Telehealth is telehealth, right?

There is increasing interest in telemedicine and telehealth, two terms that are often used synonymously to describe medical or health-related services that operate via telecommunication. These services can support healthcare providers in hospital, outpatient, and emergency systems, but tele doctors can also be used in direct communication with patients via smartphone applications (apps). Telemedicine is widely used already in radiology (tele-radiology), pharmacy (tele-pharmacy) and other areas. Service varies not only according to the healthcare setting or specialty but also according to the technological capabilities of the system; for example, some services allow bidirectional audio-video communication, while other emedicine depend simply on exchange of text. The main advantage of digital healthcare is the remote provision of service in real time. This removes limitations in distance and local resources in order to enable widespread delivery of high-level medical care. In times of increasing shortage of medical experts in all fields and growing demands on healthcare systems, telemedicine is and will be very useful to address issues of provider burnout and insufficient patient capacity. The possible range of a telehealth providers services is broad, encompassing varied functions such as exchange of patient data for a second opinion, or real-time audio-video communication between a telemedicine centre and the bedside healthcare team. Worldwide, continually available (24/7) service can be provided. Of course, successful telemedicine relies on the presence of a capable local health care provider with patient responsibility; virtual healthcare should not replace or compete with direct care, but should serve as a support to enable improved outcomes, shorter lengths of hospitalization and greater staff satisfaction. As many providers offer telemedicine in different contexts and capacities, clarification of this term is necessary. Telemedicine can vary according to its range of monitoring and grade of intervention. Data transfer for a second opinion by a telehealth doctor concerning an ECG result differs from an audio-video system that allows the patient care team to conduct regular rounds with remote experts. Germany recently opened up the market for general practitioners to offer video consultations billable to patients’ health insurance. However, modern telemedicine can provide much more, including the remote, continuous connection of medical competence centres with hospitals to deliver high-quality care as a partner and supporter of the bedside team. Even in the ICU setting, members of the bedside team cannot watch patients non-stop and are prone to developing alarm fatigue. Added to the high administrative burden of delivering medical care, these challenges can hamper the performance of the team. This is the key competence of high-quality, clinical surveillance using telemedicine; it cares for the patient at all times without any distraction or fatigue, and enables easy administrative organization.

The tele-ICU team with one highly experienced intensivist can provide service for 100 or more ICU patients at any time by leveraging high-quality telemedicine clinical decision support, made possible by predictive algorithms and artificial intelligence. Machine learning can enable the tele-ICU team to identify patterns in large data sets of high-frequency, real-time patient data (e.g. vital parameters, laboratory results, ventilator set-up, etc.), to provide support that can range from detection of unintentional pharmaceutical interactions to prediction of deterioration and outcome of ICU patients.

This transformation in ICU care will result in large medical competence centres providing this type of high-end telemedicine and will create new specialities such as 'Telemedicine Specialist'.

Again, telemedicine is not a competitor, but rather a supporter, of ICU performance optimization. Collaboration between centralized centres and bedside teams will lead to improved outcomes, shorter length of stay, decreased purchased care costs and greater staff satisfaction.

The 'Society of Critical Care Medicine' recently recommended replacing the term 'tele-ICU' with 'tele-critical-care' due to the fact that existing tele-ICU providers have extended their service to other departments (e.g. emergency department, stroke unit), indicating fast adoption of telemedicine in broad applications.

Furthermore, many medical smartphone apps exist, though quality and relevance varies greatly. As smartphones permeate modern daily life and routine, there is growing interest in utilizing them in telemedicine; however, at this point there is limited large-scale evaluation of this use.

Importantly, data protection and system security need to be carefully considered in the development of telemedicine programs, as patient privacy is important in building and maintaining trust. Fortunately, when telemedicine is employed, the majority of patients are happy to have their physician judiciously share personal health data with a third-party telemedicine provider to obtain valuable expert opinions and the potential for improved outcomes. The current standards for online security and protection in telemedicine are high. A local two-step encryption based on the latest standards ensures data security. All services are hosted in Germany on highly secure Telekom healthcare platforms.

In today’s Germany, discussion is aimed towards a transformation of the healthcare sector to a digitally supported, fully connected service network. In 2019 the Minister of Health, Jens Spahn, initiated the digital care act (Digitales Versorgungs Gesetz – DVG) as a new baseline for digital integration and successful transformation.