The keyword of any project must be interoperability: technological, organisational and clinical.
Good will is not enough. To introduce telemedicine in health services and processes requires an overall approach that cannot be limited to the mere introduction of a technological platform or to entrusting certain tasks to third parties.
Telemedicine must become part of the operational flows of prevention, assistance and patient care in a logic of integration of care. The technological platforms must be “interoperable by design”, i.e. natively conceived as a modular set of software components and services able to integrate with the information systems of local and hospital companies.
The systems with which these platforms must integrate are the CUP (work lists), the Clinical Repository (Electronic Health Dossier) and the Electronic Health File (document consultation), the electronic outpatient medical records (data and reports), the reporting systems (DSE – ESF reporting and feeding), the prescription systems (central or regional reception systems), those for the issue of certificates (INPS – INAIL), the administrative systems (ticket, reporting), and the management of the liberal profession.
Platforms must therefore be built around a “core” for interoperability, e.g. HL7 FHIR, 2.X and IHE. Many of them have instead been designed as self-contained application monoliths in which interoperability is seen as a marginal component. What I often hear when I am presented with these platforms is that “of course, the system can integrate with others”, not that the system is natively interoperable by design.
However, technological integration is not enough and is, all in all, the easiest to achieve. The real challenge is how to use and exploit the possibilities that telemedicine offers, by incorporating them into the processes and services of the NHS. I speak of a challenge because it is not only a question of thinking about the processes and services that exist today, but above all about those that could exist tomorrow thanks also and above all to telemedicine.
In other words, telemedicine is an enabling factor for developing new models of care integration. However, the problem is that, with few exceptions, these models exist on paper, mostly as theoretical concepts.
As far as technological integration is concerned, we see some attempts to outline an overall picture, such as, for example, the resolution of the Lazio Region that directs televisions within the information systems of healthcare companies.
On the other hand, with regard to organisational and clinical aspects, the tendency is to call for tenders to contract out some triage and monitoring services for chronic patients outside the NHS, sometimes with some form of care management. However, from an organisational and clinical point of view, there is little or nothing about how these should be integrated with NHS professionals. It is thought that the availability, i.e. access to the telemedicine platform by these professionals, can magically bring about the integration of care.
In other words, whether integration or technological sharing is sufficient to achieve integration of care. Unfortunately, this is not the case, there are no shortcuts or magic tools that, on their own, can solve the aspects related to responsibility, taking charge, and the division of tasks between the different care settings.