Online Medical Consultations using a Clinical Telemedicine Software

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 classification is no longer applicable due to the presence of X-ray facilities which were not available when Pott’s classification was conceived.

Legal sector pressures on the Personal Injury Assessment industry have enforced need of objective confirmation of physical findings before taking a patient to operation theatre. Taking example of operating for Anterior Cruciate Ligament (ACL) damage (a common sports knee injury) would be a good one to quote here as now it is mandatory in several western countries to have an MRI scan before operating on a ruptured ACL since physical findings such as a positive anterior draw sign being an operator dependent method can have a varying degree of inaccuracy.

Clinical Decision Support System

After taking the medical history, the clinician should review the medical notes and investigations followed by the carrying out of a visual medical examination. Then further tests might need to be ordered, or a prescription provided for the patient. In some cases, referral to another relevant medical colleague may be necessary, a facility which an efficient Telemedicine system should be designed to provide. MRI Scan support before operating on a ruptured ACL gives a surgeon a grounds to defend upon on the accuracy of need to operate.

A well-designed Clinical Telemedicine System has an embedded auto-dispatch screen with option to choose from several Labs for the speedy transit of requested investigations.

Auto-summary of the Patient-Clinician Encounter

Telemedicine software should have this embedded feature integrated using AI for various elements of the observations and comments recorded by the clinician during or after the consultation, creating an auto-summary of the patient-clinician encounter.

Such an auto-summary of the Teleconsultation should then be kept as a record of the patient-clinician encounter for future reference.

An efficient Telemedicine System for General Teleconsultation