Telemedicine falls within the sphere of ehealth and concerns the provision of care and health services by ICT, regardless of where the subjects involved (providers and users) are located. The term telemedicine indicates the digital evolution of traditional medicine: the computer and communication tools become a necessary support to the work of the doctor and to the health of the patient.
Telemedicine is considered a social and cultural revolution that simplifies the distance communication between doctor and patient and facilitates the provision of health services, from diagnosis phase to the therapy.
It is important to underline that telemedicine does not replace traditional medicine, but supports it thanks to new communication channels and new technologies. Here are the main benefits:
This is the definition of telemedicine given by the World Health Organization WHO:
“Telehealth involves the use of telecommunications and virtual technology to deliver health care outside of traditional health-care facilities. Telehealth, which requires access only to telecommunications, is the most basic element of “ehealth,” which uses a wider range of information and communication technologies (ICTs).
Telehealth examples include virtual home health care, where patients such as the chronically ill or the elderly may receive guidance in certain procedures while remaining at home. Telehealth has also made it easier for health care workers in remote field settings to obtain guidance from professionals elsewhere in diagnosis, care and referral of patients. Training can sometimes also be delivered via telehealth schemes or with related technologies such as ehealth, which make use of small computers and internet.
Well-designed telehealth schemes can improve health care access and outcomes, particularly for chronic disease treatment and for vulnerable groups. Not only do they reduce demands on crowded facilities, but they also create cost savings and make the health sector more resilient.”
There are many websites that offer various diagnoses, replacing the figure of the doctor: these enable people to be informed and search for the symptoms of illnesses on the Internet, as well as, electronically request a medical consultation direct to specialists in the field. Let’s see the other technologies that are becoming increasingly popular in the medical sector.
The application of innovative technologies, systems and procedures for the management of the clinical process, according to a logic of ehealth Service Management, allows to attenuate the trade-off between the level of service and the costs of implementation.
The potential of big data is already known to everyone. Experts have been discussing for some time about the benefits that medicine could derive from the use of this technology, especially in the diagnosis of rare diseases. The electronic storage of patient data would facilitate and speed up the comparison of data between similar cases, enabling more focused analyses and speeding up the diagnosis of a disease. Today, with the use of big data and deep learning techniques, doctors are able to offer effective preventive medicine, even before the onset of symptoms. This, especially for chronic diseases, is a significant advantage. Instant access to data makes it possible to predict the evolution of the clinical picture through support decision algorithms that make the entire process more efficient.
The technology of 3D printing is already changing the production model of many companies and is becoming increasingly important also in the world of medicine. In some universities experiments in this field can be observed: for example, a 3D print of a heart was made, in order to allow students to put into practice some operations. This technology is also widely used by researchers. Some of them created the first 3D printing of a kidney, and this could in the future allow the solution of cases of kidney failure.
ARTIFICIAL INTELLIGENCE AND VIRTUAL REALITY
Artificial intelligence is one of the most revolutionary technologies on which engineers and developers have been working for a few years. In the VR field, some hospitals already use or are working to use the viewers for the mixed reality of Microsoft, the HoloLens, for operations on the vertebrae, to help doctors to avoid mistakes.
THE EUROPEAN SITUATION
The change of approach in healthcare systems involves a different focus in the levels of care and in the health paths of the health market. Thus, in the field of care of patients, there is a shift from the centrality of the hospital to assistance at the citizen’s home, with an emphasis on prevention.
The European Commission, in the Policies of the European Union for Public Health, explains what online health care is:
“Digital health and care refers to tools and services that use information and communication technologies (ICTs) to improve prevention, diagnosis, treatment, monitoring and management of health and lifestyle. Digital health and care has the potential to innovate and improve access to care, quality of care, and to increase the overall efficiency of the health sector.”
In general, the economic burden deriving from the functioning of healthcare systems is becoming increasingly unsustainable. In fact, it absorbs on average 10.3% of the national GDP of the European Union and in Italy is about 9.1%. Chronic diseases account for 75% of medical expenditure, also due to the constant aging of the population.
In Italy, compared to other Western European countries, there has been a considerable delay in the start of this process, but concrete examples are not lacking. In June 2017, 45 telemedicine projects have been registered in Piedmont region. This is the result that was obtained from the survey conducted by the Piedmont Region – Health Department, in collaboration with IRES Piedmont (Istituto di Ricerche Economiche e Sociali – Institute of Economic and Social Research) – through the administration of a questionnaire to all Regional Health Agencies. The most common services in these centres are:
The majority of the initiatives concern the provision of care, above all in the cardiological and endocrinological field (for example diabetes).
Also, in Piedmont, in the municipality of Alba, a unique project started in Italy, in the treatment of kidney diseases and complex wounds. The program is called “Elvirus” and is a remote telemedicine model applied to peritoneal dialysis and vulnology (i.e.the treatment of complex wounds). The service allows patients to be able to provide their own daily therapy independently, thanks to a very simple training period and in direct assistance by the nurse connected via computer. This experimental organizational model allows a nurse to assist four patients connected from their home at the same time. The quality of life of the clients is improved and around 15 thousand euros a year are saved per user.
“The fundamental aspect of this organizational model – explains the director of the structure of Nephrology of Alba, Giusto Viglino – is that the patient can autonomously manage his own illness and burden less on family members, reducing also the risks represented by transfers to and returning from the hospital”.
From the beginning of 2017 in Lazio, the electrocardiogram of 419 patients was transmitted directly from the ambulances to the hospitals, allowing an optimization of the diagnosis and acceleration of the intervention, even before arriving in the emergency room.
In the meanwhile, other Italian municipalities are already making investments in telemedicine.
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