Introduction
One of the challenges that medical professionals faced after COVID-19 was the difficulty in managing patients' chronic care and follow-up appointments due to their reluctance and anxiety about going to medical facilities. Technology played a role in revolutionizing aspects of life, including medical follow-ups. Telemedicine has been promoted as a cost-effective solution for enhancing care. Surprisingly, despite its practicality and usefulness, it has yet to be widely integrated into gastroenterology practice.
What Is Telemedicine?
Telemedicine refers to the delivery of services using communication technologies, eliminating the need, for in-person interaction with patients. Telemedicine can be categorized into areas, including monitoring, education, consultation, and care. Telemonitoring involves using devices or mobile applications to communicate with healthcare professionals and track specific signs and symptoms of patients. This form of telemedicine is gaining popularity rapidly. It is expected to become a method in future healthcare practices.
How Was Telemedicine Developed?
When it comes to the use of telemedicine, the National Aeronautics and Space Administration (NASA) has taken the pioneer steps. Remote crew monitoring and environmental health have been essential components of NASA's missions in space since the beginning of suborbital flight. Ground controllers could examine and interpret a crew member's essential physiological parameters when the Space program was launched due to the telemetry of flight suit data. Even though the information was gathered and documented then, it was not immediately linked to crew members on these initial missions.
The Apollo Project (1968 to 1972) was the first to develop a biosensor harness, an integrated suite of devices that enables the real-time transmission of health parameters to the ground control. Tracking and data relay have enabled continuous real-time biomedical information communication since the Space Shuttle program (1981), which has functioned as an innovator for the integration and advancement of telemedicine. The advancement and integration of telecommunication in the medical field have been made possible by NASA's ability to monitor and maintain crew health and telemedicine system performance in spaceflight, which has proven to be a well-coordinated effort.
How Is Telemedicine Used in Post-operative Care?
Despite being adopted and implemented by NASA and considered a futuristic idea at first, the telemedicine industry has grown quickly and gained the trust of both patients and providers. The Department of Veterans Affairs (VA) in the United States (USA) has been leading pioneering work in telemedicine for the past 20 years. Despite a surge in interest in the late 2000s, the VA healthcare system, with its extensive and well-established video visit program, has been a major contributor to the widespread use of telemedicine in the surgical field. One of the first and largest pilot programs, which looked at whether a telephone visit could safely replace an in-person visit for elective general surgery cases (such as elective laparoscopic cholecystectomy and open hernia repair), was carried out by the VA health care system in 2013. This ten-month study period achieved high patient satisfaction and excellent clinical outcomes. Numerous subsequent investigations validated these results within the VA healthcare system and across a broad spectrum of surgical specializations.
While telemedicine has been widely used in many areas of surgical care, there is currently a lot of interest in its application to postoperative care. Three main uses of telemedicine have been observed during the post-operative phase:
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Planned follow-up.
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Routine monitoring.
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Management of emerging problems as required.
Recently, telemedicine has gained much popularity as a substitute for in-person clinic visits. Several studies have shown the possibility of substituting automated messaging, phone calls, or online video conferences—which can take place from the patient's home or an affiliated institution—for traditional follow-up clinic visits. There has also been some interest in smartphone-based picture-focused services for evaluating surgical wound care.
There is growing interest in routine patient monitoring. Clinicians have employed this technique in certain situations to help patients report their postoperative symptoms over a videophone or an automated phone survey. On the other hand, certain clinicians exhibit regular tracking of particular objective clinical data, such as ileostomy output (ileostomy is a surgical procedure where the lumen of the small intestine is exposed to the abdominal surface), blood pressure and medication compliance, surgical drain output, and results from home spirometry (a common test to check the functioning of the lungs). There are reports of patients communicating specific postoperative concerns through automated messaging systems and communications based on smartphone digital photography, though these methods are not as widely used. Overall, there is a great deal of opportunity for healthcare professionals to interact virtually and use a wide variety of techniques to provide patients with outstanding postoperative care.
What Is the Role of Telemedicine in Postoperative Gastrointestinal Care?
In military and space settings where in-person visits were not practical, telemedicine via phone and video has been employed since 1960. The connectedness of many people from rural to urban locations expanded as broadband technology became more widely available. The use of telemedicine in gastroenterology has only been investigated for the treatment of patients with irritable bowel disease, hepatitis C virus, and hepatology as chronic illnesses. Telemedicine has long been utilized to treat inflammatory bowel disease. Patients with IBD were satisfied with the introduction of Home Automated Telemanagement (HAT). In 2003, Finkelstein et al. documented the use of HAT for the treatment of chronic illnesses such as IBD and chronic obstructive pulmonary disease (COPD). It was first created to help individuals with various chronic medical illnesses with their self-care. It involves monitoring the course of the disease by utilizing a networked computer to upload patient survey responses to a central server automatically. For these patients, telemedicine could be used in both inpatient and outpatient settings to deliver care focusing on medication modifications (using biological therapy, corticosteroids, and anti-inflammatory agents).
What Are the Barriers to Telemedicine for Healthcare?
The broad application of telemedicine in gastroenterology has traditionally been limited by legal obstacles, reimbursement limitations, and state licensure policies. With the development of technology, sophisticated imaging, and laboratory data, the utilization of physical examinations and the amount of time spent on them have been dropping. However, a physical examination is necessary for the visit, particularly when testing options are limited. Additionally, elderly people may require lip reading due to hearing issues. Another significant barrier for elderly patients is their inability to access and use appropriate electronic devices due to a lack of expertise. For those used to more conventional approaches, telehealth modifications can be difficult to adjust to. These challenges can be partially addressed by medical assistants, who can serve as coordinators to get the patient to participate in a phone call or television visit before seeing the provider. They can also calm patient’s fears while offering technical support and assisting in troubleshooting any possible problems that may come up during the video chat.
Conclusion
With all of the recent developments, telemedicine adoption has grown rapidly and is expected to continue rising. Patients who face various obstacles to in-person appointments can be reached through telemedicine, an inexpensive and accessible technique. When used appropriately, restrictions on its widespread use can be loosened, and patients and providers receive the necessary information. This can significantly help to deliver patient-focused care of higher quality in general. In addition, telemedicine is the best way to minimize queues and delays in in-clinic visits.
