Telemedicine’s Protagonist Role During COVID-19

by Marcos R. Henríquez, MD

Photo by Edward Jenner from Pexels

Telemedicine has been playing a significant role during the COVID-19 pandemic, being a safe road for health care providers and patients during these difficult times. The pandemic has forced locked downs all over the globe, limiting health access, shutting down physician offices, including physiatrists departments. Nevertheless, telemedicine, despite lock downs and fear of physical contact, has been able to knock on patients’ doors and provide medical insight. A potential increase has been tracked towards telemedicine by people in the United States, so have been the number of articles published every year on Pubmed. Physiatrists have been taking over the potential utilities of telemedicine throughout the last few years. They have provided evidence supporting home-based therapy with positive outcomes nearly as hospital-based therapy (1).

According to the World Health Organization, telemedicine is “the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities” (2). The idea of providing health at a distance has been established before. In 1858, Dr. Jaber Baxter, with the collaboration of an engineer, Moses Gerrish Farmed, elaborated a device named “sphygmosphone.” It allowed fixing heart pulse as a curve and sending these data via a telegraph. On January 24, 1859, the sphygmosphone recorded heart rate data of a Mr. Eugene A. Groux, who suffered from a congenital sternal fissure, were sent via wires from Boston to Cambridge (3).

Telemedicine can provide health care services where conventional tools find different barriers to accomplishing their goal. Despite the demographic obstacles, rural areas can be positively impacted by telemedicine, reducing health care costs, increasing patient surveillance, and preventing health system overflow collapse. Furthermore, telemedicine has the potential to shelter those patients in need of physical medicine and rehabilitation services, initially by establishing protocols that define the role of the patient, family, and health care providers (4). Dr. Alberto Esquenazi has described an analogy about rehabilitation as being like a symphony. You have a group of therapists and different clinicians playing a slightly different tone, and the director is the one who gets everyone to play the right tone to produce the same music. Telerehabilitation might facilitate taking the whole symphony to the patient, and having the patient move to a health care facility only when needed (5).

After searching the keywords “telemedicine, telemedicina and telehealth” on Google Trend (Figure 1.1–1.2), a surprising effect was identified on this topic has increased but also population interest, searches grew exponentially in March, meaning that there’s an interest from the population. Following checking the amount of publication on “Telehealth or telemedicine” articles on Pubmed (Figure 2), it shows an increasing attention over the last ten years on this topic. Recently, Dr. Monica Verduzco-Gutierrez published an article with guidelines and helpful tips on examining a patient using telemedicine, highlighting some maneuvers that the patient might perform without assistance and some others that can be performed with the assistance from non-clinician (6).

This pandemic has proven that the use of technology such as telemedicine can take physicians to a patient’s home, and so can it be for physiatrists. Physiatrists have been providing tools and guidelines to perform a physical exam and maneuvers that would steer the clinician towards a diagnosis and further treatment (6). Technology development has been overcoming the obstacles for the development of telerehabilitation. It promises a road that might play the World Health Organization theme along it’s journey “Universal Health Coverage: Everyone, Everywhere.” (7)

Marcos is a medical and research assistant at Rehabilitek Rehabilitation Center in Santo Domingo, Dominican Republic. You can follow Marcos on Twitter @MhenriquezMD.

References

1. Buckingham S, Taylor R, Jolly K, Zawada A, Dean S, Cowie A et al. Home-based versus centre-based cardiac rehabilitation: abridged Cochrane systematic review and meta-analysis. Open Heart. 2016;3(2):e000463.
2. [Internet]. Who.int. 2020 [cited 29 May 2020]. Available from: https://www.who.int/goe/publications/goe_telemedicine_2010.pdf
3. [Internet]. Isfteh.org. 2020 [cited 29 May 2020]. Available from: https://www.isfteh.org/files/media/Preface_Content.pdf
4. Buckingham S, Taylor R, Jolly K, Zawada A, Dean S, Cowie A et al. Home-based versus centre-based cardiac rehabilitation: abridged Cochrane systematic review and meta-analysis. Open Heart. 2016;3(2):e000463.
5. [Internet]. 2020 [cited 29 May 2020]. Available from: https://www.youtube.com/watch?v=pypIJptiSXo
6. Verduzco‐Gutierrez M, Bean A, Tenforde A, Tapia R, Silver J. How to Conduct an Outpatient Telemedicine Rehabilitation or Prehabilitation Visit. PM&R. 2020
7. Universal Health Coverage: everyone, everywhere [Internet]. Who.int. 2020 [cited 1 June 2020]. Available from:https://www.who.int/westernpacific/news/events/detail/2018/04/07/western-pacific-events/universal-health-coverage-everyone-everywhere