Successful Models for Telehealth

The global pandemic of severe acute respiratory coronavirus 2 (SARS-CoV-2), which causes the novel beta coronavirus 2019 disease (COVID-19), has become an unprecedented medical, economic, and psychosocial crisis. The pandemic and its management strategies have resulted in immense challenges for health systems, not only in caring for those with COVID-19 but also in the ongoing management of chronic medical conditions. Kidney transplant recipients present a unique challenge given their need for ongoing monitoring and management as well as their higher risk of COVID-19 infection. In the absence of clear guidelines, it is unclear how to best provide routine care to this unique patient population during the pandemic. Rigorous medical and psychosocial patient-centered risk stratification strategies are needed to avoid adverse outcomes in stable solid organ transplant recipients. This review will focus on the challenges faced by kidney transplant recipients and health care providers and provides strategies to address these issues.

The adoption of telemedicine into mainstream health services has been slower than expected. Many telemedicine projects tend not to progress beyond the trial phase; there are a large number of pilot or project publications and fewer ‘service’ publications. This issue has been noted since 1999 and continues to be acknowledged in the literature. While overall telemedicine uptake has been slow, some services have been successful. The reporting and evaluation of these successful services may help to improve future uptake and sustainability. The aim of this literature review was to identify peer-reviewed publications of deployed telemedicine services in hospital facilities; and to report, and appraise, the methodology used to evaluate these services.

Computerised literature searches of bibliographic databases were performed using the MeSH terms for “Telemedicine” and “Hospital Services” or “Hospital”, for papers published up to May 2016.

A total of 164 papers were identified, representing 137 telemedicine services. The majority of reported telemedicine services were based in the United States of America (n = 61, 44.5%). Almost two thirds of the services (n = 86, 62.7%) were delivered by real time telemedicine. Of the reviewed studies, almost half (n = 81, 49.3%) assessed their services from three different evaluation perspectives: clinical outcomes, economics and satisfaction. While the remaining half (n = 83, 50.6%) described their service and its activities without reporting any evaluation measures. Only 30 (18.2%) studies indicated a two-step implementation and evaluation process. There was limited information in all reported studies regarding description of a structured planning strategy.

Our systematic review identified only 137 telemedicine services. This suggests either telemedicine service implementation is still not a part of mainstream clinical services, or it is not being reported in the peer-reviewed literature. The depth and the quality of information were variable across studies, reducing the generalisability. The reporting of service implementation and planning strategies should be encouraged. Given the fast paced technology driven environment of telemedicine, this may enable others to learn and understand how to implement sustainable services. The key component of planning was underreported in these studies. Studies applying and reporting more rigorous methodology would contribute greatly to the evidence for telemedicine.

The adoption of telemedicine technologies has enabled collaborative programs involving a variety of links among distributed medical structures and health officials and professionals. The use for telemedicine for transmission of medical data and the possibility for several distant physicians to share their knowledge on given medical cases provides clear benefits, but also raises several unsolved conceptual and technical challenges. The seamless exchange and access of medical information between medical structures, health professionals, and patients is a prerequisite for the harmonious development of this new medical practice. This paper proposes a new approach of semantic interoperability for enabling mutual understanding of terminologies and concepts used. The proposed semantic interoperability approach is based on conceptual graph to support collaborative activities by describing how different health specialists can apply appropriate strategies to eliminate differential medical diagnosis. Intelligent analysis strategies are used to narrow down and pinpoint medical disorders. The model proposed is fully verified by a case study in the context of elderly patients and specifically dealing with synucleinopathies, a group of neurodegenerative diseases that include Parkinson's disease (PD), dementia with Lewy bodies (DLB), pure autonomic failure (PAF) and multiple system atrophy (MSA).