Telemedicine use for special case

Prepared by :
Prof. Abdulla Elmansoury
Dr. Ghada. Hadiia
ILOS :
By the end of this lecture student should be able to :
1. Discuss Telediabetes Concepts ,diabetic diary applications and evidence
supporting the telediabetes services.
2. Mention indicators which ensure telediabetes sustainability and main
barriers for implementation.
3. Explain teleemergency service concept, applications with emphasis on
rural area application, and Current and future trends.
4. Discuss most popular telemedicine applications that used in
teleemergency.
Telediabetes
one of several telemedicine services that has proven to
improve patients’ health and the delivery of health services to people with
diabetes.
Concepts and applications
The main goal of diabetes treatment is to optimize glycemic control , SO clinical studies have suggested a
number of action points, including:

Frequency of visits to a Regulations of insulin dose Continuous training Improved education

multidisciplinary clinic
Telediabetes program found sustainability with three indicators of success:
• The administration took a long-term view of the value of the telemedicine
service.
• Enabled structured use of staff time and facilities;
• Service delivery followed national diabetes standards and a well, defined cycle
of care within a long-term quality improvement program.
- According to the International Diabetes Federatio review we
still have a long way to go before every diabetes patient has
reached his/her treatment goals.
The review considered factors such as :
Feasibility/acceptability
Intermediate outcomes (service utilization and screening
adherence)
Health outcomes (glycemic control, lipid levels, body weight,
physical activity).
- This review concluded that :
There is consistent and strong evidence that telemonitoring
and telescreening had positive effects in glycemic controld &
reduction in body weight and contributed to an increase of
physical exercise.
Multiple studies have provided evidence supporting the equivalence of telediabetes
with in-person clinical visits.
 One paper reported that 79% of the patients did not find problems related to not meeting the
physician in real life.
 Self-management of diabetes is a complex task, which involves maintaining healthy blood glucose
levels through a balanced diet, physical activity, and medication (insulin) and success depends on
extensive monitoring of these parameters.
 A large number of tools have been developed for self-management of diabetes.
 We also have experienced that patient groups have taken initiatives themselves to develop advanced
tools , that are not (commercially) available.
 Users can easily view progression of daily blood glucose levels, their physical activity, and how they
are doing as compared with their set goals for blood glucose level, diet, and physical activity
 Automatically
transfers blood
The Diabetes Diary glucose and
physical exercise
Application data to the user's
smartphone.

Users can
record time of their
meals, or
description of what
kind of food they had.

information
about diabetes
and some
practical advice

Transfer health
values to HER OR
Healthcare
provider
Few Touch Application was renamed:
“Diabetesdagboka” (Norwegian)
or
“Diabetes Diary” (English).

The functionality of the Few Touch application is described

Automatic data transfer
Entry of nutrition data
Motivational information.
 Automatic data transfer:
• To capture blood glucose
data and exercise data
• To optimize usability, data
from these sensors is
automatically transferred
using a “no-touch”
principle. ‘
• A more recent version
includes the possibility to
record data from
continuous glucose
monitor CGMs.
Entry of nutrition data:
The users can record their
food intake using two
different levels of detail:
(a) a simple choice of the
kind of meal
(b) choosing the kind of
food they eat This design
has been chosen to make
the data entry process as
easy as possible
Thus the process requires
only two or three screen
touch or navigation
moves.
Motivational information.
Daily tips and information
related to practical
situations, that is,
information that is
sufficiently “down to
earth,”
aim is to motivate and
educate the user.
Newer functionality
includes the possibility to
reflect upon the
development of the
glucose level
A systematic review of telediabetes services within indigenous communities based on findings from
the United States, Canada, Australia, and India identified several enablers of telemedicine, including:
• the use of cultural and spiritual elements
• acknowledgement of local beliefs and traditions
• appropriate community engagement
• Another success factor was the participation of indigenous health workers since they spoke the local
language and could help clinicians to better understand the local community.
The main barriers of telediabetes services included
• Lack of technical skills associated with the operation of telehealth equipment
• Lack of availability of local staff
• Potentially high fail-to-attend rates

They argued that the understanding of the enablers and barriers related to healthcare services in
indigenous communities is essential when planning a telediabetes service
Twenty years ago, I recall a series of
frantic calls to the doctor, a rushed cab to
the hospital, and almost a month of
painful dressings for my cousin when she
burned her foot.
Then 5 years ago, in a similar episode,
telehealth accelerated the healing process
for a friend.
A With the severe and time-sensitive
nature of ED-related injuries, a simple
teleconsult can often be lifesaving.
Concepts and applications:
- Telehealth is especially useful in emergency care, where time
is of the essence.
- In 1995 the Global Emergency Telemedicine Services was
launched collectively by the Ministries of Health in France
and Italy.
- That initiative was aimed at providing an immediate
telemedicine-based response to any emergency situation
globally.
- Since then, applications of telemedicine in emergency
medicine have progressed from improving emergency
response in rural settings to reducing patient load in urban
hospitals thereon to video consults directly to the patient’s
home
- Rural areas in particular suffer from the
drawback of lack of access to timely care.

- Rural areas had a higher tendency than

urban areas to utilize telemedicine in
emergency care.

- So Telemedicine can go a long way

towards addressing this socioeconomic gap.
Most popular teleemergency applications:
• Teleradiology :
or transmission of digital images was one of the
earliest and most effective applications in
emergency.
• Teleconsult:
to specialists from emergency departments in an
effort to improve patient care and decision-making
regarding transfers to a specialized trauma center.
• Remote patient monitoring :
Vitals of the patient in an ambulance can now be
remotely monitored by the hospital, saving crucial
time and enabling the hospital to provide the best
possible care in the shortest possible timeframe.
One particular hospital in New York, the United States,
introduced teleconsultation as an option in the ED.
 The advantages of this process are that it
significantly cuts down on the wait time for
the patient (as much as 75% sometimes)

 decreases burden in the ED,

 frees time for the on-call doctors to see

more urgent cases.

 Early surveys have shown high satisfaction

scores among patients with this process

 A number of hospitals in the United States

are now implementing similar programs in
their emergency departments.
Virtual Urgent Care App
Software and apps now exist that make even a visit to
the ED unnecessary.
 It is now possible for the patient to connect with an ED
physician from his home and receive a consult within
minutes.
 The On Demand Virtual Urgent Care App provides patients
with immediate access to an ER physician for a teleconsult.
If the symptoms are sufficient for the physician to make
a diagnosis, the patient can skip hospital visits and
directly pick up a prescription from the pharmacy,
saving time and cost, decreasing burden in the ED, and
allowing appropriate care delivery to the sicker
patients.
Such an app was recently launched in a New York
hospital.
Current and future trends :
A 2015 report of a survey done in India, found: emergency telemedicine systems to
be :
Cost-saving
Time-saving
Effective as in-person examinations by both healthcare providers and patients.
Recent studies on tele- emergency in developed countries have shown :
High levels of user satisfaction for the patients and the healthcare professionals, in
terms of quality of care, interaction, and health outcomes.
The rate of return to the ED, after evaluation through a teleconsult, was observed
to be similar to a regular visit, indicating similar rates of success.
These studies however have been limited in their
approach due to the dynamic nature of the ED and
limitations of scales for measuring qualitative
patient outcomes.

While these studies hypothesize an expected cost-

benefit for both patients and providers, in terms of
reduced visits to the ED with increased teleconsults,
the same is yet to be evaluated.

More rigorous and methodological studies are

needed to identify both strengths and limitations of
the current approaches in teleemergency.
Reference :
1. Shashi Gogia (2020), Fundamentals of Telemedicine and Telehealth
2. 369. Sharma R, Gordon J, Greenwald P, et al. Revolutionizing the delivery of care for ED patients. NEJM Catal. 2017.
https://catalyst.nejm.org/telehealth-express-care-service-rev
3. Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health
outcomes by expanding support for rural care systems. Health Aff. 2014;33(2):228–234.
https://doi.org/10.1377/hlthaff.2013.1016.
4. Dharmar M, Romano PS, Kuppermann N, et al. Impact of critical care telemedicine consultations on children in rural
emergency departments. Crit Care Med. 2013;41(10):2388– 2395. https://doi.org/10.1097/CCM.0b013e31828e9824.
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http://austinpublishinggroup.com/emergency-critical-care-medicine/fulltext/ajeccm-v3-id1050.php
8. Rifat Latif Charles R. Doarn Ronald C. Merrell (2021) Telepresence. Principles, Strategies, Applications, and New
Directions.
Thank You