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Telemedicine and teleconsultation in the future of healthcare

"We must use telemedicine and reach people in their homes, if not physically, with advice. It is indeed useful to speak to your doctor over the phone, but it would take the health care staff a more accurate assessment. However, many try to observe all the recommendations but get anxious when they start coughing or have a little fever.
Exclusively, we publish on our website a preview of the chapter dedicated to telemedicine and teleconsultation.
The Superior Health Council, in particular, identifies two types of telemedicine services: specialist telemedicine and Telehealth.
In turn, specialist telemedicine is divided into:
Television: it is the medical act through which the doctor interacts with the patient at a distance. The Internet connection must allow you to see and interact with the patient. The television can take place in real or deferred time. The diagnosis resulting from the visit can result in the prescription of drugs or treatments;
Teleconsultation is the diagnosis or indication of therapy in the absence of the patient's physical presence. This is a remote consulting activity between doctors that allows a specialist or a general practitioner to ask for a consultation with one or more professionals;
Health telecooperation: it is the assistance provided by a doctor or a health worker to another doctor or health worker. This is the case of a hospital doctor who remotely manages emergency rescue operations carried out on the ambulance.
Telehealth, on the other hand, concerns the systems and services that connect patients, especially chronic ones, with doctors to assist them in diagnosing, managing, monitoring, and assuming responsibility. Telehealth includes the exchange of data relating to vital parameters between the patients - from home, from the pharmacy or in care facilities - and a monitoring station; this practice can be used to make a diagnosis and support therapy management programs and to improve patient education. The category of Telehealth psychiatry services includes wearable medical devices, i.e., devices approved as medical instruments that can be used by the citizen-patient to measure the physical-clinical parameters. These devices can be considered simple health motivators and as support tools, allowing the automatic sending of vital values ​​to the doctor and their monitoring in real-time.
Teleservice does not appear in the Italian Guidelines on Telemedicine of the Higher Health Council, however, this term means a socio-assistance system for taking charge of the elderly or frail person at home, through the management of alarms that activate emergency services calls for help from a service center. Tele-assistance has prevalently social content and has blurred borders towards the health sector with which it must connect to ensure socio-assistance continuity. This is the case, for example, of the elderly who wears a bracelet with a button to send an alarm signal in the event of an illness. As soon as it receives the signal, the service center will contact the patient and immediately communicate the incident to the health professionals.
Another example of remote assistance is home automation devices installed in the homes of people with reduced mobility, which automatically sends alarm alerts to a list of pre-established contacts in the event of a fall.


The term telemedicine has a number of meanings. The World Health Organisation describes telemedicine as 'a provision of treatment and assistance where distance is a vital factor for sharing knowledge useful for diagnosing, managing, avoiding, carrying out testing, assessing and maintaining training of healthcare professionals, through information and communication technologies.'
One of the most exhaustive definitions of telemedicine is the one proposed by a group of experts from the European Commission according to which it is "The integration, monitoring, and management of patients, as well as the education of staff and patients, using systems that allow prompt access to expert advice and information about the patient, regardless of where the patient and the information are. " Therefore, telemedicine not only has the purpose of ensuring medical assistance to patients far from health centers but also and above all of adapting and updating national health systems (in particular emergency services), of organization and health education, of teaching and professional training. All this is realized through remote home assistance, specialist teleconsultation,
Therefore, telemedicine is indicated in many quarters as one of the keys to responding to the phenomena that are putting health systems under pressure: the increase in demand for social and health services due to the aging of the population; the growth of chronicity; the continuous increase in the costs of healthcare services; the employment dynamics of clinical professionals. The use of telemedicine would facilitate:
  • the provision of individual services;
  • the timeliness of treatment by reducing the waiting period;
  • the efficiency of specialist consultancy avoiding waste, including that related to equipment, supplies, and energy;
  • equity in access to care, providing healthcare also in peripheral areas.
But what is the real spread of telemedicine? The research carried out so far shows that its application is very variable territorially both within each country and between one nation and another.
An emblematic example comes to us from Norway, also for territorial reasons, in this Northern European country, telemedicine is used quite extensively in all regional health areas and in 68% of hospitals, especially in the form of teleconsultations through videoconferencing.
It should also be emphasized that the devices used for telemedicine (telephone, e-mail, and video screens), verbal contents, and direct and indirect relationships with healthcare personnel - the presence or absence of a professional capable of relating with the patient - significantly affect the use and effectiveness of this method of clinical intervention. The differences in telemedicine practices do not allow to support certainty and, in a generalized way, the negative or positive effects of this medical technology on therapeutic relationships. Therefore, considering such a limited and sporadic telemedicine application.
Telemedicine has a modern way of operating to re-configure working procedures, culminating in a variety of improvements in teamwork, job methods, and power ties. The technical devices are built based on typical use models and the end consumer and users' information.
In reality, the models of use, inscribed by the designer in the technological device, come to life only in the context of the daily activity of the users: that is when once the digital instrument is put into operation, it interacts in complex ways and fits into the of existing work practices. The result is the start of a negotiation process between innovation and work, the result of which is, on the one hand, the real use of the device and, on the other, the production of change in the practice of work. This adaptation is necessary to favor the implementation of the technology and its development, if this were not the case, the device would be rejected and its potential.


Let us now look at the degree to which teleconsultation, i.e., the evaluation of patients who do not have the same role as the doctor, is carried out through the remote transfer of data provided by diagnostic instruments. Teleconsulting shifts medical practises, particularly when done in a multidisciplinary setting.
What and any adjustments does teleconsultation require of healthcare professionals? It involves a delegation of tasks: a large number of clinical and technical gestures are delegated to the health care team present in the place where the patient is. These new forms of delegation are based above all on trust in the professional (delegate) skills, in which delegation can take place between professionals at different levels of the medical or paramedical hierarchy. For the delegating physician, teleconsultation involves translating knowledge and activities often tacit in his daily activity into verbal language. It should also be considered that not all specialists are ready to delegate some of their clinical actions and, conversely,
Therefore, if the delegation is theoretically possible, the specialist must accept the principle of entrusting other colleagues some actions at the center of his professional identity, which allows him to formulate a judgment on the patient's condition. Professional culture could represent a resistance factor to teleconsultation because of the rituality of reassuring practices for the doctor risks colliding with the delegation's tasks.