Making a virtue out of necessity: this is what is happening with telemedicine in Italy, even if in a still rudimentary way.
The guidelines addressed to GP regarding the behaviour to be adopted towards their patients with regard to the Coronavirus epidemic contain (for the first time in the history of Italian Healthcare) an explicit reference to the opportunity to make “virtual” visits through the telephone, with the aim of reducing the use of the outpatient clinic and the consequent risks of contagion to a minimum.
The prefix “tele” officially enters the language of the institutions, associated with the noun “visit”, even if it refers to the dear old telephone. However, a significant step forward.
It is important that the ISS and the Ministry have prepared a timely tele-visit protocol, with a list of questions and a pre-established route based on the answers received. They are taking it seriously this time.
At the same time, in these days hospital facilities located in the areas so far affected by the contagion are using tele-consultation to involve specialized structures in order to improve the appropriateness of the diagnosis and treatment of “doubtful” patients, those who do not manifest obvious symptoms but are positive for the swab.
More generally, the entire scientific and clinical community worldwide uses information and telecommunications technologies to exchange information, protocols, guidelines. The information has to travel faster than the virus, so we privilege fast channels able to reach as many recipients as possible in a very short time.
A highly critical situation such as this one of the COVID-19 epidemic is producing some interesting and positive effects with respect to the current scenario of delay in the adoption of ICT technologies and telemedicine tools in Italian Healthcare.
The Ministry recommends the phone as a physician-patient communication channel, but many GPs already use Skype-like platforms to add patient viewing to the set of information available over the phone. Maybe the Privacy Guarantor will have something to say, but it must be said once and for all that channels like Skype are already widely used for consultations between professionals and also in the daily contacts between GP and patient.
Probably you should use something more secure from the point of view of security of the transmission channel and confidentiality, but until the market develops and proposes “this thing” you make do with what there is.
The positive thing is that in these days of alarm everything that begins with “tele” is acquiring a new dignity, starting with the telework proposed by many companies to give their employees the opportunity to work from home, avoiding risky trips.
In a way it is a pity that “tele something” becomes popular and is accepted in a critical situation at the limits of the dramatic, but perhaps it is better than ever.
Television and teleconsultation are two practical applications of telemedicine that can help hospitals and outpatient facilities to solve in the first place the problem of access by citizens who want to understand if and how much they may need diagnostic insights on COVID-19 infection, a sort of specific tele-triage. But more generally, tele-triage could also be useful for chronic at-risk patients (COPD and cancer patients, above all) regardless of fears about the virus: these days (and unfortunately nothing makes us think that this criticality lasts very little) it is better that those who have serious respiratory problems or oncological pathologies limit to the minimum necessary to leave home and access health facilities.
Tele-rehabilitation could also be seriously considered by those who provide rehabilitation services to chronic patients, always with the aim of reducing exposure to the possibility of infection to the indispensable.
Technologies offer possibilities, it is up to all of us to try to make the most of them and apply them to problem-solving. And it is up to the market to come up with intelligent solutions to complex and – unfortunately – sometimes dramatic problems.
Paolo Colli Franzone
President IMIS – Institute for the Management of Innovation in Healthcare