Understanding telehealth and telemedicine

Telehealth and telemedicine

The beginnings of utilising telecommunications technology to bridge the distance between a patient and his doctor started more than a century ago. It was in 1905 when Dr. Willem Einthoven used the readily available telephone technology to transmit an electrocardiogram report to a hospital that is a mile away. Today, we see new and inventive ways to utilise telecommunications technology in the medical field.

With the rise of these innovations comes the introduction of new terminologies to ensure precise and consistent use of language or technical terms. Terms like telehealth and telemedicine are often used interchangeably but there are distinctions and this article will make their individuality clearer. When should you say "telehealth" and when should you say "telemedicine". Knowing the correct term to use will allow stakeholders like legislators, manufacturers, advocacy groups, and the public to be on the same common ground. More importantly, patients will receive the right type of service.

Both terms are now used to refer to utilising electronic communications to deliver medical services from a distance which is apt because the prefix "tell" means "at a distance". What would differ between the two is the scope of services, so let us now take a look at the specific definitions, characteristics, and services of each term.

What is telehealth care

Starting off with the broader of the two, telehealth covers any type of health care that is delivered digitally and remotely. This includes both remote clinical and non-clinical services. Clinical services refer to all medical services done by doctors in clinics and hospitals while non-clinical services include administrative and professional meetings of health professionals as well as training and continuing medical education. The World Health Organization even includes health promotion, surveillance, and public health functions. So, when the Prime Minister appears on your telly to talk about new policies about his government's health measures to combat the coronavirus pandemic, he is administering telehealth.

Telehealth affects many stakeholders in society and is not limited to a doctor and his or her patient. It is not a particular service but a collection of different services that ultimately aims to administer and improve health care and health education. Let us further consider the different modes under telehealth.

Telehealth may be an encompassing term but there are four particular ways of doing actual telehealth. These are Remote Patient Monitoring, Mobile Health, Video Conferencing, and Store and Forward.

Remote Patient Monitoring (RPM) utilises electronic devices to monitor, report, collect, transmit, and evaluate the health and medical data of a patient so their doctors can make informed choices. These electronic devices have increased in the past few years, so it is no longer limited to internet-connected computers but also wearable medical devices, mobile devices, and smartphone apps.

These devices function in varying levels of intervention, depending on the needed data. The device can take and send data regularly, or it can remind the patient to take and transmit the data. The most common devices are digital stethoscopes, otoscopes, ophthalmoscopes, wearable biosensors, and smartphone cameras. These devices can collect and transmit data like a person's blood oxygen level, blood pressure, glucose readings, cardiac stats, respiratory rates, and others.

Related to RPM is another mode, Mobile Health or mHealth. 95% of households in the UK have at least one mobile device, so it is no surprise that healthcare apps have grown in use and popularity for the past years. Mobile health uses mobile devices like smartphones, smartwatches, laptops, and tablets to obtain and transmit their health information and data. These applications can even set appointments and reminders and share information with doctors.

The third mode is Video Conferencing. This is quite popular nowadays as most meetings and reunions are held online now. But even before the pandemic has limited human contact, doctors have been providing medical assistance to their patients who cannot travel through video conferencing. This way, they can synchronously communicate; that is, in real-time. There are communication platforms that can support HD videos so a doctor can examine their patient with better resolution. Video Conferencing also supports continuous learning for people in the medical profession, so 50 doctors from different locations around the world attending an online conference to discuss recent trends, techniques, and information about their field of specialisation are considered telehealth.

The final mode is called Store and Forward. This refers to the act of capturing, storing, and transmitting patient data for healthcare. The data can come in the form of text, video, or images. This is considered an asynchronous mode since the interaction between the patient and doctor is not in real-time. This mode involves secured servers, storage, and routers to work.

As technology evolves, expect telehealth to continue evolving with it.

What is telemedicine

The World Health Organization (WHO) defines telemedicine as "the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities".

This lengthy definition, though, does not make a clear distinction between the terms telemedicine and telehealth. So for this article, telemedicine will be defined as the utilisation of telecommunications and information technology to provide remote clinical services. It involves using electronic devices like smartphones, tablets, and laptops with software, apps, and websites to provide the necessary clinical services to patients without the need for an in-person visit. Think of it as having an in-person visit to your doctor but you and your doctor are both doing it online.

Telemedicine is advantageous to treating patients who cannot regularly go to clinics and hospitals or who reside in places with little to no access to medical care. Telemedicine can also be used for follow-up visits, consultations, medical diagnosis, and medication management as these services can all be provided remotely. You can send your doctor a picture of your mole or wound so the doctor can make recommendations. Doctors can also use it to remotely monitor their patients after their surgery.

The best thing about telemedicine is that it eliminates borders and travel time as well since you can have a video conference with a specialist on another continent.

Differences between telehealth and telemedicine

The overlap between telehealth and telemedicine is by design. All telemedicine is telehealth since telemedicine is one component of telehealth. Both services use telecommunications technology, the internet, and software or websites.

To illustrate the difference between telehealth and telemedicine further, let us take a look at the four modes of telehealth again.

Most Remote Patient Monitoring services are telemedicine because it is actual clinical patient care. However, if a medical researcher is collecting a patient's daily step counts from the wearable or mobile device as data for a research project, then it is telehealth and not telemedicine.

Likewise, many forms of mHealth are telemedicine. It is still a close interaction between the doctor and his patient. However, if the government sends a text alert reminding you about proper precautions to prevent a disease outbreak, then it is not telemedicine but telehealth.

A video conference between a patient and his doctor about his particular case is telemedicine because it is a clinical service. A video conference between a doctor and his medical students is non-clinical so it is telehealth.

Finally, if a patient's file is being remotely accessed by his doctor, this is telemedicine. If the data being accessed is the latest academic publication about a rare disorder, then it is not telemedicine.

We can see from these differences that telemedicine is limited to clinical patient care while telehealth involves telemedicine and then some.

Telehealth, telemedicine, and NHS

The United Kingdom's National Health Service wants telehealth and telemedicine to become standard forms of patient care to save lives. Furthermore, they recognise that telehealth and telemedicine plus other developments like tele-coaching and self-care apps all have "the potential to transform the way people engage in and control their healthcare" so they can "manage it in a way that is right for them".

To do this, the NHS unveiled a plan in 2019 to do a long-term digital-first medical service for every UK citizen. This has five goals: empowering consumers, supporting healthcare providers, supporting clinical care, improving population health, and improving clinical efficiency and safety. They also unveiled the NHS app, where people can access their medical data and care providers. The NHS hopes to reduce the millions of annual in-person doctor visits. The NHS estimates that as many as 500,000 lives can be saved a year by helping them detect and treat chronic diseases earlier while improving and reducing health complications.

In the wake of the Covid-19 crisis, we have all experienced the rapid integration of digital technology in our lives. And this has made a considerable impact on healthcare delivery. The NHS was already digitally transformed even before the first case of the virus was reported. The pandemic became a catalyst for the completion of this transformation. Telehealth was instrumental to respond quickly and dynamically to the challenges of the pandemic. Furthermore, it has also allowed the continuation of health services despite following social distancing and travel ban protocols. This is the boon of telehealth and telemedicine.

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