Perspective on COVID-19: Finally, Telemedicine at Center Stage

Introduction

In the past few years, telemedicine/telehealth has become more acceptable and is present in >125 countries, even though in the past telemedicine has had challenges and some resistance despite a great potential.¹ With the COVID-19 pandemic of 2020,² however, the usefulness of telemedicine and the ability to provide safe, rapid, and high-quality care have become more evident worldwide.^3–5 This is a major shift in advancing the current and the future of telemedicine/telehealth caused by the current pandemic that has changed the world like no war or catastrophe since the 1918 Spanish flu.^6–8

The new world order caused by COVID-19 has brought telemedicine and telepresence to center stage of our health care as applicable, desirable, acceptable, and much sought after first by all our patients, and by the health care community and industry at large. In the early stages of this pandemic, an article on the perspective on telemedicine elegantly brought the depiction of the current state, and opportunities, telemedicine may offer during the COVID-19 pandemic.⁹

As previous pandemics have impacted humanity, comparable with wars, revolutions, or economic crises, the ongoing COVID-19 pandemic is thought to make a sustained and responsible change in our behavior and attitudes to shape a new mankind: 2020-nMan.¹⁰ The 2020-nMan may be inclined to prefer the virtual perfection of telemedicine (especially those with chronic diseases) to in-person hospital visits not only during the pandemic, but also afterward. Telemedicine and telepresence practice should be evidence-based. Its performance and quality control measures should be measured and reported, and continuity of care should be seamless.¹¹

However, in order for telemedicine and telehealth to offer true benefits, it must be fully integrated telepresence, and should be used instead of in-person hospital visits not only during the pandemic but also in daily use as much as possible. Everything that one can see in a patient physically can be seen, if not better, through telepresence. In addition, the entire perioperative care process can be done virtually; we agree that there is really little or no benefit to a physical visit,¹² particularly during crisis like this one, and other public health emergencies and disasters, which highlights the need for further application and integration of telemedicine.¹³

Covid-19 and the Rise of Telemedicine

In a very short period of time, COVID-19 has had a significant and transformative impact on the way we practice medicine across the entire clinical continuum. Telemedicine has also emerged as a critical tool in providing medical care to patients while attempting to reduce the transmission of COVID-19 among other patients, clinicians, and families.¹⁴ Specific tools to support outbreak management, including triaging, electronic check-in, standard ordering and documentation, secure messaging, real-time data analytics, and telemedicine capabilities are required, while maintaining high-quality prepandemic medical care.¹⁵

There are a number of clinical conditions in which telemedicine has been used or suggested during the COVID-19 pandemic. These include the elderly population,¹⁶ dermatology,¹⁷ orthopedics,¹⁸ urological cancer,¹⁹ emergency colon and rectal cancer patients,²⁰ primary care,^21,22 telepsychiatry,^23,24 podiatry,²⁵ global emergencies,²⁶ and management of migrains.²⁷

Others have advocated for telemedicine as a platform of protection of staff, as well as a way to reduce the burnout rate of health care providers, as it has become clear that telemedicine and telehealth not only benefit the patients, but can also be used as a model of health care protection in a highly infected and stressed environment.²⁸

In response to COVID-19, the Center for Medicaid and Medicare Services has permitted patients to be seen through videoconferencing in their homes, without having to travel to a qualifying “originating site” for Medicare telehealth encounters. Furthermore, the Drug Enforcement Administration approved an exception that allows prescriptions for controlled substances through telemedicine without a prior in-person evaluation. It is our hope that these guidelines will not be revoked once this pandemic has subsided. We will need to carefully document the benefits of telemedicine during this pandemic, to continue to pressure the policy makers that there is a need to continuous support and advancement of telemedicine services.

Hopefully, these examples, new U.S. and other government’s support, along with other lessons from around the world that have been well documented^29–32 will ensure continuation, expansion, and sustainability of current enthusiasm for telemedicine across the world, and in all clinical disciplines.

Telemedicine for Disaster Management

Although there is no visible disaster, such as an earthquake, war, hurricane, or volcanic eruption, this pandemic, caused by COVID-19, is a disaster that has affected the entire world. Public health experts agree that this is a biologic catastrophe? Is there a role for telemedicine in disaster management? The answer is clear.

Telemedicine use has been extensively reported in the management of various disasters.³¹ Disasters can be broadly categorized as (1) natural, (2) manmade, (3) war and conflict related, and (4) land mines and unexploded devices or ordnance. Other subtypes of disaster include epidemics or pandemics, floods, volcanic activity, transportation problems, and many more^33,34; disaster management is a complex process that broadly has been described in four phases that include (1) preparedness, (2) mitigation, (3) response, and (4) recovery phase. Telemedicine has been applied and reported in a variety of situations, some extreme conditions and major disaster; however, incorporation of telemedicine technology in disaster and emergency response has not been as frequent and as robust as we would like it to be.^35,36 Successful inclusion of telemedicine in complex multinational disaster simulation has been reported.^37–39

As in this pandemic, response to disaster may involve multiple countries, but when it comes to telemedicine, the effectiveness of these responses is determined by several factors, including the technical infrastructure, modalities, and human capacities present before the onset of the disaster. Setting up of telemedicine system or capability during the disaster may be challenging and difficult if no infrastructure is in place before the disaster. Although the mobility of telemedicine technologies in recent years has improved significantly and quick deployment has become much easier, mobile web-based solutions are easy to use,³⁹ nonetheless training and preparing personnel to use mobile and other telemedicine solution must be part of preparedness and mitigation.

A low cost telemedicine with Arabic speaking intensivist from North America has been used in Syrian war.⁴⁰ In addition, telemedicine has great potential for large scale manmade or natural disasters and emergencies that are characterized by unpredictability to place, time, and the number of injured people as well as their injury severity score, when other mode of transmission of information is not possible, or when the terrestrial infrastructure is lacking or has been destroyed by war or neglect, or simply did not exist at all.^41–45 As a result of these studies, a number of nation-wide telemedicine programs have been established^46,47 and have successfully increased access to care, particularly, specialized care. Telemedicine for disaster should be part of the nation-wide mass casualties structured centers that mimic trauma and stroke centers in high-income countries.^48,49

Recovery from disaster includes re-establishing infrastructure or revising infrastructure to more adequately meet the needs of disaster management, and rebuilding health care system destroyed during the war or major conflicts. Establishing functional and sustainable country-wide telemedicine systems, such as those created by the International Virtual e-Hospital, has increased access to care and ∼70% of patients managed through telemedicine do not require to transfer to tertiary centers.^50,51

The usefulness of telemedicine for disaster recovery has been used as early as 1988.^52–54 This telemedicine system once in place and operational was easily adapted for use in a disaster.⁵³ The disaster is usually unpredictable and impersonal.⁵⁴ Incorporating telemedicine in disaster management has not yet become an acceptable practice for most countries, but its applicability has been demonstrated during the NATO Consequence Management Field Exercise in Lviv, Ukraine, “Ukraine 2015,” where Multinational Telemedicine System was tested.^37–39 This exercise demonstrated that an integrated system, including personnel, hardware, communication protocols, portable power generation, medical kits, and web-based tools, can be integrated for assistance with disaster management.

Conclusions

The world has come to understand and accept the promise and potential of telemedicine to provide timely, safe, and less expensive care, where the patient does not need to be in the same room with the health care providers. In addition to providing routine health care services, telemedicine has consistently shown to be effective in increasing access to care in extreme conditions, such as health care crises, wars, disasters, remote areas, or in limited-resource countries and regions. Moreover, during this pandemic, telemedicine has not only allowed partially relieving the enormous workload from the workers in the hospitals and protect patients and health care workers from exposure to the virus, but has also made possible the COVID-19–positive asymptomatic clinicians in quarantine to continue providing health care services. Last, but not least, continuous telemedicine support has allowed continuity of care for other unrelated clinical conditions, such as cancer, peritransplant, post-trauma, and acute care surgery, and other patients with various conditions.

Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was provided for this article.