Telehealth can be defined as the remote delivery of health care to a patient through technology.
It has been used across most developed countries to deliver health care in a wide range of specialities, for numerous conditions and through varied means.
The interest in Telehealth is being driven by a number of challenges and opportunities in our current health care delivery system.
In light of the current global pandemic of COVID-19, Telehealth is the more practical approach to explore as social distancing, curfews and lockdowns have been enforced to prevent the spread of COVID-19.
Telehealth is a fairly new concept that is still evolving and needs to be explored further in Fiji. The concept is mostly practised in general practice in developed countries with more effective and advanced Tele communication technology.
A growing body of evidence suggests that care delivered via telemedicine can be both safe and effective, in some cases with better outcomes than conventional face-to-face care.
There is a growing demand by the general public of the need to access health services from a remote location without any restriction. The provision for Telehealth would be to address:-
- COVID-19 restrictions and outpatients: With the current restrictions on social distancing, mass gatherings, curfew and lockdown regarding COVID-19, there is added pressure on the health system to continue to provide health care services to the general population.
Telehealth provides such a platform to enable patients to have access to their preferred health carer. The patient could range from mild to severe cases. In addition, there is also the group of patient who has no symptoms but needs timely advice on other aspects such as replenishing medications and appointments with the specialist’s clinic.
- Chronic illness: Telehealth also provides the opportunity for medical doctors to interact with their patients with different health needs at an individual level. Chronic diseases account for the majority of our patients in clinics which do require follow up on a consistent level on a short and long term basis depending on the urgency.
This platform is able to address issues relating to booking times to the clinics, accessing our diagnostic facilities, treatment plans for discharged patients and their follow up, and also facilitating patient care follow up from treatment received abroad.
- Travellers: having access to Telehealth also gives the accessibility to our travelling patients abroad who may need advice on important issues relating to their medical condition such as medications, falling ill while overseas and discussing or sharing important information to specialists overseas.
- Referrals: the platform allows for a medium of exchange of health information between different health clinics or hospitals (public-public or public-private). This would facilitate the transfer of cases from health clinics or hospitals to a more advanced setting for treatment.
It is also important to note that the use of Telehealth is a relatively new concept which does have limitations and all parties accessing it needs to be fully aware of the regulatory uncertainty, patchy financing and reimbursement, and vague governance that may be associated with its use.
Because of inequalities in health and digital literacy, patients that most stand to benefit are those that are able to access and make use of Telehealth.
Telehealth services can also be cost-effective in different settings and contexts. Telehealth has the potential to improve effectiveness, efficiency and equity in health care, but can also introduce new risks and amplify existing inequalities.
Telehealth can be accessed in two main ways:
- Synchronous or real-time: this is the most common modality used where a consult, diagnose and treat process is involved. The patient interacts directly with the doctor by being able to see each other.
- Asynchronous or store and forward: this involves sending electronic data or information of a patient to a doctor to aid in evaluating a patient’s case. This modality does not use the face to face encounter and is useful for the specialist in determining the next treatment option for their patients.
The other forms of approach include:
- Remote patient monitoring where the patient’s clinical parameters such as vital signs and blood sugar are monitored. This method allows for close monitoring of discharged patients from the hospital to reduce the rate of readmissions into the hospital.
- Mobile Health: mhealth involves other online services and mobile phone apps aimed directly at the consumer.
At present Fiji does not have any act that governs particular videoconference services as meeting the requirements of the Health Information Security Framework.
Important consideration should be given to using a network provider or portal that should encrypt all information transferred during a Telehealth consultation, and no information should be stored by the system.
Limitations of telehealth.
The greatest risk for telehealth providers and host providers is misdiagnosis. Additional risks particular to telehealth are also potential liabilities arising from inferior equipment and technology and the storage of images.
Risk management and other legal requirements
Risks can be minimised by health services:
- Adopting a policy of open disclosure; and
- Implementing appropriate and adequate incident reporting guidelines.
If a notifiable event occurs, the telehealth provider and host provider should communicate as to who will report the event. Obtaining informed consent is a process that ensures the health care providers comply with all rules and regulations and ethical responsibilities.
Health practitioners and health organisations should keep accurate and contemporaneous records as a matter of risk management and best practice.
Every observation, decision and communication should be recorded accurately and contemporaneously to minimise the risk of miscommunication or error, and therefore to minimise the risk of adverse events occurring.
Accurate records also provide documentary evidence in the event that a complaint, claim or investigation is made.
The Telehealth platform will definitely be a platform for the future between doctors and patients. The COVID-19 pandemic has brought about new or unfolding technologies that were once thought of as impossible. However, it may also expose us to the exploitation and crimes associated with the internet.
- The views expressed in this article are his and do not reflect the position of his employers and is not necessarily the views of this newspaper.
