Definitions & Key Components

1. Definition of Telemedicine

Telemedicine is a subset of telehealth, and it refers to the use of communication networks to deliver healthcare services at a distance. The communication and networking technologies also vary, such as satellite communications, the internet, Global System for Mobile Communications (GSM). The COVID-19 pandemics led to such a need for socially distanced health care that telemedicine visits increased 683% at the height of the pandemic. It seems that telemedicine will permeate pervasively into healthcare delivery over time (CHIRON, n.d.).

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”. What we recognize as telemedicine today started in the 1950’s when a few hospital systems and university medical centers started to try to find ways to share information and images via telephone. In one of the first successes, two health centers in Pennsylvania were able to transmit radiologic images over the phone (WHO, n.d.).

When it comes to patients, the main benefits of telemedicine are less time away from work, no travel expenses, less interference with a child or eldercare responsibilities, privacy, and no exposure to other potentially contagious patients. On the other hand, in the case of providers, their benefits are an increase in revenue, improvement in office efficiency, better patients follow through and improved health outcomes, fewer missed appointments and cancellations, and private payer reimbursement. 

There are few limitations to how telemedicine can be applied. Some examples of how it is being used today are follow-up visits, remote chronic disease management, remote post-hospitalization care, preventive care support, school-based telehealth, and assisted living center support (WHO, n.d.). 

According to an economic forecast organization, the size of the telemedicine market was around $45 billion in 2019, and it is projected to reach $175 billion by 2026. The reasons for this growth are the increasing healthcare cost, geriatric population, government funding and grants for telemedicine, medical tourism, the prevalence of chronic and lifestyle-associated diseases, the medical requirement in remote areas, and the need for remote patient monitoring services in developing countries. In the European Union, five projects related to telemedicine are carried out. The scope of these projects is teleradiology, teledermatology, teleneurology, telemonitoring for diabetes and chronic heart failure, but there is no topic on education(Isights, n.d.).

2. Key components of Telemedicine

Teleconsultation, Telementoring, Telemonitoring, and Teleassistance are the key elements in Telemedicine.

2.1. Teleconsultation

Teleconsultation is defined as synchronous or asynchronous consultation using information and communication technology to omit geographical and functional distance (Deldar et al., 2016).

Examples:

1. Both sides are health providers [e.g., who may need a second expert opinion]
2. Physician–physician consultation
3. Physician–primary care provider (PCP) communication, like nurses
4. One side is health provider and another side is the patients [e.g., for tele-monitoring or tele-visiting]
5. Physician – patient relationship
6. PCP–patient relationship
7. Tripartite communication among physician – PCP – patient

2.2. Telementoring

Telementoring is mentoring that is carried out at a distance (usually online), when face-to-face mentoring is not possible (Telementor Guide, n.d.).

2.3. Telemonitoring

Telemonitoring is the remote monitoring of patients, including “the use of audio, video, and other telecommunications and electronic information processing technologies to monitor patient status at a distance”(Meystre, 2005).

Examples:

1. Cardiovascular: Heart rate, Fetal Heart rate, Blood pressure, ECG, Pacemaker parameters
2. Hematologic: Coagulation (INR)
3. Respiratory: Pulse oximetry, Spirometry, Respiratory rate, CO2 production, O2 consumption
4. Neurologic: EEG, EMG, Intracranial pressure

2.4. Teleassistance

Teleassistance represents the act of a doctor to assist other health professionals at a distance in the performance of some medical act(IGI Global, n.d.).

3. Further considerations

Telemedicine applications can be classified into two basic types, according to the timing of the information transmitted and the interaction between the individuals involved—be it health professional-to-health professional or health professional-to-patient. Store-and-forward, or asynchronous, telemedicine involves the exchange of pre-recorded data between two or more individuals at different times. For example, the patient or referring health professional sends an e-mail description of a medical case to an expert, who later sends back an opinion regarding diagnosis and optimal management.

In contrast, real time, or synchronous, telemedicine requires the involved individuals to be simultaneously present for immediate exchange of information, as in the case of videoconferencing. In both synchronous and asynchronous telemedicine, relevant information may be transmitted in a variety of media, such as text, audio, video, or still images. These two basic approaches to telemedicine are applied to a wide array of services in diverse settings, including teledermatology, telepathology, and teleradiology. The majority of telemedicine services, most of which focus on diagnosis and clinical management, are routinely offered in industrialized regions including, but not limited to the United Kingdom of Great Britain and Northern Ireland, Scandinavia, North America, and Australia.

In addition, biometric measuring devices such as equipment monitoring heart rate, blood pressure and blood glucose levels are increasingly used to remotely monitor and manage patients with acute and chronic illnesses. Some predict that telemedicine will profoundly transform the delivery of health services in the industrialized world by migrating health care delivery away from hospitals and clinics into homes(WHO, n.d.).