Source: Journal of Pakistan Society of Medicine - JPSIM
Author: Dr Suhail Chughtai FRCS - Telehealth Expert & Strategist
Telemedicine is defined as “means to connect a Healthcare provider to a care-recipient through one or more channels of Telecommunication without an in-person meeting between them.” In short, Telemedicine implies as a Virtual Medical Consultation over the Internet with a care receiver and a caregiver not required to be present at the same physical location.
Essential Elements of a Live Medical Teleconsultation
The basic elements can be summed as below, although with increasing level of sophistication, further layers are added:
· History Taking Interface
· Visual Medical Examination Window
· Medical Notes and Investigation Folders
· Clinical Decision Support System
· Auto-summary of the Patient-Clinician Encounter
History Taking Interface
An integral part of any patient-clinician interaction is the medical history-taking where a clinician assesses various symptoms of a patient to form a qualified medical opinion. Taking medical history involves asking questions about the present complaint, establishing its description, exploring relevant the past medical history of illnesses and surgical operations, the current medications the patient is taking, and other relevant critical individual information.
Visual Medical Examination Window
For common day-to-day medical practices, many conditions have nothing to show except for pain and discomfort. However, several conditions present with overt physical markers and are visible on the patient's skin or mucosa. At times, such findings can be one of the variety of physical signs such as muscle wasting, bony deformities, swelling of body parts, discolouration, pigmentation, particular patterns etc.
Visual examination can safely substitute for most of the physical examination requirements for several specialities, particularly in Psychiatry and Dermatology. With experience, a tactfully conducted visual examination can replace a physical examination to gain sufficient information for reaching a clinical opinion or differential diagnosis.
In specialities like Orthopaedics and Rheumatology, the active joint movements can be checked without needing to touch a patient and instructions given to a patient verbally, supported by self-demonstration usually would suffice, e.g., a doctor putting hand behind head asking patient to follow the same to assess external rotation of a shoulder joint.
The gap of information can be filled in by patients providing self-checked blood pressure,
temperature, and blood glucose readings. A large number of smart gadgets are now available for patients to use at home or through a Practice Assistant at a Telemedicine Spoke to provide additional medical information such as heart and lung sounds, live ECG, and even live ultrasound scanning, as well as high-definition imaging of skin, ear, nose, and throat or inside the eye.
Medical Notes and Investigation Folders
Advanced scientific developments empower clinicians to be supported by advanced medical investigations like MRI scans, nerve conduction studies and echocardiogram. These investigations are non-invasive and are of enormous value in diagnosing medical conditions to confirm or rule out several pathological entities.
The scientific evolution in the domain of medical investigations, have necessitated amendment of classifications of injuries taught in medical schools. In some cases, previously well-established classification of injury required to be abolished as they presented no additional value to the diagnosis.
Quoting Pott’s classification for ankle fractures serves to explain well here. This c