Telemedicine and telemonitoring: theory and practice for the era of coronavirus

Frederich Llordachs
Co-founder of Doctoralia, partner at Docplanner Group and partner at Braincats Consulting

The basic definition of telemedicine is the one that corresponds to its etymology: this is how the provision of medical services at a distance is defined (from the Greek “tele”, distance, and medicine). This definition is broader than it seems since it encompasses traditional technologies that would also be telemedicine, such as the warning bells of the arrival of lepers or requests for health resources and medicines by cable telegraph during the American Civil War.

The coronavirus alert and the need for telemedicine

Cultural and political reluctance has been wiped out by the tsunami of a pandemic in which doctors and health workers are among those affected and, therefore, can become infectious agents. Beyond trying to size ICUs and emergency services staff to the expressed demand, in the second phase of resistance it’s expected that the technology, which has flooded the social sphere during confinement, will also be useful in the field of the medicine. In Spain, we think of today, while in the United States they think of tomorrow as reflected in this NEJM article.

Telemedicine can be the secret weapon to try to circulate health professionals confined by previous pathologies, age or COVID-positive, but also to monitor asymptomatic COVID-positive patients remotely (beyond the telephone). It would have been perfect to have pulsemeters and thermometers connected to an online monitoring platform to control the deterioration. There are still other patients, beyond COVID-19, who must be treated and it’s documented that the cases arrive increasingly complicated at hospitals (from appendicitis in children to AMI or stroke) which has justified paediatric monographic centres such as Paidodex or the HM Children Hospital have enhanced their telemedicine service by attending hundreds of consultations in a few days. In Spain, Mutua Universal has used this telemedicine triage system for more than 10 years (4) to centralize trauma surgeries for patients treated at its more than one hundred outpatient centres throughout the Spanish territory.

Monitoring at home: technically possible, medically desirable

The change in care from monitoring chronic patients at home so as not to attend to them in acute centres may finally be a reality. In this way, with fewer infrastructures and the same support staff, the entire population can be served using medical devices controlled with artificial intelligence. This would reduce the number of emergencies by 80%, and the healthcare process could be much more personalized and efficient (Vanessa Sánchez's name in the graph is false).

It is also important that long-term centres and the third sector have a strong health focus. The presence of digital tools for monitoring and control of physical and mental health, as well as the necessary physical stimulus, must be in the hands of the health managers of the nursing homes, in addition to having telemedicine systems for a correct transmission and registration of the medical orders. In this way, the scarce medical presence that until today has been the general norm would be compensated, improving health coverage.

Telemedicine will be a useful tool for prioritizing services and relieving healthcare pressure or it will not be

Telemedicine will be a useful tool for prioritizing services and relieving pressure, or it will not be. Above all, it should be the way for primary care, currently little taken into account, to move from home visits to telemedicine control, a change as natural as that from face-to-face conversation to the teleconference.

Patients need this step forward in 21st-century medicine and they will seek it after the coronavirus because our tomorrow depends on what we do today.