Telemedicine In Response Research Articles

Telemedicine, COVID-19, and disparities: Policy implications

While the rapid expansion of telemedicine in response to the COVID-19 pandemic highlights the impressive ability of health systems to adapt quickly to new complexities, it also raises important concerns about how to implement these novel modalities equitably. As the healthcare system becomes increasingly virtual, it risks widening disparities among marginalized populations who have worse health outcomes at baseline and limited access to the resources necessary for the effective use of telemedicine. In this article, we review recent policy changes and outline important recommendations that governments and health care systems can adopt to improve access to telemedicine and to tailor the use of these technologies to best meet the needs of underserved patients. We suggest that by making health equity integral to the implementation of telemedicine now, it will help to ensure that all can benefit from its use going forward and that this will be increasingly integral to care delivery.

Corrigendum to: Rapid Deployment of Inpatient Telemedicine In Response to COVID-19 Across Three Health Systems.

Corrigendum to: Rapid Deployment of Inpatient Telemedicine In Response to COVID-19 Across Three Health Systems.

Feasibility and safety of urgently initiated maternal telemedicine in response to the spread of COVID-19: A 1-month report.

AimIn Hokkaido, Japan, the number of people suffering from coronavirus disease 2019 (COVID‐19) is rapidly increased, and by the end of February 2020, there were already 70 confirmed cases of the disease. We investigated the safety of urgently initiated maternal telemedicine in preventing the spread of the coronavirus infection.MethodsThis retrospective, single‐institution study examined maternal telemedicine at the department of obstetrics of the Hokkaido University Hospital from March 4 to April 2, 2020. The physicians remotely examined the pregnant women from their homes using a visual communication system which kept communication confidential, performed prenatal checkup and administered medical care according to their various blood pressures, weights and cardiotocograms.ResultsForty‐four pregnant women received a total of 67 telemedicine interventions. Thirty‐two pregnant women (73%) had complications, and 22 were primiparas (50%). Telemedicine interventions were provided 19 times at less than 26 weeks of gestation, 43 times between 26 and 36 weeks of gestation and 5 times after 37 weeks of gestation. There was one case with an abnormality diagnosed during the remote prenatal checkups, and the patient was hospitalized on the same day. However, there were no abnormal findings observed in mothers and children during the other 66 remote prenatal checkups and medical care.ConclusionMaternal telemedicine can be safely conducted in pregnant women who are at risk of having an underlying disorder or fetal abnormality 1 month following the start of the attempt. It should be considered as a form of maternal medical care to prevent the spread of COVID‐19.

Opportunities and Development of Telemedicine in Response to COVID-19: Experience from Public Sector Medical University

<p>Over the past six months, the world has undergone drastic changes related to unprecedented emergence of deadly virus namely novel Coronavirus, COVID-19. Telemedicine service provides excellent platform for technology based remote patient care in the time of current pandemic crisis. It is emerging as an effective and sustainable solution if current pandemic continues for long time. Telemedicine is revolutionising patient care and help to support the health system of country by reducing the impact of pandemic. There is a need to create the multidisciplinary team of health professionals striving to serve the patients by provision of quality health care service delivery.</p>

Rapid Deployment of Inpatient Telemedicine In Response to COVID-19 Across Three Health Systems.

ObjectiveTo reduce pathogen exposure, conserve personal protective equipment, and facilitate health care personnel work participation in the setting of the COVID-19 pandemic, three affiliated institutions rapidly and independently deployed inpatient telemedicine programs during March 2020. We describe key features and early learnings of these programs in the hospital setting.MethodsRelevant clinical and operational leadership from an academic medical center, pediatric teaching hospital, and safety net county health system met to share learnings shortly after deploying inpatient telemedicine. A summative analysis of their learnings was re-circulated for approval.ResultsAll three institutions faced pressure to urgently standup new telemedicine systems while still maintaining secure information exchange. Differences across patient demographics and technological capabilities led to variation in solution design, though key technical considerations were similar. Rapid deployment in each system relied on readily available consumer-grade technology, given the existing familiarity to patients and clinicians and minimal infrastructure investment. Preliminary data from the academic medical center over one month suggested positive adoption with 631 inpatient video calls lasting an average (standard deviation) of 16.5 minutes (19.6) based on inclusion criteria.DiscussionThe threat of an imminent surge of COVID-19 patients drove three institutions to rapidly develop inpatient telemedicine solutions. Concurrently, federal and state regulators temporarily relaxed restrictions that would have previously limited these efforts. Strategic direction from executive leadership, leveraging off-the-shelf hardware, vendor engagement, and clinical workflow integration facilitated rapid deployment.ConclusionThe rapid deployment of inpatient telemedicine is feasible across diverse settings as a response to the COVID-19 pandemic.

Rheumatologists rapidly adjust patient care during COVID-19 pandemic.

Rheumatologists rapidly adjust patient care during COVID-19 pandemic.

The Connected Intensive Care Unit Patient: Exploratory Analyses and Cohort Discovery From a Critical Care Telemedicine Database.

BackgroundMany intensive care units (ICUs) utilize telemedicine in response to an expanding critical care patient population, off-hours coverage, and intensivist shortages, particularly in rural facilities. Advances in digital health technologies, among other reasons, have led to the integration of active, well-networked critical care telemedicine (tele-ICU) systems across the United States, which in turn, provide the ability to generate large-scale remote monitoring data from critically ill patients.ObjectiveThe objective of this study was to explore opportunities and challenges of utilizing multisite, multimodal data acquired through critical care telemedicine. Using a publicly available tele-ICU, or electronic ICU (eICU), database, we illustrated the quality and potential uses of remote monitoring data, including cohort discovery for secondary research.MethodsExploratory analyses were performed on the eICU Collaborative Research Database that includes deidentified clinical data collected from adult patients admitted to ICUs between 2014 and 2015. Patient and ICU characteristics, top admission diagnoses, and predictions from clinical scoring systems were extracted and analyzed. Additionally, a case study on respiratory failure patients was conducted to demonstrate research prospects using tele-ICU data.ResultsThe eICU database spans more than 200 hospitals and over 139,000 ICU patients across the United States with wide-ranging clinical data and diagnoses. Although mixed medical-surgical ICU was the most common critical care setting, patients with cardiovascular conditions accounted for more than 20% of ICU stays, and those with neurological or respiratory illness accounted for nearly 15% of ICU unit stays. The case study on respiratory failure patients showed that cohort discovery using the eICU database can be highly specific, albeit potentially limiting in terms of data provenance and sparsity for certain types of clinical questions.ConclusionsLarge-scale remote monitoring data sources, such as the eICU database, have a strong potential to advance the role of critical care telemedicine by serving as a testbed for secondary research as well as for developing and testing tools, including predictive and prescriptive analytical solutions and decision support systems. The resulting tools will also inform coordination of care for critically ill patients, intensivist coverage, and the overall process of critical care telemedicine.

Telemedicine in response to challenges of modern diabetology

Due to the steadily increasing number of patients with diabetes all over the world, access to specialist diabetes care is becoming difficult, especially in rural areas. Approximately 30% of diabetic patients do not achieve the target blood glucose values, which is certainly an important problem of modern diabetology, because it translates into late vascular complications of diabetes, lower quality of life and premature death. In response to the raising demand for diabetes care, technological solutions increasing the accessibility to healthcare professionals with a concomitant reduction of costs of such care may be very useful. In a view of the above, the contribution of continuously developing widely understood information and communication technologies (ICT) to an improvement of blood glucose control in diabetic patients has been recently evaluated in research studies. Phone consultations, remote blood glucose levels monitoring and video consultations are the most commonly studied telemedical interventions. Each of them leads to an increased accessibility to specialist diabetes care. Besides clinical trials, in real patients’ life there are many mobile health applications (apps) available which may be helpful in daily life diabetes management however raise concerns about regulation and approval, privacy, accuracy and safety. Contrary to cardiology, telemedical solutions in diabetology are not popular for commercial use yet, which is why patients and their physicians still have to wait for standardisation and appropriate legal regulations for telemedical interventions in diabetes care. Although as evidenced by clinical trials, such interventions translate into improved blood glucose control, lower costs of diabetes care and even a reduction of hypoglycaemia risk.