Telemedicine allows to create an intervention network in the territory that can assist and monitor patients using the available technologies. The advantages are considerable but in Italy this system is not widely used, let’s try to understand why.
What is telemedicine
The term telemedicine refers to the set of technologies and methods used to make diagnosis remotely. In particular, telemedicine is generally entrusted with the so-called second opinion, which means that data from diagnostic tools are sent to one or more doctors who are physically in distant places.
It is important to stress that the goal of telemedicine is not to replace traditional medicine but to support it. The ways in which telemedicine develops are basically 4:
- remote visit. The doctor visits the patient using communication systems such as Skype, Zoom and the like
- teleconsultation. Doctors confront each other on the diagnosis and treatment to be prescribed without the presence of the patient
- remote cooperation. In cases of emergency the doctor can help other doctors or healthcare professional
- telemonitoring. The parameters of patients with chronic diseases are monitored using special devices (IoMT). In the latter case, even apps can be used in order to remind the patient to follow the prescribed care or to enable alerts that allow to improve his or her lifestyle
Which are the benefits of telemedicine?
When talking about the benefits of telemedicine, one often refers to the economic impact it can have on the National health service. The economic factor is certainly one of the most important to consider, especially when the average age of the population is increasing as well as the number of patients suffering from chronic diseases. In these cases, telemedicine can significantly reduce the access to already crowded facilities and allow to monitor the patient while staying at home.
There are other positive aspects related to telemedicine to consider, such as the possibilities to:
- break down geographical and temporal barriers, allowing an homogeneous distribution of health care provision on the territory
- provide tools to facilitate the communication and the interactions among doctors and between the doctor and the patient
- reach more people, including those living in remote areas or living in areas without adequate health facilities
- assist the chronically ill or the elderly directly from home
- speed up bureaucratic-administrative procedures
- make it easier for the patient to search for and consult the doctor
- facilitate the telematic transmission of examinations and patient data
- view examinations online without losing image quality
- avoid long waiting lists
- reduce the access to already crowded facilities while saving costs
The economic impact of artificial intelligence in telemedicine
When considering the economic savings resulting from telemedicine, one immediately thinks about the reduction in the number of stays. Of course, as we have seen before, this aspect is very tempting, but it is also true that one must not fall into easy illusions: without intervention that can reduce costs and make the organisation more flexible there is no significant economic impact.
To stay on the cost optimisation side, the introduction of artificial intelligence with big data can bring great benefits, not only in economic terms but especially in the field of care, monitoring and prevention.
A medical software made ad hoc, for example, allows to monitor the parameters of thousands of patients in which data can be anonymised but made available for the purposes of medical research. Artificial intelligence and big data can create a synergistic work in which data is monitored at the same time and reused to generate new knowledge for medicine.
The potential is enormous, but to develop a coherent framework, the intervention of individual states and the European Union is undoubtedly necessary.
The Digital Single Market to promote telemedicine in Europe
In 2018, the European Commission sent an official communication to the European Parliament on the need to enable the digital transformation of health, to build an homogeneous system both to protect the right to health of European citizens and to promote the creation of a Digital Single Market for the development of e-health solutions.
Given the heterogeneity of the member states’ national health systems, three key points have been drawn up in order to be able to take the first steps:
- data access and secure sharing
- connecting and sharing health data for research, faster diagnostics and better health care
- enhancing individual assistance through digital services
The communication sent to the European Parliament was born as a reflection of the Commission following the report “Market study on telemedicine”. This study outlines all the most important aspects of developing a common telemedicine system, it looks at the state of the art and emphasises the factors that are holding back its development. It is not surprising that these include: the lack of adequate funds, the compatibility of e-health tools and poor ICT support.
Main barriers to telemedicine solutions
Fonte: Melchiorre M.G., Papa R., Rijken M., van Ginneken E., Hujala A., Barbabella F., eHealth in integrated care programs for people with multimorbidity in Europe: Insights from the ICARE4EU project, 2016.
Telemedicine in Italy: how it’s going?
Italy boasts the International Centro Internasionale Radio Medico (CIRM) founded in 1934 by Dr. G. Guida and a group of doctors with the aim of giving health care to men at sea. The first president was Guglielmo Marconi and today the institution is under the supervision of the Ministry of Infrastructure and the Ministry of Transport.
If you consider that in almost all cargo ships there are no medical or paramedical personnel, you can well understand how internationally known the CIRM foundation is for the emergency telemedicine service, which is completely free.
Apart from some excellence such as the foundation mentioned above, Italy is significantly behind in the use of telemedicine, but there is no shortage of concrete examples. As of June 2017, 45 telemedicine projects were launched in the Piedmont region. This is the result that was obtained from the survey conducted by the Health Authority of Piedmont Region in collaboration with IRES – Piedmont, through the administration of a questionnaire to all regional health companies. The most popular services in these centers include:
- teleconsultation, televisit and telehealth cooperation
- telemonitoring
- telerefertation, tele-assistance and tele-rehabilitation
The majority of initiatives are related to the provision of care in ordinary regime, especially in cardiology and endocrinological (diabetes).
A unique project in Italy has been started in the municipality of Alba (Piedmont, again) in the treatment of kidney diseases and complex wounds. The program is called “Elvirus” and is a model of remote telemedicine applied to peritoneal dialysis and vulnology (the treatment of complex wounds). The service allows the patient to provide for their daily therapy independently, thanks to a period of very simple training and live assistance with a telematically connected nurse.
This experimental organisational model allows a nurse to assist four connected patients from their home at the same time. This system improves the quality of life of patients and allows to save about 15,000 euros per user per year.
“The fundamental aspect of this organisational model – explains the director of the Nephrology facility in Alba, Giusto Viglino – is that the patient is able to manage his own illness and by doing this it burdens much less on family members, also reducing the risks represented by the transfers to and from the hospital”.
In Lazio, since 2017, the electrocardiogram of 419 patients has been transmitted directly from ambulances to hospitals, allowing an optimisation of diagnosis and rapid intervention, before the arrival in the emergency room.
In many cases, however, these are small-scale tests that fail to impose themselves on the entire national territory.
What to do about telemedicine in Italy
One of the reasons behind the low prevalence of telemedicine in Italy is the lack of digital literacy. A global direction able to promote technologies and economic development starting from public institutions is needed.
At the same time, a plan should be made in order to improve the training of doctors and nurses thanks to the promotion of systems related to the telemonitoring and the share of diagnostic information.