Telemedicine

from Wikipedia, the free encyclopedia

The telemedicine is a partial area of telematics in health and designated diagnosis and therapy while bridging a spatial or temporal ( "asynchronous") distance between doctor ( Tele doctor ), therapist (Tele therapist), pharmacist and patient or between two consulted physicians by means of telecommunication .

history

The first application of telemedicine is considered to be a banal event on March 10, 1876. The British inventor Alexander Graham Bell accidentally spilled acid on his suit while working with his patented "telephone apparatus" and used the device to control his - in the next room - Call colleague Thomas A. Watson for help. While the distance for this first medical emergency or long-distance call was only a few meters only 130 years ago, telemedicine has developed into an instrument that enables the ground staff of the American space agency " NASA " to carry out medical monitoring and care for those in the Astronauts located in the thermosphere - in real time!

aims

The goals of telemedicine are

  • improving the health of citizens by providing vital information - possibly also between countries - using e-health services,
  • improving the quality and accessibility of medical care by integrating e-health services into health policy and by coordinating the political, financial and technical strategies of EU countries,
  • creating efficient, user-friendly and widely accepted e-health services by involving professionals and patients in strategy, design and implementation.

General

Telemedicine (explanatory video)

Telemedical procedures have been tried out on a larger scale since the 1980s. The driving force behind telemedicine is a spatial separation of doctor and patient or doctor and specialist, as in space travel (here also telemetry), during expeditions ( Arctic , Antarctic ) or in military operations. Even large countries with a small number of inhabitants in remote areas saw a need for telemedical applications early on. For this reason, much research has been done in Norway . In addition to telemedicine, there are also other forms of care, such as the Flying Doctors from Australia . Telemedical rehabilitation offers enormous advantages, especially when it comes to the quality of care . The patient exercises at home under the supervision of therapists whom he already knows from his stay in the specialist clinic . With telerehabilitation , comprehensive rehabilitation aftercare is also possible outside of metropolitan areas. There are no trips to the therapy facility. Patients who have already returned to work after their inpatient rehabilitation measure can complete their exercises while they are working as they choose.

In medically well-supplied areas, telemedicine is used with the aim of improving quality, for example by obtaining a second opinion, and also to improve the quality of life of patients by saving trips to the doctor or to prevent emergencies by means of monitoring. Telemedicine can thus provide an answer to the medical challenges of our time, which is characterized by an aging society and chronic diseases. The use of ICT in the medical field is already being implemented in individual projects, but is only finding its way into standard care to a limited extent. In order to meet the current medical challenges, however, comprehensive telemedical care for the entire population is necessary. Despite a large number of projects, only a few have been included in standard care, which is why we speak of pilotitis in this context in the telemedicine area. Telemedicine can also make a contribution to improving training, further education and training .

A three-part randomized study by the Group Health Center for Health Studies in Seattle has shown that the success of the treatment is not just based on improved technical conditions . According to the publication in the US medical journal JAMA in June 2008, only the patients with direct personal Internet counseling experienced a statistically significant increase in therapy success (adjusted relative risk of improved blood pressure control: 3.32; 95 percent confidence interval 1.86 -5.94). In view of these and similar research findings, a "substitution of the personal doctor-patient exchange, which is very important for the healing process, by telemedicine (...) is neither sensible, let alone seriously wanted." Telemedicine is often misunderstood, it is not the use of electronic devices and Software, but a new form of treatment using a new medium. Such treatment methods must obey precisely defined rules and their effectiveness must be proven - not just work technically. In addition to the medical and legal requirements, you need a business management concept for service providers and service providers that is transparent, valid and comprehensible. There are new approaches in which the core element is a personal and confidential interaction between doctor / therapist and patient, i.e. in which telemedicine supports and helps to expand the treatment interaction between practitioner and patient. As in any doctor-patient relationship , “taking care of” is an important part of this.

The 113th German Medical Association declared: "Telemedicine supports medical action - but does not replace it!" And stated that "telemedicine is not an instrument to replace medical competence".

Telemedicine is not an instrument to undermine quality standards of conventional medical treatment. Telemedical procedures should only be used if conventional methods are not available or can only be made available with a disproportionately high level of effort, taking into account the specific requirements of the procedure, the place and time of use. Telemedicine and conventional medicine require the acceptance of the doctors involved and must not be viewed as opposites. Telemedical applications support medical action and should be viewed as supplementary components of conventional care scenarios that can contribute significantly to increasing the quality of care .

As of April 1, 2017, the EBM was expanded to include the fee schedule items (GOP) 01439 and 01450 relating to the care of a patient as part of a video consultation . At the same time, it was determined for which clinical pictures a video consultation is possible to monitor the progress. In May 2018, the German Medical Association decided to change the model professional code for doctors, which allows only remote treatment by doctors based in Germany via digital media. Medical care in diagnostics, advice, therapy and documentation must be guaranteed, and patients must be informed about the online treatment. In connection with the corona pandemic, the National Association of Statutory Health Insurance Physicians published information on video consultation hours in 2020. These apply to doctors and psychotherapists. “The video consultation is just as uncomplicated as a normal consultation. The technology relies on standard devices, which are often already available: Internet connection with firewall, screen (monitor / display), camera, microphone and loudspeaker. ”The quantity restrictions were temporarily lifted for the second quarter of 2020. “Usually, doctors and psychotherapists are only allowed to treat a maximum of one in five patients per quarter exclusively via video. Only 20 percent of the benefits may be conducted via video consultation. "Stand March 30, 2020 was the National Association of Statutory Health Insurance Physicians total certified 21 providers for video consultations (KBV), Booth 16.06.202 there were 34 providers.

application areas

Challenges

Telemedicine faces medical, technical, organizational, economic and legal challenges as well as subjective concerns:

Medical challenges

Telemedicine is not necessarily related to telematics, but always to medicine and has to meet their basic requirements. This includes the efforts of the various health service providers [such as B. doctors, mobile nurses, physiotherapists and the multitude of other health professions] to maintain health, i.e. (according to the World Health Organization ) a "state of perfect physical, mental and social well-being and not the mere absence of illness or ailment" for the patients to be cared for or restore. From a medical point of view, there may be a local division of labor, where z. B. patient, examining medical professional (such as a radiology technologist ) and specialist are not in the same place, but are connected to each other by a common medical treatment order. From a medical point of view, it is essential that the specific tasks, duties and rights for the various professional groups involved are transparently defined for the patient and carried out in a quality-assured manner. All of the sub-aspects listed below are intended to help provide the best possible support for the core medical processes. The use of modern information and communication technologies has created numerous new opportunities, but also risks, for this form of medicine. Internet- and telemedicine-based follow-up care: Investigation of the effectiveness of the follow-up care concepts IRENA and EvoCare teletherapy for patients with diseases of the musculoskeletal system in relation to physical parameters. Rehabilitation aftercare at home: study proves the effectiveness of tele-rehabilitation aftercare is now an optional component of the care of orthopedic patients at DRV Bayern Süd. The medical journalist Martin U. Müller spoke out in April 2020 in favor of introducing a kind of additional designation for doctors who treat patients telemedically. It requires special skills to remotely diagnose certain diseases.

Technical challenges

Telemedicine means the use of means of communication and thus includes the requirement of interoperability between communication partners. In recent years, for example, B. Established video conference standards. However, the technical effort is sometimes high, especially when radiological modalities (NMR) have to be connected to distant workstations and archives using the DICOM standard. Another problem is the data quality, which can be changed by the extraction of the data, its forwarding or the compression of data. Telemedical procedures should therefore be clinically validated. Due to the extremely restrictive regulations for the transfer of patient data , ensuring data protection is a challenge for telemedicine. As a rule, personal data may only be exchanged anonymously or pseudonymized . Technical solutions for this are also encryption of the data stream, which, however, require the sender and receiver to be appropriately equipped. Ease of use of the devices is important: Another hurdle for telemedicine is the usability of the technologies required for this - especially for older people. This group has had relatively few points of contact with such devices so far. This is particularly important for the chronically ill, as the patients have to use the corresponding devices independently, mostly in their own home. Older people in particular often have difficulty seeing, hearing or dexterity. This must be taken into account when designing the displays and operating elements. Additional controls are also important in order to avoid incorrect applications.

Organizational challenges

The communication partners must agree on how the data exchange should take place. Fixed times are to be agreed for synchronous transmission. This cannot always be guaranteed in everyday clinical practice. Teleconsultation also requires documentation of what u. U. leads to additional work. Malfunctioning processes are a major cause of medical error . It has long been known that in medicine, as an "action science", the process quality (the quality of the treatment procedures) is much more important for the therapy result than the structural quality (for example the equipment of a facility). This is confirmed, for example, by analyzes of faulty treatments, which in an estimated 70 percent of cases can be attributed to inadequate process quality. In particular, coordination problems between those involved, deficiencies in documentation, transition problems or a lack of therapy guidelines can lead to treatment errors. In recent years, structured procedural aids such as guidelines and so-called treatment pathways have gained in importance. It is hoped that they will increase the quality of the treatment processes. It is particularly important for the service providers and service providers that the treatment is subject to the applicable guidelines , quality-assured processes and certifications .

Economic challenges

Telemedicine causes fixed costs (hardware and software costs) and operating costs (connection costs, personnel costs). The question here is who will bear these costs. In many places, remuneration and billing are still an obstacle to the introduction of telemedicine. Many funded projects are therefore no longer operated after the funding period. For the establishment of telemedicine, in addition to effectiveness, economic efficiency must also be proven. The EvoCare method has been recognized by health insurers - after proof of effectiveness and profitability has been given - and is billable as a standard care. It is the first reimbursable digitized health service.

Legal challenges

In general, a “first opinion” is differentiated from a supplementary second opinion. While the second opinion causes fewer legal concerns, an initial opinion based purely on telemedicine can be legally problematic. Such a situation can e.g. For example, if there is no specialist on site and the diagnosis is carried out solely through a telemedical consultation from a remote specialist. The data quality is also decisive for the legal assessment. A validation of the procedure should therefore be carried out. It is controversial whether there is a remote treatment ban . The "prohibition of exclusive remote treatment " is not a law, but the content of the professional code . The origins are probably in a Reich law to combat sexually transmitted diseases from 1927; it was about regulating that doctors are not allowed to treat syphilis or gonorrhea remotely. Nowadays, data protection in particular plays a major role.

Germany

In Baden-Württemberg , the Telemedicine Laboratory was operated as a model project based on an exception regulation by the Baden-Württemberg Medical Association . In the meantime, the ban on remote treatment has been lifted nationwide by the Medical Association, so that there is no longer any need for an exception. Only corresponding psychotherapeutic services cannot be billed through the statutory health insurance companies. This restriction was also lifted due to the COVID-19 pandemic in 2020.

Switzerland

From August 9, 1999 to June 7, 2018, the University Hospital Zurich (USZ) offered clinical telemedicine and online medical advice on the Internet. A team of doctors answered around 2500 anonymous questions each year, usually within 24 to 48 hours. The team consisted of up to six doctors who are specialists in clinical telemedicine at the USZ and who have many years of experience, especially in internal and general medicine. During the entire period, 59,360 inquiries were sent and answered. The majority of users were female and an average of 38 years old. Over time, however, significantly more men and older people began to make inquiries. The variety of medical inquiries covered all categories of the international statistical classification of diseases and related health problems (ICD) and correlated with the statistical frequency of diseases in hospitals in Switzerland. Most of the inquiries were about unclassified symptoms and signs, reproductive services, respiratory diseases, skin diseases, health services, eye and nervous system diseases, injuries and disorders of the female genital tract. As with the Swedish online medical advice service, one sixth of the inquiries related to often shame and stigmatized diseases of the genitals, gastrointestinal tract, sexually transmitted diseases, obesity and mental disorders. By providing an anonymous space in which users can talk about (shame-laden) diseases, online medical advice services strengthen patients and their health literacy is promoted through the provision of individual health information. The service of clinical telemedicine and online advice at the University Hospital Zurich is currently being revised and will be offered in a new form in the future.

See also

literature

  • Erik Hahn: Telemedicine and remote treatment prohibition - an inventory of the current development. In: Medizinrecht (MedR) 36, 2018, doi: 10.1007 / s00350-018-4932-x , pp. 384–391 ( link-springer-com-443.webvpn.jxutcm.edu.cn PDF).
  • A. Gärtner: Teleneurology and requirements of the Medical Devices Act (MPG) . (PDF; 757 kB) Presentation of the safety standards in accordance with the Medical Devices Act and the relevant standards, taking into account the 3rd edition of IEC 601-1 for teleneurology from a technical point of view.
  • Peter Haas: Health Telematics: Basics, Applications, Potentials. Springer, Berlin 2006, ISBN 3-540-20740-6 .
  • Erik Hahn, Marcel Reuter: “Virtual doctor” - medical advice and information via email. KU Gesundheitsmanagement 2011, special issue IT in the hospital, pp. 26–29.
  • Achim Jäckel (Ed.): Telemedicine Guide Germany. In: Yearbook of Telemedicine 2008. 9th edition, Bad Nauheim 2007, ISBN 978-3-937948-06-5 .
  • Sabrina Heike Kessler, Sabine Schmidt-Weitmann: Diseases and Emotions: An Automated Content Analysis of Health Narratives in Inquiries to an Online Health Consultation Service . In: Health Communication . 2019, ISSN  1041-0236 , p. 1–10 , doi : 10.1080 / 10410236.2019.1673950 .
  • Christian Link: Telemedical Applications in Germany and France - A comparative legal study of the fundamentals and the liability structure as well as international private law - with a summary in French. Herbert Utz Verlag, Munich 2007, ISBN 978-3-8316-0731-0 .
  • Andreas Menn: How cell phones are becoming virtual nurses. In: WirtschaftsWoche. 17/2011, pp. 64-68 ( wiwo.de ).
  • Stephan Metzger: Legal aspects and perspectives of telemedicine - with special consideration of contract law. Helbing & Lichtenhahn, Basel 2009, ISBN 978-3-7190-2880-0 .
  • Reinhard Oeser: Project management from the client's point of view for the implementation of telemedical concepts. Diploma thesis Vienna University of Technology (1999) Download
  • Reinhard Oeser: Technology-dependent system observation method for the implementation of telemedical concepts. Dissertation TU-Vienna (2001) Download
  • Richard Wootton, Nivritti G. Patil, Richard E. Scott, Kendall Ho .: Telehealth in the Developing World. Royal Society of Medicine Press / IDRC, 2009, ISBN 978-1-85315-784-4 e- ISBN 978-1-55250-396-6 ( idrc.ca ).
  • Christoph Wendelstein: Conflict of laws problems in telemedicine - At the same time a contribution to the coordination of contract and offense at the level of European conflict of laws. Mohr Siebeck, Tübingen 2012, dissertation University of Passau, ISBN 978-3-16-152011-2 .
  • Thomas Wink: Telemedicine - developments, possible applications and economic potential in the health policy area of ​​tension between state regulation and marketability. In: Philipp Plugmann (Ed.): Future trends and market potentials in medical technology. Berlin 2011, ISBN 978-3-89574-778-6 , pp. 73-96.

Web links

Wiktionary: Telemedicine  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ German Bundestag of May 11, 2011: Current term telemedicine - definition and aim of telemedicine (PDF)
  2. ↑ European Commission Accessed on October 27, 2015: ( page no longer available , searching web archives: Strategy - E-health (eHealth) - EU goals: )@1@ 2Template: Dead Link / ec.europa.eu
  3. ^ TJ Eide & I. Nordrum. 1994. Current Status of Telepathology. APMIS 102 (12), pp. 881-890.
  4. ↑ Fit for the future with telemedicine. In: Kurzeitung from August 2015, p. 36 ( docplayer.org ).
  5. ↑ Federal Ministry of the Interior of October 2013: ( Page no longer available , search in web archives: IT Planning Council: Zukunftspfade Digitales Deutschland 2020 )@1@ 2Template: Toter Link / www.bmi.bund.de
  6. ↑ Deutsches Ärzteblatt, June 25, 2008: Hypertension: Personal contact also determines the success of the therapy on the Internet ( memento of the original from July 29, 2018 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.aerzteblatt.de
  7. ↑ See Thomas Wink: Telemedicine - Developments, possible applications and economic potential in the health policy area of ​​tension between state regulation and marketability , in: Philipp Plugmann (Ed.): Future trends and market potentials of medical technology , Berlin 2011, ISBN 978-3-89574-778-6 , P. 90
  8. ↑ DeviceMed from January 12, 2015: Participation in Germany's first reimbursable telemedicine provider
  9. ↑ a b Regarding item V of the agenda: Activity report of the German Medical Association: 1. Requirements for good telemedicine. German Medical Association, accessed on May 28, 2017 .
  10. ↑ Video consultation - New EBM nos. from April 1st, 2017. Institute for Knowledge in Business (IWW), March 1, 2017, accessed on May 28, 2017 .
  11. ↑ Doctors' Day relaxes the rules for online treatments. (No longer available online.) In: Zeit online. May 10, 2018, archived from the original on May 11, 2018 ; accessed on May 10, 2018 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.zeit.de
  12. ↑ Video consultation. National Association of Statutory Health Insurance Physicians (KBV), May 18, 2020, accessed on June 24, 2020 .
  13. ↑ Coronavirus: Information on video consultation hours (PDF). National Association of Statutory Health Insurance Physicians (KBV), March 27, 2020, accessed on June 24, 2020 .
  14. ↑ Oliver Löw: Video consultation: providers in direct comparison | Docrelations GmbH. In: Practice Marketing & PR | Docrelations GmbH. March 30, 2020, accessed on June 9, 2020 (German).
  15. ↑ Deutsche Rentenversicherung, scientific publication of March 11, 2014, DRV-Schriften, Volume 103, 23rd Rehabilitation Science Colloquium in Karlsruhe, page 268: Investigation of the effectiveness of the aftercare concepts IRENA and EvoCare teletherapy for patients with musculoskeletal disorders in relation to physical parameters (PDF)
  16. ↑ forward now - the magazine of the German pension insurance, Bavaria South, issue 4/2014, page 23: rehab aftercare for home. Study proves effectiveness of tele-rehab. (PDF) Retrieved October 31, 2019 .
  17. ↑ Christina Pohl, Olaf Heuser, DER SPIEGEL: Podcast: Visiting a doctor without the risk of infection - DER SPIEGEL - Health. Retrieved April 10, 2020 .
  18. ↑ cinc.org (PDF) M. Struck, S. Pramatarov, C. Weigand (2008): Method and System for Standardized and Platform Independent Medical Data Information Persistence in Telemedicine. IEEE Computers in Cardiology Proceedings. 35: 257-260.
  19. ↑ Deutsche Bank of January 27, 2010: Telemedicine improves patient care (PDF)
  20. ↑ Information system of the health reporting of the Federal Health in Germany from 2006 Quality management in the health system, 4.3.4 Certifications and guidelines (PDF)
  21. ↑ Kurzeitung from August 2015, pages 37–38: We bring health home
  22. ↑ PTA-News: GUB Investment Trust GmbH & Co. KGaA: GUB participates in telemedical service provider and software developer EvoCare, accessed on September 21, 2018 ( finanznachrichten.de ) /
  23. ↑ To the doctor without going to the doctor . Pure remote diagnosis is prohibited - for how much longer? In: Frankfurter Allgemeine Sonntagszeitung , June 15, 2014, p. 7
  24. ↑ Martin U. Müller : No contact on the web . In: Der Spiegel . No. 26 , 2016 ( online ).
  25. ↑ In the immediate distance . FAZ.net, March 26, 2018
  26. ^ Sabrina Heike Kessler, Sabine Schmidt-Weitmann: Diseases and Emotions: An Automated Content Analysis of Health Narratives in Inquiries to an Online Health Consultation Service . In: Health Communication . October 4, 2019, ISSN  1041-0236 , p. 1–10 , doi : 10.1080 / 10410236.2019.1673950 .
  27. ↑ G Umefjord, H Sandstrom, H Malker, G Petersson: Medical text-based consultations on the Internet: A four-year study . In: International Journal of Medical Informatics . tape 77 , no. 2 , February 2008, p. 114-121 , doi : 10.1016 / j.ijmedinf.2007.01.009 .
  28. ↑ Welcome to the University Hospital Zurich. Retrieved January 22, 2020 (Swiss Standard German).