes of myocardial infarction prompting the team to prep him for cardiovascular stent placement. This surgery increased his cardiovascular risk of hypertension and dyslipidemia forcing the cardiology team to keep him under observatory watch for 3 weeks. Two weeks later, he developed infarction-induced ischemic cardiomyopathy leaving him with an ejection fraction of 20% to 25%. He was discharged with an observatory referral to a primary healthcare provider in Andoabat. His primary healthcare provider was to coordinate with the team in Cairo, sending weekly evaluation reports covering medication adherence, frequency of activity per day, diet chart, and vitals. Follow-up visits were scheduled for a month later after his coronary artery bypass surgery.

Back in Andoabat, Mowat lived with his extended family, eating almost the same diet as them but in smaller quantities. The first follow-up visit was smooth as he only complained of frequent body weakness and fatigue associated with traveling the long distance from Andoabat to Cairo. The cardiologist suspected nothing since the updated primary care provider report transmitted to the team showed no anomalies. However, between the first follow-up visit and the next, two months later, Mowat was admitted to the hospital three times on account of congestive heart failure. Historical documentation revealed he had been consuming a high-sodium diet after the first follow-up visit and had significantly reduced his activity-minute-per-day index.

Mowat complained about his frequent admissions and expressed frustrations with his frequent long-distance travels to Cairo. In an attempt to solve these issues and optimize healthcare delivery, the cardiology team drafted him into a remote patient monitoring program and referred him to a telemedicine consultation center situated about 2 kilometers from Andoabat. The Nurse Coordinator at the consolation center worked closely with the cardiology team in Cairo, transmitting real-time clinical reports on outpatient diuresis, fluid intake level, and weight tracking. With this report, the cardiology team performed interventions that lowered Mowat’s cardiovascular risk and prevented episodes of fluid overload. Transmitting his vitals to Cairo over a secured network solved the problem of fatigue and his frustrations on travels. After six months on the remote patient monitoring program, his frequency of readmission was reduced, and his cardiovascular risk was significantly lowered. Mowat now lives a happy life leveraging real-time medical guidance from the cardiology team in Cairo and the telemedicine consultation close to Andoabat.

Overview of Definitions, Origin, and Concepts of Telemedicine

Telemedicine, a widely adopted concept in modern science, is described as a branch of e-health that uses communications networks for the delivery of healthcare protocol, medical monitoring, and medical education from one geographic location to another. The first use case of “Telemedicine” (pre-coded as ‘TLM’) is traced back to 1920 and is credited to the National Aeronautics and Space Administration (NASA). Faced with the need to provide medical assistance to its team of astronauts in space, NASA deployed a system of virtual communication focused on exchanging medical information between experts on the ground and astronauts in space. Since 1920, Telemedicine, as a term and concept, has found its way into the medical glossary, heralding a new wave of healthcare delivery that defy distance and other common barriers to in-person hospital visits. In 1960, TLM was deployed as a care protocol in ‘group therapies’ designed by the military (Jafarzadeh et al., 2022).

Historically, the term ‘Telemedicine’ was coined by Thomas Bird in 1970 with a word origin described as “healing at a distance”. It is derived from the Latin word ‘Medicus,’ meaning cure, and the Greek word ‘tele’ meaning far away (Jafarzadeh et al., 2022). ‘Tele-Medicus’ directly implies the use of a virtual channel to exchange information usable as protocols for the management of diseases in humans.

In 1978, the first satellite setup dedicated to medical coverage was established in rural Queensland, Australia. The satellite project was designed solely to improve remote access to medical information and treatment. The concept grew rapidly after 1978, and in 2001 the first robotic surgery leveraging telemedicine was recorded. A team of surgeons in New York operated on a patient with gallbladder illness in Eastern France at a distance of roughly 8,000 kilometers. Using a network of telemedicine-enabled high-speed fiber optic lines and a robotic surgical system, the team completed the surgical procedures, transmitted real-time care optimizations, and set up a post-surgical monitoring protocol (Jafarzadeh et al., 2022).

Today, ‘Telemedicine’ is considered an umbrella term for telecommunication networks uses for establishing, promoting, and accelerating healthcare services around the world (Teixeira et al., 2018). Without the need for a routine doctor-patient encounter, telecommunication primarily advances the reach of modern medicine to the slums of Africa, the mountainous regions of the Himalayas, the scantily populated territories of the Northern Pole, and far into Space. Aided by the wide reach of the internet, this protocol facilitates the two-way transmission of health signals packaged as texts, audio recordings, images, videos, and in-app prompts. Over the past 20 years, modifications of these concepts have been adopted to serve primary functions in health monitoring, distant surgery, terminal disease diagnosis, mental healthcare optimization, and medical education (Mechanic et al., 2021).

Telemedicine in Three Different Eras

In a broad description, the history and use cases of ‘Telemedicine’ can be described as consisting of three different eras: the “telecommunication era”, the “digital era”, and the “internet era”.

In the “telecommunication era” of the 1970s, telemedicine was primarily designated as a secondary alternative, complementing the limited range of in-person medical arrangements (Bashshur et al., 2016). This era was characterized by a one-way transmission of audio and visual data with no integrating interface or store front for clinical records and patients’ data. With tons of limitations on telecommunication during this era, telemedicine networks only transmitted care packages and lacked the complex clinical applications available today.

The second era spans into the late 1980s when the telecommunications system had improved greatly by digitalization (Bashshur et al., 2016). The “digital era” was characterized by the integration of telecommunications and computer services for the delivery of medical information and care protocols on limited bandwidths. More specifically, the “digital era” introduced the use of telephone lines and switches designed in various combinations, ranging from partially dedicated telephone lines to a combination of multiple, full ‘T1’ lines. For context, the T1 line has a transmission capacity of 1.544 Mbits per second. These dedicated lines could only connect a few patients to clinicians on three bases (Bashshur et al., 2016):

  • Point to point (hospital to hospital)
  • Point to multipoint (hospital to remote clinics)
  • Multipoint to multipoint (a multicomplex network).

More prominently, the “digital era” also featured the introduction of the Integrated Service Digital Network Technology (Krittanawong, 2021). This system includes digital two-way audiovisual communications protocols permitting the transmission of voice, video, high-definition images, and texts over a secured universal network at a high speed. Using a full multiplex network, the second era of telemedicine was highly dependent on television techs for image capability.

Although the internet has been around since 1969, the dedicated use of internet technology for medical purposes is relatively recent. Heralding the third era of telemedicine, the “internet era” allowed the integration of telecommunications and computers with standardized protocols and tools for wide accessibility and connectivity (Bashshur et al., 2016). This era features open access to a global-communication environment with a heterogenous set of activities enabling a wide spectrum of personal and professional interactions. In addition, advancements in computer technology also created large data repositories and the integration of multiple medical interfaces operating from a single platform (Bashshur et al., 2016).

The possibilities of this arrangement are limitless. Substantially enhanced visuals, intensive images, large-sized audio files, and patient data can be stored in multiple forms and retrieved on-demand at points of care (Kichloo et al., 2020). The digital protocols opened up by the internet made modern medicine accessible, more ubiquitous, and cheaper. With over 70 million daily web users, there are simply no limitations to the reach of telemedicine. Today, information sources and virtual services on patient care, medical information, monitoring, and reporting are popular on the web.

Adoption, Authorization, Implementation, and Practical Use of Telemedicine Around the World

Around the world today, telemedicine is becoming increasingly popular as a care protocol for non-emergency services and conditions requiring no hospitalization. Primarily, it lifts the burden of a physical visit for the patient and helps clinics optimize the use of medical resources. The experience around the world only differs in the level of technological advancement and level of reception, however, the primary purpose remains largely similar.

Africa

The reach of telemedicine is gradually improving in Africa. Its benefit in this climate has been widely reported. In a 2006 report, the World Health Organization reported a 24% disease burden in Africa with only 3% of health workers commanding less than 1% of health expenditures in the different regions (Adams et al., 2021a). Unfortunately, the situation has not improved significantly over the past few years. In another report, the population growth has significantly exceeded the population size of healthcare professionals, explaining why 31 African countries reportedly have less than 20 doctors per 100,000 people (World Health Organization [WHO], 2021). This limited reach of healthcare in Africa provided ample opportunities for the wide use of telemedicine. In addition to a shortage of healthcare professionals, the prevalence of tropical diseases, poverty, poor infrastructure, and a high mortality rate constituted a huge barrier to medical care.

Telemedicine has since been proposed as the solution to the healthcare woes of Africa. Literature on the deployment of telemedicine in Africa reported telemedicine protocols in at least 14 countries on the continent. Nigeria and South Africa led the pack, with Ghana, Kenya, and Egypt following closely behind. In South Africa, the government operates a two-tiered health system – a state-funded public healthcare plan and a private healthcare scheme funded largely by personal contributions to insurance aid. As in Nigeria, healthcare professional in South Africa has resorted to telemedicine for the delivery of medical protocols to remote locations in a bid to improve reach and quality of life (Townsend et al., 2020).

Until now, the deployment of telemedicine in Africa faced challenges due to technical limitations and restrictive general ethical guidelines for good medical practices. Now, it is commonplace to find radiology information systems, laboratory information systems, and patient monitoring systems leveraging a two-way communication protocol in Africa. Surveys have identified about 16 clinical disciplines where telemedicine has been largely deployed in Africa. The most common ones include oncology, obstetrics and gynecology, rheumatology, pediatrics, dermatology, and mental health. In South Africa alone, tele-triage has reportedly reduced the pressure on healthcare facilities, with about 80% of all non-emergency medical cases handled by telemedicine in general practice. Patient reception is also rapidly improving in the wake of the pandemic, as 97% of patients in a survey review agreed to tele-consult again.

Latin America

As in Africa, the barriers to telemedicine in Latin America include poor patient reception, a poor demographic, insufficient communication infrastructure, and a limited range telecommunication setup. LeRouge et al., (2019), a publication focused on healthcare system approaches in Latin America, reported that 56% of hospitals in Chile have adopted a telemedicine network. However, only a meager 30% of hospitals in Costa Rica, Peru, Colombia, Mexico, and Argentina have at least one active telemedicine protocol (LeRouge et al., 2019). According to this publication, the recommendations of the 2015 Global Survey on health reports are poorly implemented in the region, with only Mexico and Colombia following the guidelines. Surprisingly, physician resistance was documented as the second most important barrier to telemedicine deployment in Chile. Recently the trend of telemedicine adoption is changing with culturally collectivistic countries like Guatemala experimenting with the new care delivery method.

In Argentina, the Senate approved a bill to regulate telemedicine in the future following the passage of medical laws allowing the electronic transmission of prescriptions and medical data. In March 2020, the number of calls from first-time telemedicine users reportedly increased by 226%, with electronically generated prescriptions increasing by 342%. These observations signaled a gradual shift from the conventional modes of in-person hospital visits during the pre-pandemic era to a more convenient, faster virtual tele-consult (Busso et al., 2022).

Healthcare institutions in Latin America have developed awareness programs and technical solutions in a swift attempt to improve telemedicine reach in the region. As a direct impact, the telemedicine market in Latin America is currently projected to grow at an annual rate of 20.5% between 2020 and 2026. This is considered a huge shift in the 2019 valuation of $1.5 billion in US dollars.

Asia

Until the pandemic, the adoption of telemedicine had received a limited review in Asia. Restrictions to movement forced health institutions and regulators to experiment with virtual means of healthcare delivery. The activities and effectiveness of these alternative systems, including telemedicine, were largely tracked in Saudi Arabia, Japan, China, and the Gulf Countries. Kaliyadan et al., (2020) documented how clinics in Gulf countries offered remote healthcare services using telemedicine protocols designed for transmission via phone calls, e-mail, Microsoft Teams, and smartphone applications such as WhatsApp and Zoom (Kaliyadan et al., 2020). Alongside other digital medical services available before the pandemic, telemedicine was used in prescription transmission, patient monitoring, appointment scheduling, and care regimen modification. With the quick implementation of multiple telemedicine protocols in this region, a high patient satisfaction index was recorded with 88% of first users agreeing to continued use of these services (Al-Sofiani et al., 2021).

In China, three different telemedicine platforms were designed and implemented for use during the pandemic. These include the local government digital service platforms, public hospitals’ tele-consult systems, and enterprise-owned internet hospitals (Wang et al., 2021). Literature reviews on the implementation of telemedicine in China have largely identified different classes of remote care services delivered. These include medical assistant robots, artificial intelligence (AI)-assisted e-screening solutions for identifying at-risk patients, e-consultation systems, medical imaging transmission services, and non-emergency remote consultation services, especially psychological counseling. In response, about 6662 individuals initiated about 10,557 online consultations between February to April 2020 (Li et al., 2020). In Japan, the Ministry of Health, Labor, and Welfare developed a system for the adoption of telemedicine in large cities and remote districts. The early use case sanctioned by the government allowed the temporary adoption of virtual consultations and the transmission of online prescriptions. Since this period, the Japanese government has sped up its’ implementation strategies on telemedicine with a final declaration maintaining permanent support for telehealth service in June 2021. Following the initial temporary authorization for telemedicine, the number of institutions with at least one active telemedicine service in Japan increased from 10,812 (9.7%) in April 2020, to 16,095 (14.5%) in June 2020 (Miyawaki et al., 2021).

Australia

The limited adoption of telemedicine in Australia changed rapidly during the pandemic. In a bid to reduce the rate of transmission, the government activated different protocols introducing different telehealth services to the population. Since a few of these services were initially available in limited quantities, the scaleup process was easy and the reception was massive. The quick adoption helped solve the barriers to medical care due to movement restrictions, with effective coverage achieved in just a few days (Adams et al., 2021a; Dykgraaf et al., 2021).

The most reported concern on the wide adoption of telemedicine was the inability to perform physical examinations. Except for this, Australia seemed to have a functional system of packages leveraging telemedicine in its districts. In an online survey, about 38% of surgeons in a participant pool of 683 agreed that the quality of telehealth services was equivalent to in-person hospital consultations (Wiadji et al., 2021). In recent surveys, conducted to optimize care delivery options, patients have expressed a desire for the implementation of a hybrid system with a focus on a solution to the common problems encountered with telemedicine services in Australia (Adams et al., 2021b).

Overview of Telemedicine Systems

Telehealth

The term ‘Telehealth’ has been used interchangeably with ‘Telemedicine’ in different literature reviews and clinical studies. Although the scope covered by both terms is similar, they are however not the same in concept. Telehealth has evolved to capture a broad outlay of digital healthcare solutions and virtual care delivery packages. It primarily described the practice of exploring information and communication technology (ICT) in delivering healthcare remotely (Maqbool, 2021).

According to the World Health Organization (WHO), telehealth is defined as:

‘the delivery of healthcare services, where patients and providers are separated by distance, by using ICT for the exchange of information for the diagnosis and treatment of diseases and injuries, research evaluation, and the continuing education of health professionals' (Maqbool, 2021).

The Department of Health Care Services expanded on this definition, describing telehealth as ‘the mode of delivering public healthcare via information and communication technologies to facilitate diagnosis, consultation, treatment, education, care management, and self-management while the patient is at the originating site and the healthcare provider is at a distant site' (Maqbool, 2021).

In essence, telehealth is identified with direct medical care as it covers teleradiology, telepsychiatry, telepathology, teledermatology, and remote patient monitoring (Maqbool, 2021). The WHO global survey report on eHealth in 2016 confirmed that more than 50% of responding countries to the Telehealth initiative have a specific national telehealth policy, with over 75% having teleradiology and about half reported at least one of a telepathology, teledermatology, or a patient monitoring plan (Maqbool, 2021). Other prominent technologies currently identified under the telehealth umbrella include digital photography, store and forward, audio-visual systems, remote patient monitoring, and mHealth (mobile health).

Store and Forward

The ‘store and forward’ technology enables the capture, archival, and transmission of patients’ healthcare and personal data over a secure network for asynchronous healthcare delivery.

As an asynchronous system, ‘store and forward’ models do not include healthcare delivery via telephone calls, and images transmitted via facsimile and text messages without visualization of the patient. Data storage and transmission technologies are the backbones of this telehealth model. Diagnostic and monitoring data are generated using CAT Scans, MRIs, X-rays, and other high-definition imaging protocols. Using authorized protocols for archival and transmission, information gathered is sent to specialists and members of the care team for evaluation, and to inform decisions on care plan designs. Secure servers temporarily house incoming packets on data before re-routing each packet across an extensive network to designated end users (Pasadyn et al., 2022).

Telemedicine allowing for only real-time transmission of delivery services may automatically limit the use of ‘store and forward’ technologies. Depending on State regulations, these technologies are expected to fulfill a range of requirements on data privacy and handling.

Remote Patient Monitoring

Primarily, Remote Patient Monitoring (RPM) technologies in telehealth record medical data from a patient in one location and electronically transmit this data on-demand to healthcare providers in a different location for the purposed of recording, monitoring, and evaluation.

Packets of medical data transmitted on this protocol may include physiological measurements, vital signs, drug adherence scores, and clinical survey answers. In modern-use cases, RPM protocols are designed as a stand-alone system generating medical data and evaluating the clinical course of different medical conditions using AI-powered interfaces. As a stand-alone system, the RPM protocols can monitor data packs relevant to specific medical conditions.

Recent use includes data monitoring in implantable cardiovascular devices, glucometers for ambulatory care, and chronic pressure airway machines in the management of sleep apnea (Bouabida et al., 2021). RPM models, regardless of the design, follow a unique process flow: Acquire, transmit, analyze, notify, and intervene.

Digitally generated medical data are acquired through passive patient-application (app) interactions and peripheral devices. Primary healthcare provides a personal measure of well-being such as:

  • Temperature
  • Heart rhythm
  • Pulse
  • Oxygen saturation
  • Cardiac auscultations
  • Locations (in addiction care)
  • Medical adherence
  • Blood glucose

Some RPM designs may require active data input from the patient, other simply transmit data packs across peripheral devices connected to a hub. Patient response data can be transmitted directly to digital archive systems or more preferable, a cloud-based monitoring software. During the analysis phase, data packs run through a patient-specific algorithm capable of real-time evaluation of risk scores. If data packs exceed the normal range, care providers may be alerted.

At elevated risk levels, a dashboard sorted by risk level may be presented to the care providers with an in-system interface for initiating intervention. These notification types may be slightly different in standalone and Integrated RPM programs. Interventions initiated, sometimes remotely, may include counseling, medication review, emergency home visits, in-app prompts, and remote care device reconfiguration. With the current deployment of RPM protocols in telehealth services, the reach of telemedicine has been significantly expanded with data exchange that ultimately leads to medical interventions and increased productivity for clinicians (Vegesna et al., 2017).

mHealth (Mobile Health)

Globally, there are about 6.6 billion smartphone users. Medical apps developed for use on smartphones have revolutionized the remote delivery of healthcare. These applications provide real-time tracking of health information, the sharing of this information with clinicians, and advising on healthy habits.

Mobile health technologies are prominently used in telehealth protocols for the management of substance abuse and addiction therapy. In substance care programs, these applications improve patients’ awareness of their addiction problem, help patients assess daily alcohol use, document weekly recovery plans, and provide access to medical publications with information on craving triggers and dangers of substance abuse. This digital intervention method offers users a coping strategy to reduce the rate of hazardous drinking and combat psychological distress that can cause relapse.

Modules available for users include health information sources on addiction management, counselor support, self-assessment of recovery, and discussion groups.

A newer addition to mobile health technologies is the Interactive Voice Recognition System (IVR). Designed as a modern adaptation of motivational interviewing, IVR uses a telephone-based delivery of recorded scripts with medical contents informing users on various medical information and homecare plans. In addiction therapy, IVR delivers medical information on the methods of abstinence and recovery assessment. Scheduled phone calls are made by the therapist to addiction patients discussing techniques of medication adherence, craving management, adverse effect, and monitoring of daily substance use. Voice prompts from the therapists elicit a user’s real-time response using voice feedback or keypad responses. A series of correctly answered responses help the therapist with vital data recording for recovery evaluation.

In a review published by the International Journal of Behavioral Medicine, Andersson et al. (2017) study the effectiveness of IVR with feedback output in outpatient care plans. The research report concluded that IVR may be useful for follow-up and repeated interventions as an add-on to regular treatment. Personalized feed generated from mHealth applications leveraging IVR could also improve the mental health score in patients battling substance use disorders. The therapist simply evaluates a stream of user-centered feedback to grade recovery and the effectiveness of the care plan (Andersson et al., 2017).

Telemedicine Consultation Centers

Telemedicine consultation centers are popular in hybrid systems. These centers primarily take patient visits and are established as secondary points of data collection, especially in a rural setting where patients’ medical data are generated onsite and transmitted to care providers for evaluation. The heart of a teleconsultation center is an optimized telemedicine software designed to capture physiological data and transmit the same. A ‘store and forward’ protocol may be useful for consultation centers catering to a large population of patients.

Personal healthcare data such as body temperature, pulse rate, oxygen saturation, and heart rate can be captured on-site and transmitted in packets over a secured network. The equipment setup in these centers includes sophisticated third-party imaging devices such as dermatoscope (handheld instrument to visualize skin structures not visible by the naked eye), otoscopes (ear scope), and ultrasound machines. Images are captured in high resolution and encoded before transmission and storage. The equipment setup is connected using cables and wireless connections leveraging low bandwidths.

Telemedicine Specialty Center

Telemedicine specialty centers house the specialists responsible for remote care. Primarily, these centers provide technical support for physicians and patients in specialty care plans. Depending on the telemedicine workflow adopted by these centers, the processes involved in data capture, storage, and transmission can be customized to suit special conditions.

Patients receive medical assistance via live video streams and RPM protocols with a focus on improving symptom scores and providing self-management recommendations. Telemedicine specialty care arrangements provide chronic care management for conditions such as asthma, arthritis, cardiovascular disease, and depression. These arrangements generally improve access to specialty care for local dwellers and underserved populations. Compared to other care protocols available in telemedicine, Telemedicine Specialty Care is governed by special guidelines and considerations.

Since the risk of mortality is high in patients receiving specialty care, these guidelines primarily optimize the process involved in physician intervention and evaluation. For instance, the American Association of Physicists in Medicine (AAPM), the American College of Radiography (ACR), and the Society for Imaging Informatics (SIIM) update the technical requirements and guidelines for generating and transmitting medical imaging in patients under specialty care.

Telemedicine Workflow

On the surface, a ‘telemedicine workflow’ moves the patient-care provider interface to a digital server. The complete module of a patient-centered telemedicine network primarily includes three interacting parties –the patient, a telemedicine provider, and a digital network provider.

Depending on the care offered and local regulations on telemedicine, each party may be housed in a different unit, hundreds of miles apart. The telemedicine specialty center houses the care providers, and in a ‘store and forward’ module, patients may be housed in the telemedicine consultation centers. Telemedicine network software provides the virtual connection needed and a secure channel for a two-way exchange of data packets. In many cases, this software is cloud-hosted, providing unlimited storage space.

Care providers may require patients to register and supply a series of preliminary personal data needed to document a medical history on the doctor’s end. Each package of data collected from all patients is encoded and marked with a unique digital identifying system. AI algorithms complete the detailed process of data marking, archival, and analysis. Depending on the setup, this digital databank of patient medical records may be accessible to the patient at all times or available only on request. Based on data collected and sorted, customized medical information may be sent to patients belonging to particular categories (Pego-Regiosa et al., 2022).

Online consultations are arranged as a two-way digital interface between care providers and the patient. Audio-visual prompts provided by the algorithms allow the care providers to conduct patient examinations, interviews, and surveys. Patients can send in pictorial depictions of skin defects, glucometer measurements, and vital signs recorded. Online prescriptions are generated remotely by the doctor and sent over the secure network.

A telemedicine network requires a lot of organization at the provider's end of the workflow. Although virtual clinics hosted on a secure server can replace conventional in-person visits, they are only perfect for conditions requiring no hospitalization or emergency interventions.

Most telemedicine providers operate two modules of care delivery:

  1. In-person appointments
  2. Facilitated Virtual Visits

Networks using the ‘store and forward’ protocol may provide a mechanism to help patients troubleshoot the virtual technology on their end to ensure the integrity of data generated, stored, and forwarded. To this end, telemedicine consultation centers are usually equipped with Automatic Logic Flows (bots) to help patients and contact persons through the setup and troubleshooting process. Experts also recommend the installation of a secondary data flow network in these centers. Providing an alternative route of data transfer may help during technical breakdowns. Ideal secondary options include physical mailings, electronic medical records, and website-based information and links (Singh, 2022). Overall, a telemedicine technical workflow depends on the care plans offered by the provider.

Telemedicine Protocols

Teleradiography

Teleradiography was first developed by the military to aid the remote transfer of medical imaging from troops on the field to specialists in their home countries. Images sent provided valuable clinical insight into the process involved with clinical diagnosis, treatment, and remote patient monitoring. In its earliest usage, a simple teleradiography setup included camera systems or video-grabbed hardcopies prepped for subsequent digitalization and transfer. Laser digitizers were introduced as an improvement to this simple setup. However, laser digitizers could only transmit one image at a time. In the mid-eighties, the first generation of Picture Archive and Communication Systems (PACS) developed for telehealth purposes was introduced. This system, combined with advances in virtual communications morphed into a valuable work tool for Radiologists (Bashshur et al., 2016).

With an increase in clinical demand, PACS helped radiologists report directly from home to their workspace in a distant location. Large radiology groups could also routinely evaluate medical images sent over the network while including real-time commentary and subspecialty coverage. With time, teleradiography services expanded from field services to emergency services and now to commercial services. Licensed companies providing teleradiography services leverage the expertise of certified radiologists for remote reading and round-the-clock assessment coverage.

To transmit medical images over a network, the setup in teleradiography must include data packet modules available in a transmissible format and a network technology. The most common network technology for teleradiography today includes the area networks (local or wide) and the internet (cloud computing) (Tahir et al., 2022).

At both ends of data transfer, good technical infrastructure including state-of-the-art diagnostic workstations is required. Guidelines on data confidentiality must also be maintained. Data encryption guidelines, laptop security guidelines, security incident guidelines, and malware prevention guidelines have become popular in teleradiography (Bashshur et al., 2016; Goelz et al., 2021).

Data transmission protocols usually include several validation checks to make sure images are transmitted through a secured channel in the right format, definition, and dimension.

Radiologists on a teleradiography network must also have liability insurance and local licensure to provide legal coverage for services rendered remotely. Other requirements might include technical and professional qualification protocols to be fulfilled at both the transmitting and the receiving ends.

Telepathology

The American Telemedicine Association describes ‘Telepathology’ as ‘a form of communication between medical professionals that includes the transmission of pathology images and associated clinical information for various clinical applications including, but not limited to, primary diagnosis, archiving, rapid cytology interpretation, intraoperative and second opinion consultations, quality review activities and ancillary study review’ (Orah & Rotimi, 2019).

This description provided a comprehensive technical framework and clinical applications of telepathology in telemedicine. Telepathology is changing the face of modern medicine and is providing a quick, easy-to-use digital system that eliminates the human vulnerability factor in accurate medical diagnosis.

Remote diagnosis over a secured channel can be performed with real-time (dynamic) image transfer or the’ store and forward’ telemedicine protocol (Pasquali et al., 2020). Today, hospitals offering telepathology services use one or more of the four platforms:

  1. Static imaging
  2. Whole slide imaging
  3. Dynamic non-robotic telemicroscopy
  4. Dynamic robotic telemicroscopy

Static Imaging

With static imaging telepathology, pre-captured digital images are transmitted over a secured channel to a team of pathologists for examination.

In its simplest form, static imaging telepathology offers a low-cost telehealth approach to medical pathology (Mremi et al., 2022).

Its major drawbacks are the limited field of view, lack of remote controls, and common errors associated with field-generated medical images.

Whole Slide Imaging (WSI)

Whole slide imaging (WSI) involves the scanning and modifications of images to produce high-resolution digital copies in formats transmissible over a secured network (Orah & Rotimi, 2019).

Unlike in static telepathology, the modifications on images generated by WSI allow pathologists to view the transmitted images on different levels of magnification and resolution. The entire specimen can be examined as a whole from different angles. Granting remote user control on the slides helps provide valuable insights to the team.

WSI is not without a few challenges. Production of digital slides is time-consuming, labor intensive, and expensive. Images generated with WSI also have large storage spaces and require large bandwidths for transmission.

Dynamic Non-Robotic Telemicroscopy

Non-robotic telemicroscopy (NRT) improves on the drawbacks of that of WSI.

NRT platforms transmit medical images in real-time via a two-way communications channel. By providing a continuous stream of data packets transmitted in real-time, NRT eliminates the time limitation associated with WSI.

Although the receiving team has no control over the field of display, live-chat features on NRT allow the team to ask for different images of the specimen at customized viewing scales, magnification, and resolution.

Dynamic Robotic Telemicroscopy

With robotic telemicroscopy, the receiving team has control over the live images. This allows for real-time customization of the resolution, view field, and magnification.

As expected, remote robotic manipulation of images requires the transmission of huge data packs. These packs require high-speed internet connections and high bandwidth for transmission. As a result, robotic telepathology setups are limited to urban settings and require a high cost of maintenance and acquisition (Orah & Rotimi, 2019).

Telepsychiatry

The adoption of ‘Telepsychiatry’ as a protocol for mental healthcare globally is sponsored largely by two observations: the uneven distribution of mental healthcare professionals across communities and the increasing trend of mental illness and substance use disorders globally.

In a bid to solve the problems presented by these observations, mental health advocates have promoted telepsychiatry as a possible solution (Li et al., 2021). Telepsychiatry uses advanced telecommunications (computers, telephones, mobile apps, and videoconferencing modules) to provide mental health services remotely.

Based on the communication technology deployed, telepsychiatry services are classified as:

  1. Synchronous or interactive
  2. Asynchronous or store-forward

Synchronous

The synchronous telepsychiatry technology features a two-way interactive communication setup between the therapist and patients, support groups, or caregivers over a long distance (Malhotra et al., 2022).

Videoconferencing is the common mode of data transfer for synchronous telepsychiatry. In addition to chat forums, in-app prompts, and telephone, this communication mode mimics the patient-physician exchange in conventional in-person hospital appointments. The collection, recording, and assessment of medical information happens on a real-time basis over a secured channel.

Asynchronous

Asynchronous telepsychiatry technology uses the ‘store and forward’ module of medical data exchange. The collection and transmission of medical data are done through web applications and email. Data transmitted are the archive for a later assessment by the psychiatry team. In outpatient settings, telepsychiatry is largely deployed for remote patient monitoring in medication adherence and addiction therapy assessment.

In in-patient settings, telepsychiatry also uses one of the three common models:

  1. The collaborative/integrative care model
  2. Teleconsultation model
  3. The direct care model

Collaborative/Integrative Care Model

The collaborative/integrated model is a patient-centered approach involving a collaboration between primary care providers and a telepsychiatry service provider. The primary care provider, in most cases a psychiatric nurse, conducts daily ward rounds, notes medication changes, gauges patients’ response to medications, suggests modifications to care regimen, and produces a care report.

Data generated at this end is transmitted over the network to the psychiatry team, providing valuable insights for patient care. Ghosh et al. (2020) identified notable modifications adopted by telepsychiatry providers to further expand the range of mental health services delivered remotely through the collaborative/integrative model. These modifications include:

  • ‘Hub and spokes’:
    • This consists of a center with telepsychiatrists receiving medical insights from multiple centers (hubs) and transmitting medical care in return.
  • Stepped-care:
    • This involves a system of referral from telepsychiatrists to an onsite psychiatrist for a more comprehensive care.
  • Multidisciplinary:
    • This involves contributions from a team of professionals providing inter-profession mental healthcare services.

Figure 1:
Adaptation of the Collaborative/Integrative Care Model
(Ghosh et al., 2020)

graphic adaptation of the collaborative/integrative care model

Teleconsultation Model

The teleconsultation model connects a telepsychiatrist working at a specialized center with a team of onsite medical professionals requesting psychiatry consultation for a patient. With the support of the primary care team, the telepsychiatrist makes recommendations on ongoing therapy and conducts medication reviews (Kimmel & Toor, 2019). This model best suits specialty care in psychiatry.

Figure 2:
Adaptation of the Teleconsultation Model
(Ghosh et al., 2020)

graphic adaptation of the teleconsultation model

Direct Care Model

The direct care model of telepsychiatry involves the delivery of mental healthcare remotely to underserved populations.

The burden of care falls directly on the telepsychiatrist who conducts initial assessments and designs the care protocol for the patients. The modalities of the communication might involve videoconferencing and other two-way communication technology. Medication review and treatment recommendations may be discussed with other primary care providers. Compared to others, the direct care model is simple, affordable, and requires no huge technical infrastructure.

Figure 3:
Adaptation of the Direct Care Model
(Ghosh et al., 2020)

graphic adaptation of the direct care model

Two-Way Interactive Television & Other Audiovisual Communication Systems in Telemedicine

As telemedicine expanded and hospitals adopted at least one of its protocols, the need to develop improved communications technology became important.

The Bell System was the first of many engineering companies that promised an ultimate two-way communications system by 1970. In 1959, Nebraska Psychiatric Institution (NPI) started using the first two-ways television to transmit demonstrations and other data forms to medical students after a 12-year trial with the tech. Data packet transfer included motion picture images with accompanying sound. In 1961, a grant-supported trial examining the potential of two-way television in psychiatric treatment started. In addition to assessing the potential of telemedicine in mental healthcare, this trial also tested the reliability of the new technology in telepsychiatry. The trial provided valuable insights, and in 1964, the Nationals Institute of Mental health sponsored the installation of a two-way closed-circuit television system between NPI and the Norfolk State Memorial Hospital. At a distance of 112 miles away, the new technology was charged with transmitting data packs on in-service training opportunities and providing teleconsultation services remotely.

Since the first use case in the 1960s, two-way interactive technologies have become a huge part of telemedicine. Today, the modifications available on this technology make it possible for the real-time exchange of medical information remotely over a secured network.

Closed circuit televisions enable healthcare professionals to establish a patient-care provider connection with patients or underserved patient groups in remote locations.

Data packs are shared as texts, high-resolution images, and quality sound useful for gauging patient’s response, physical examination (teledermatology), adherence monitoring (telepharmacy), and patient monitoring (telepsychiatry).

Biomedical telemetry, in geriatric care, measures a patient’s vital signs and transmits the same using standard medical biometric sensors. Geriatric specialists on the receiving end, using a two-way interactive television, may better assess a patient’s health using real-time images, audio responses, and biometric signals transmitted through the closed-circuit television.

The quality and format of images transmitted using a two-way interactive television may depend largely on the type of healthcare delivery it is used for. For instance, with the exemption of teledermatology (dermatology telemedicine services), the black-and-white, high-resolution view is considered preferable for diagnostics purposes. Other critical factors such as lightning effect, depth illusion, and magnification are also important when using a two-way interactive television. In essence, this technology has significantly expanded the frontiers of telemedicine by adding the personal touch considered absent in non-visual telemedicine. Patients can relate better with their care providers as audio-visual tech of the two-way television better mimic the conventional in-person hospital appointment.

Recently, the possibilities of a three-dimensional (3D) visualization fusing AI-aided technology with the audio-visual tech of two-way television have received wide publicity. This new proposal seeks to improve the data packs sent using two-way televisions. 3D visualizations provide a real-time, true-form high-definition image of the internal organs. This is particularly useful in tumor care, teledermatology, and maternal care.

At the Radiological Society of North America’s Scientific Assembly Meeting in 2009, telecommunication giants, Siemens and NVIDIA, demonstrated a new 3D ultrasonic imaging technology that can be hooked to a two-way interactive television. This new technology provided incredible insight into the internal organs in different magnification and resolution. There are also possibilities of deploying this technology for maternal healthcare, especially in fetal imaging. 3D imaging in telemedicine opens a new era of medical imaging, helping healthcare stakeholders improve the reach of modern medicine.

The Roles of Telemedicine in Modern Medicine

Primarily, the clinical applications of telemedicine are designed to optimize patient care and solve the common barriers to healthcare delivery. Early reports evaluating the clinical roles of telemedicine in healthcare largely recognized six classifications. These include:

  1. Consultation, including a second opinion
  2. Remote monitoring and tracking of vital signs, medication adherence, and therapy effectiveness
  3. Remote supervision of primary care by caregivers in underserved populations
  4. Initial evaluation of patients for stabilization, triage, and referral
  5. Provision and supervision of primary care by a specialist or primary care provider in underserved populations
  6. Real-time assessment and analysis of vital medical data for the modification of ongoing therapy

These broad classifications describe the primary challenges of healthcare delivery by offering an alternative method of care delivery.

Today, telemedicine plays a direct role in how medical personnel delivers care and how patients receive care. These roles include:

  • Public health
  • Disease prevention
  • Addiction care
  • Patient monitoring and counselling

Public Health

The role of telemedicine in public health is balanced on how easy it makes the processes of diagnosis, patient evaluation, and supervision easy for medical professionals providing healthcare remotely. Reaching an underserved population remotely ultimately expands medical coverage with a direct effect of improving the healthcare index of a community under study. Clinical diagnosis is rapidly shifting away from clinical-examination-based processes to accommodate evidence-based processes banking on the doctor’s objective interpretation of the presenting symptoms. To catch up easily, hospitals have adopted telemedicine protocols that allow the assessment of evidence onsite and remotely. By combining teleconsultation with telediagnosis, physicians can now make accurate diagnoses using the artificial intelligence algorithms provided by telemedicine networks. Remote diagnosis is now supported by advances in Artificial Intelligence (process automation) and telemedicine (digital technology).

Artificial Intelligence can remotely generate and store diagnostic images and vital signs from different patients suffering from a medical condition. Data generated and transmitted can offer a remarkable insight into epidemiology, incidence, and the prognosis of a medical condition in a community under review. In an early publication of Nature, Esteva et al., (2017) reported how telemedicine protocols helped with the dermatologist-level classification of skin cancer with deep neural networks. This research demonstrated how deep convoluted neural networks (CNNs) help dermatologists classify skin lesions using only images generated remotely and diseases labeled as inputs. Dermatological conditions are underreported globally, prompting dermatologists to experiment with other methods of remotely generating medical insights that can help with the early diagnosis of these conditions. Using telemedicine-enabled delivery methods, deep neural networks can potentially expand the dermatologists’ reach to underserved populations, proving people with cost-effective, easy access to diagnostic care (Esteva et al., 2017).

According to the United Nations’ data on World Population Aging, the global population aged 65 years and above is growing faster than other age groups. By 2050, the population of people aged 80 years is projected to reach 426 million people globally. This data suggests that a more effective healthcare method will be needed in the nearest future to cater to the world’s rapidly aging population. Telemedicine has been proposed as an efficient method of delivering geriatric care. This method requires no hospitalization and prevents the risk of nosocomial infections in geriatric patients. By extrapolation, telemedicine services can also help deliver medical education and data to the younger population. Using in-app prompts and two-way interactive technology, telemedicine facilitates the exchange of medical data, imaging findings, and lifestyle information between medical professionals and mobile phone users. Physicians can collaborate easily with this demographic via mobile chart and recommend lifestyle modifications and other medical information as needed.

Substance Use

Substance use and drug addiction constitute major public health problems in different regions of the world. Recently, researchers have conducted different clinical surveys and epidemiological impressive attempts to study and specifically categorize drug use problems. In 2017, the National Survey on Drug Use and Health (NSDUH) reported an estimated number of 20 million people with an alcohol or drug use disorder. On a broad scope, drug use disorders are categorized as opioid use disorder (OUD), substance use disorders (SUD), and alcohol use disorders (Lipari & Van Horn, 2017).

Compared with the conventional methods, telemedicine-aided addiction therapies are readily available, convenient, privately delivered on a low budget, sustained over long durations, and require no hospitalization. To monitor effectiveness and adherence rate, these digital therapies are linked with different technology-based tools that deliver data insights for actionable intelligence.

In conventional methods of addiction therapy plans, blood tests and take-home assessments submitted by participants are important in evaluating the effectiveness of therapy. For instance, in Alcohol Use Disorder Identification Tests (AUDIT), participants fill out questionnaires that help therapists assess, test, and identify the risk of alcohol use disorders. Telemedicine-aided therapy models provide a patient-focused plan that responsibly tasks participants with the provision of documented proof of sobriety and accountability for substance use. This plan simply increases the participants’ awareness of their substance use problem and puts them in charge of their recovery plan as the therapist provides a periodic evaluation of the monitoring plan. In updated assessment plans, telemedicine-aided digital tools can also present a relapse prevention model that completely replaces in-person routine blood tests.

In conventional alcohol use therapy, on-the-spot-monitoring systems are the mainstay of clinical management while also doubling as the methods for monitoring alcohol levels. Recently, Near Field Communication Tags (NFC Tags) have been developed as a more effective remote approach to managing alcohol use disorders. These tags are advanced monitoring systems enabling electronic devices to execute non-contact medical data transmissions over a short distance. The application of this short-range high-frequency technology is rapidly changing the narrative about addiction care.

Remote digital monitoring tools are also important in addiction therapy. These devices are designed to measure substance use and provide data on abstinence and control. Recent telemedicine inputs in alcohol monitoring are devices designed to measure alcohol levels in body fluids as an implantable or wearable device. Literature studies examining this new approach have demonstrated the use of Alcohol Monitoring Systems to measure transdermal alcohol concentration (TAC) as a means to objectively identify alcohol units consumed for a period under review (Dougherty et al., 2015).

Patient Monitoring and Counseling

Telemedicine systems are leading the field of patient monitoring in both in-patient and out-patient settings. Internet-enabled wearable devices are now a common personal accessory for millions of people worldwide. By 2023, the number of these devices actively connected to a large data ecosystem is projected to surpass 1 billion. Telemedicine providers are planning to leverage this data by providing innovative systems for remote patient monitoring. Combined with artificial intelligence capabilities, these systems provide medical professionals with a better insight into therapy effectiveness and patient adherence. Primarily, remote patient monitoring using digital tools helps in tracking disease progression, assessing response to therapy, and ascertaining the need for therapy modification (Volterrani & Sposato, 2019). These tools are designed with remote patient monitoring technologies that use sensors to collect and transmit medical data over a telemedicine network. Modified versions of these systems combine telemedicine services with other enabling technologies including cloud computing, ambient sensors, and artificial intelligence (Gentry et al., 2021).

These technologies integrate the processes involved in medical data monitoring, enabling medical professionals to conduct interventions more easily. Telemedicine-aided automatic monitoring systems have also been developed for ambulatory care services and the patient is managed remotely.

In 2018, Bernocchi et al., (2018) published a report of medical research examining the feasibility and efficacy of tele-surveillance and remote monitoring in patients with chronic heart failure and pulmonary comorbidities. The result proves the feasibility and safety of telesurveillance in reducing hospitalizations, reducing mortality index, and increasing the quality of life of patients in clinical settings (Volterrani & Sposato, 2019). Telemedicine providers have also explored different modules of remote patient monitoring using advanced audio-visual technology. Combined with machine learning technologies, audio-visual modules of tele-surveillance can produce remote-controlled robot-aided monitoring systems gathering real-time data on patient response to therapy.

Medical Data Management

Automating the processes involved in clinical data gathering, medicine management, and analyzing medical records is possible with Artificial Intelligence. A vital part of remote healthcare delivery rests heavily on accurate health information management. Beyond merely compiling clinical data in cloud storage, Artificial Intelligence helps the medical team determine the incidence of disease in a region, alert a medical institution to an emerging novel disease or help clinicians compare the outcome of medical procedures.

Cloud storage is considered an innovative approach to medical data management. It replaces the conventional methods of manual data input in low-capacity storage tools. Real-time data queries can help medical statisticians and epidemiologists understand the incidence rate and risk index of disease conditions in a community.

Interactive Health Communication Across the Disciplines

Interactive healthcare communication takes a principal role in patient management. People with chronic disease conditions have multiple medical needs. This includes information about their illness and the treatment options available. Interactive health communication tools hosted on telemedicine networks may help the exchange of this vital information between the healthcare team and the patients. Generally, interactive healthcare tools improve patients’ knowledge about their disease condition, provide social support from the health community, and help the clinical team better control the clinical outcomes of therapy, especially in telepsychiatry (Calvache-Mateo et al., 2021).

Interprofessional communications across healthcare teams have been identified as a contributing factor to the effectiveness of therapy. In a patient with chronic medical conditions requiring long-term hospitalization, the therapy regimen may require interventions from different members of the medical team.

Many times, these interventions are communicated on a secured channel to provide a real-time update on the course of therapy and modifications proposed. As a team, developing an effective channel of communication can be quite challenging in the medical setting. In addition, members of the healthcare team may be required to make real-time inputs on the medical regimen implemented for different patients. A telemedicine network help solve the common barriers to communication in healthcare settings. Interactive Health Communication protocols on these networks use in-app chat features, question prompts, and image sharing features to facilitate the easy flow of information among team members. The importance of these internal communication systems cannot be overemphasized in patient management.

Merits and Demerits of Telemedicine

The COVID-19 pandemic championed a global awareness of the use of telemedicine protocols. Nationwide lockdowns forced medical professionals to initiate remote patient monitoring plans using texts, in-app prompts, and two-way interactive platforms. Online appointments also replaced in-person hospital visits, cutting off travel time and waiting time at the clinic. The usefulness of remote healthcare delivery is becoming obvious to a large population of patients and caregivers.

Merits of Telemedicine

Telemedicine completely changes the narrative of healthcare delivery from conventional in-person visits to online interfaces. Primarily, this simple shift has been linked with (Mubarak et al., 2021):

  • Improved therapeutic index
  • Enhanced quality of care
  • Real-time provision of psychological support for caregivers and patients

In a 2020 review study, Singh et al., (2020) demonstrated how virtual healthcare delivery using live streaming help physicians improve patient surveillance and enhance the learning skills of a patient requiring self-help with medical equipment used at home (Singh et al., 2020). By reducing the frequency of hospital visits, telemedicine also significantly reduces the risk of nosocomial infections in immunocompromised patients while reducing fatigue associated with long-distance travel for others.

For care providers, the merits of telemedicine are limitless. The use of automated data transmission and cloud computing help telemedicine providers make better data-driven decisions about their patients. This reduces the time spent on face-to-face appointments and helps make quick interventions when required.

Demerits of Telemedicine

Perhaps, the biggest drawback to the use of telemedicine for the underserved population is its overreliance on good internet connectivity. In many cases, the target population of remote healthcare delivery lived in the parts of the world where internet bandwidths are small are unreliable. This technical barrier cut off a large percent of the target population from receiving remote specialized care.

A proper telemedicine workflow also requires huge technical investments in digital equipment, control panels, and medical devices. Establishing multiple telemedicine consultations and specialty centers requires huge financial investments.

There is also a lack of personal touch in remote healthcare delivery. In many telemedicine surveys conducted to gauge patient satisfaction, the lack of personal human touch during the virtual appointment process was a much-reported challenge (Brown, 2019).

The vulnerability of telemedicine workflow to a cyberattack has also generated much debate over the years. Patient medical data and reports are stored in a secured digital cloud. Compared with the local storage methods in physical hospital visits, data clouds may be a subject of malicious cyberattacks. A successful cyberattack may breach patients’ data and violate the ethics of medical confidentiality.

Conclusion

Telemedicine specifically relies on electronic transmission, artificial intelligence, cloud computing, virtual storage, and telematics technology for the generation and transmission of medical data. Arguably, using the technology of the future is a welcome development in modern medicine. These technological inputs primarily enhance the reach of medical care and provide a reliable care option for at-risk populations in remote parts of the world.

Although this mode of care delivery opens a bright future for the medical profession, it is important to understand that the human factor in care delivery holds a significant position in telemedicine workflow. In essence, telehealth services should be considered a complementary approach to in-person medical care and not a replacement. Regional regulatory agencies are expected to develop guidelines and standards moderating the technological input and the professional quality of telemedicine providers. Telemedicine holds massive breakthroughs for the global medical community in the future. Well-guided research and policies are required to shape the future of remote healthcare delivery and address its multiple sociocultural and technical challenges.

Select one of the following methods to complete this course.

Take TestPass an exam testing your knowledge of the course material.
OR
Reflect on Practice ImpactDescribe how this course will impact your practice.   (No Test)

Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.

References

  • Adams, J., MacKenzie, MJ., Amegah, AK., Ezeh, A., Gadanya, MA., Omigbodun, A., Sarki, AM., Thistle, P., Ziraba, AK., Stranges, S., & Silverman, M. (2021a). The conundrum of low COVID-19 mortality burden in sub-Saharan Africa: Myth or reality? Global Health: Science and Practice. 9(3):433-443. Visit Source.
  • Adams, L., Lester, S., Hoon, E., van der Haak, H., Proudman, C., Hall C, Whittle, S., Proudman, S., & Hill, CL. (2021b). Patient satisfaction and acceptability with telehealth at specialist medical outpatient clinics during the COVID-19 pandemic in Australia. Journal of Internal Medicine. 51(7):1028-1037. Visit Source.
  • Al-Sofiani, ME., Alyusuf, EY., Alharthi, S., Alguwaihes, AM., Al-Khalifah, R., & Alfadda, A. (2021). Rapid implementation of a diabetes telemedicine clinic during the coronavirus disease 2019 outbreak: Our protocol, experience, and satisfaction reports in Saudi Arabia. Journal of Diabetes Science and Technology. 15(2):329-338. Visit Source.
  • Andersson, C., Öjehagen, A., Olsson, MO., Brådvik, L., & Håkansson, A. (2017). Interactive voice response with feedback intervention in outpatient treatment of substance use problems in adolescents and young adults: A randomized controlled trial. International Journal of Behavioral Medicine. 24(5):789-797. Visit Source.
  • Bashshur, R. L., Krupinski, E. A., Weinstein, R. S., Dunn, M. R., & Bashshur, N. (2016). The empirical foundations of telepathology: Evidence of feasibility and intermediate effects. Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association, 23(3):155–191. Visit Source.
  • Bernocchi, P., Scalvini, S., Galli, T., Paneroni, M., Baratti, D., Turla, O., La Rovere, MT., Volterrani, M., & Vitacca, M. (2016). A multidisciplinary telehealth program in patients with combined chronic obstructive pulmonary disease and chronic heart failure: study protocol for a randomized controlled trial. Trials. 17(1):462.
  • Bouabida, K., Malas, K., Talbot, A., Desrosiers, MÈ., Lavoie, F., Lebouché, B., Taguemout, M., Rafie, E., Lessard, D., & Pomey, MP. (2021). Remote patient monitoring program for COVID-19 patients following hospital discharge: A cross-sectional study. Front Digit Health. 3:721044. Visit Source.
  • Brown, S. (2019). Preserving the human touch in medicine in a digital age. Canadian Medical Association Journal. 191(22):E622-E623. Visit Source.
  • Busso, M., Gonzalez, MP., & Scartascini, C. (2022). On the demand for telemedicine: Evidence from the COVID-19 pandemic. Health Economics. 31(7):1491-1505. Visit Source.
  • Calvache-Mateo, A., López-López, L., Heredia-Ciuró, A., Martín-Núñez, J., Rodríguez-Torres, J., Ortiz-Rubio, A., & Valenza, MC. (2021). Efficacy of web-based supportive interventions in quality of life in COPD Patients, a systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 18(23):12692. Visit Source.
  • Dougherty, DM., Hill-Kapturczak, N., Liang, Y., Karns, TE., Lake, SL., Cates, SE., & Roache, JD. (2015). The potential clinical utility of transdermal alcohol monitoring data to estimate the number of alcoholic drinks consumed. Addictive Disorders and Their Treatment. 14(3):124-130. Visit Source.
  • Dykgraaf, S., Desborough, J., de Toca, L., Davis, S., Roberts, L., Munindradasa, A., McMillan, A., Kelly, P., & Kidd, M. (2021). A decade's worth of work in a matter of days: The journey to telehealth for the whole population in Australia. International Journal of Medical Informatics. 151:104483. Visit Source.
  • Esteva, A., Kuprel, B., Novoa, RA., Ko, J., Swetter, SM., Blau, HM., & Thrun, S. (2017). Dermatologist-level classification of skin cancer with deep neural networks. Nature. 542(7639):115-118. Visit Source.
  • Gentry, M., Luxton, D., & Krupinski, E. (2021). Sensor, wearable, and remote patient monitoring competencies for clinical care and training: Scoping review. Journal of Technology in Behavioral Science. 6(2):252-277.
  • Ghosh, A., Verma, M., & Lal, S. (2020). A review of models and efficacy of telepsychiatry for inpatient service delivery: Proposing a model for Indian settings. Indian Journal of Psychological Medicine. 42(5):34S-40S. Visit Source.
  • Goelz, L., Arndt, H., Hausmann, J., Madeja, C., & Mutze, S. (2021). Obstacles and solutions driving the development of a national teleradiology network. Healthcare (Basel). 9(12):1684. Visit Source.
  • Jafarzadeh, F., Rahmani, F., Azadmehr, F., Falaki, M., & Nazari, M. (2022). Different applications of telemedicine - Assessing the challenges, barriers, and opportunities- A narrative review. Journal of Family Medicine and Primary Care. 11(3):879-886. Visit Source.
  • Kaliyadan, F., A Al Ameer, M., Al Ameer, A., & Al Alwan, Q. (2020). Telemedicine practice in Saudi Arabia during the COVID-19 pandemic. Cureus. 12(12):e12004. Visit Source.
  • Kichloo, A., Albosta, M., Dettloff, K., Wani, F., El-Amir, Z., Singh, J., Aljadah, M., Chakinala, RC., Kanugula, AK., Solanki, S., & Chugh, S. (2020). Telemedicine, the current COVID-19 pandemic and the future: A narrative review and perspectives moving forward in the USA. Family Medicine Community Health. 8(3): e000530. Visit Source.
  • Kimmel, RJ., & Toor, R. (2019). Telepsychiatry by a public, academic medical center for inpatient consults at an unaffiliated, community hospital. Psychosomatics. 60(5):468-473. Visit Source.
  • Krittanawong, C. (2021). TeleHealth in the digital revolution era. European Heart Journal. 42(21):2033-2035. Visit Source.
  • LeRouge, CM., Gupta, M., Corpart, G., & Arrieta, A. (2019). Health system approaches are needed to expand telemedicine use across nine Latin American nations. Health Affairs (Millwood). 38(2):212-221. Visit Source.
  • Li, P., Liu, X., Mason, E., Hu, G., Zhou, Y., W., & Jalali, MS. (2020). How telemedicine integrated into China's anti-COVID-19 strategies: A case from a National Referral Center. BMJ Health & Care Informatics. 27(3):e100164. Visit Source.
  • Li, Z., Harrison, SE., Li, X., & Hung, P. (2021). Telepsychiatry adoption across hospitals in the United States: A cross-sectional study. BMC Psychiatry. 21(1):182. Visit Source.
  • Lipari, RN., & Van Horn, SL. (2017). Trends in substance use disorders among adults aged 18 or older. In: The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). Visit Source.
  • Malhotra, S., Chand, P., Chatterjee, K., & Brahma, A. (2022). Practice of telepsychiatry and its current legal status. Indian Journal of Psychological Medicine. 64(Suppl 1): S176-S184. Visit Source.
  • Maqbool, A. (2021). Telehealth and eHealth. WebDoctors. Visit Source.
  • Mechanic, OJ., Persaud, Y., & Kimball, AB. (2021). Telehealth systems. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Visit Source.
  • Miyawaki, A., Tabuchi, T., Ong, MK., & Tsugawa, Y. (2021). Age and social disparities in the use of telemedicine during the COVID-19 pandemic in Japan: Cross-sectional study. Journal of Medical Internet Research. 23(7): e27982. Visit Source.
  • Mremi, A., Bentzer, NK., Mchome, B., Mlay, J., Blaakær, J., Rasch, V., & Schledermann, D. (2022). The role of telepathology in the diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania. PLoS One. 17(4): e0266649. Visit Source.
  • Mubaraki, AA., Alrabie, AD., Sibyani, AK., Aljuaid, RS., Bajaber, AS., & Mubaraki, MA. (2021). Advantages and disadvantages of telemedicine during the COVID-19 pandemic era among physicians in Taif, Saudi Arabia. Saudi Medical Journal. 42(1):110-115. Visit Source.
  • Orah, N., & Rotimi, O. (2019). Telepathology in low resource African settings. Front Public Health. 7:264. Visit Source.
  • Pasadyn, SR., McAfee, JL., Vij, A., & Warren, CB. (2022). Store-and-forward teledermatology impact on diagnosis, treatment, and dermatology referrals: Comparison between practice settings. Journal of Telemedicine and Telecare. 28(3):177-181. Visit Source.
  • Pasquali, P., Sonthalia, S., Moreno-Ramirez, D., Sharma, P., Agrawal, M., Gupta, S., Kumar, D., & Arora, D. (2020). Teledermatology and its current perspective. Indian Dermatology Online Journal. 11(1):12-20. Visit Source.
  • Pego-Reigosa, JM., Peña-Gil, C., Rodríguez-Lorenzo, D., Altabás-González, I., Pérez-Gómez, N., Guzmán-Castro, JH., Varela-Gestoso, R., Díaz-Lambarri, R., González-Carreró-López, A., Míguez-Senra, O., Bóveda-Fontán, J., Charle-Crespo, Á., Caramés-Casal, FJ., Barbazán-Álvarez, C., Hernández-Rodríguez, Í., Maceiras-Pan, F., Rodríguez-López, M., Melero-González, R., & Rodríguez-Fernández, JB. (2022). Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology. BMC Health Services Research. 22(1):60. Visit Source.
  • Singh, AD. (2022). Telemedicine workflow and platform options: What would work well for your practice? Clinics of Liver Disease (Hoboken). 19(4):148-152. Visit Source.
  • Singh, RP., Javaid, M., Kataria, R., Tyagi, M., Haleem, A., & Suman, R. (2020). Significant applications of virtual reality for COVID-19 pandemic. Diabetology & Metabolic Syndrome. 14(4):661-664. Visit Source.
  • Tahir, MY., Mars, M., & Scott, RE. (2022). A review of teleradiology in Africa - Towards mobile teleradiology in Nigeria. SA Journal of Radiology. 26(1):2257. Visit Source.
  • Teixeira, PA., Bresnahan, MP., Laraque, F., Litwin, AH., Shukla, SJ., Schwartz, JM., Reynoso, S., Perumalswami, PV., Weiss, JM., Wyatt, B., & Schackman, BR. (2018). Telementoring of primary care providers delivering hepatitis C treatment in New York City: Results from Project INSPIRE. Learning Health System. 2(3):e10056. Visit Source.
  • Townsend, B., Mars, M., & Scott, R. (2020). The HPCSA’s telemedicine guideline during COVID-19: A review. South African Journal of Bioethics and Law. 13(2): 97. Visit Source.
  • Vegesna, A., Tran, M., Angelaccio, M., & Arcona, S. (2017). Remote patient monitoring via non-invasive digital technologies: A systematic review. Telemedicine Journal & E-Health. 23(1):3-17. Visit Source.
  • Volterrani, M., & Sposato, B. (2019). Remote monitoring and telemedicine. European Heart Journal Supplements. 21(Suppl M):M54-M56. Visit Source.
  • Wang, H., Yuan, X., Wang, J., Sun, C., & Wang, G. (2021). Telemedicine may be an effective solution for the management of chronic disease during the COVID-19 epidemic. Primary Health Care Research & Development. 22:e48. Visit Source.
  • Wiadji, E., Mackenzie, L., Reeder, P., Gani, JS., Carroll, R., Smith, S., Frydenberg, M., & O'Neill, CJ. (2021). Utilization of telehealth by surgeons during the COVID 19 pandemic in Australia: Lessons learned. ANZ Journal of Surgery. 91(4):507-514. Visit Source.
  • World Health Organization. (WHO). (‎2021)‎. World health statistics 2021: Monitoring health for the SDGs, sustainable development goals. World Health Organization. Visit Source.