Televisits for specialty care are pretty much the same as a regular doctor’s visit. The only difference is, the entire visit is done either through video conference or over the phone. It has its limitations and in most fields detailed clinical examination is not possible remotely. However, preliminary examination can be carried out in most of the cases. In some specialties, almost in-person care can be delivered online. For example, in dermatology, with good video quality, lesions can be identified, diagnosed and treated on the basis of video conferencing. The patient or primary care center needs to buy a dermascope, which is attached to the mobile phone in order to provide good imaging of the lesion. In a study conducted by Krömer et al, it was shown that teledermatoscopy had both high sensitivity and specificity in diagnosing malignant melanoma as well as other malignant skin cancers . If put into practice thoroughly, teledermatology could greatly improve treatment outcomes, especially in time sensitive cancers.
Telesupervision refers to the practice of a midlevel health provider or general physician presenting to a specialist located in another area. This allows the physician posted in a remote area opportunity to grow in their desired field, while the supervisor is able to attend to a higher volume of patients. This holds more promise as there are trained professionals present on both ends of communication. The channels utilised to support the healthcare workers include but are not limited to videoconference, teleconference, and emailing. The method used depends on the task which is required of the supervisee. For example, when a supervisee is learning a clinical skill, the visual aid of videoconference would be more apt. However, in case of relaying data or information to the supervisor after having consulted with the patient, teleconferencing or emailing would suffice. Ideal use of the various mediums has shown to provide optimistic results .
Telemonitoring, also known as clinical supervision, uses various technologies to keep track of patients at a distance. It is invaluable in keeping the doctor up to date with the patient’s day to day condition. The tools used are microsampling blood test devices, continuous glucose monitoring devices, as well as wearable technology to monitor patient’s heart rate, oxygen levels and blood pressure. Remote monitoring is being implemented across the world to combat COVID19, including monitoring oxygen saturation, daily remote monitoring by nurse and tele-consultation with doctor after every few days.
In the long run, the usefulness of telemonitoring is mainly for chronic diseases in which diagnosis has already been done, and follow up and sometimes slight adjustments in treatment are all that is required. People often do not do what is in their best interest, and this can be a great source of frustration for physicians. However, remote monitoring allows physicians to have an oversight on their patients’ health while making them participate, thus leading to better compliance and in turn, better health outcomes with their treatments. In fact, the majority of patients want health care providers that allow them to be active participants in their own care .
It cannot be predicted with certainty what the future holds in case of specialty care via telemedicine. Robotic surgery is one such area that has undergone rapid innovation. Though the steps taken may seem small and incremental, they are drastically improving the quality of lives of people around us.
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