Challenges of  Telemedicine during the COVID-19 pandemic: a systematic review

Ftouni, Racha; AlJardali, Baraa; Hamdanieh, Maya; Ftouni, Louna; Salem, Nariman

doi:10.1186/s12911-022-01952-0

Cited by 122 publications

(89 citation statements)

References 51 publications

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“…Research and surveys undertaken by others in 2021-2022 affirmed a number of findings of this familiarisation phase, including problems of accessing primary care 29 ; substantially increased workload in UK primary care 30 ; perceptions by GPs of increased clinical risk with some remote consultations 31 , 32 or when patients are encouraged to monitor their own chronic conditions such as blood pressure and report by telephone 33 ; exacerbation of inequities, especially among the most vulnerable groups, as services went digital 34 – 40 ; a primary care workforce that is increasingly stressed and underconfident 41 – 44 ; multiple infrastructural challenges to establishing remote services during the pandemic 45 – 48 ; and challenges to patient input to research efforts during the pandemic 49 .…”

Section: Discussionmentioning

confidence: 99%

Remote care in UK general practice: baseline data on 11 case studies

et al. 2022

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Background: Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs. Methods: Mixed-methods (mostly qualitative) case study across 11 general practices. Researchers-in-residence have built relationships with practices and become familiar with their contexts and activities; they are following their progress for two years via staff and patient interviews, documents and ethnography, and supporting improvement efforts through co-design. In this paper, we report baseline data. Results: Reflecting our maximum-variety sampling strategy, the 11 practices vary in size, setting, ethos, staffing, population demographics and digital maturity, but share common contextual features—notably system-level stressors such as high workload and staff shortages, and UK’s technical and regulatory infrastructure. We have identified both commonalities and differences between practices in terms of how they: 1] manage the ‘digital front door’ (access and triage) and balance demand and capacity; 2] strive for high standards of quality and safety; 3] ensure digital inclusion and mitigate wider inequalities; 4] support and train their staff (clinical and non-clinical), students and trainees; 5] select, install, pilot and use technologies and the digital infrastructure which support them; and 6] involve patients in their improvement efforts. Conclusions: General practices’ responses to pandemic-induced disruptive innovation appear unique and situated. We anticipate that by focusing on depth and detail, this longitudinal study will throw light on why a solution that works well in one practice does not work at all in another. As the study unfolds, we will explore how practices achieve timely diagnosis of urgent or serious illness and manage continuity of care, long-term conditions and complex needs.

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Section: Discussionmentioning

confidence: 99%

Remote care in UK general practice: baseline data on 11 case studies

et al. 2022

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“…However, it has also been successfully applied for surgical consultations during the pandemic period being favoured by patients when travel and infection control restrictions were implemented [ 39 ]. Nevertheless, limitations in telemedicine visits suggest it cannot completely replace perioperative consultations, with surgeons unable to examine and assess health status accurately [ 40 ]. Despite limitations, research indicates significantly higher utilisation of telehealth across all surgical specialties post-pandemic compared to pre-pandemic [ 41 ].…”

Section: Methodsmentioning

confidence: 99%

Evolution of the digital operating room: the place of video technology in surgery

Youssef

Haram²,

Noël

et al. 2023

Langenbecks Arch Surg

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Purpose The aim of this review was to collate current evidence wherein digitalisation, through the incorporation of video technology and artificial intelligence (AI), is being applied to the practice of surgery. Applications are vast, and the literature investigating the utility of surgical video and its synergy with AI has steadily increased over the last 2 decades. This type of technology is widespread in other industries, such as autonomy in transportation and manufacturing. Methods Articles were identified primarily using the PubMed and MEDLINE databases. The MeSH terms used were “surgical education”, “surgical video”, “video labelling”, “surgery”, “surgical workflow”, “telementoring”, “telemedicine”, “machine learning”, “deep learning” and “operating room”. Given the breadth of the subject and the scarcity of high-level data in certain areas, a narrative synthesis was selected over a meta-analysis or systematic review to allow for a focussed discussion of the topic. Results Three main themes were identified and analysed throughout this review, (1) the multifaceted utility of surgical video recording, (2) teleconferencing/telemedicine and (3) artificial intelligence in the operating room. Conclusions Evidence suggests the routine collection of intraoperative data will be beneficial in the advancement of surgery, by driving standardised, evidence-based surgical care and personalised training of future surgeons. However, many barriers stand in the way of widespread implementation, necessitating close collaboration between surgeons, data scientists, medicolegal personnel and hospital policy makers.

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“…Like others, 10 our health system rapidly implemented telehealth capabilities in 2020 out of necessity for providing care. Clinicians received instruction through prerecorded videos walking through workflows and ti sheets.…”

Section: Introductionmentioning

confidence: 93%

Twenty-first century house calls: a survey of ambulatory care providers to inform organisational telehealth strategy

Holt

Cusatis

Mortensen

et al. 2022

BMJ Health Care Inform

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ObjectivesWhile patient interest in telehealth increases, clinicians’ perspectives may influence longer-term adoption. We sought to identify facilitators and barriers to continued clinician incorporation of telehealth into practice.MethodsA cross-sectional 24-item web-based survey was emailed to 491 providers with ≥50 video visits (VVs) within an academic health system between 1 March 2020 and 31 December 2020. We quantitatively summarised the characteristics and perceptions of respondents by using descriptive and test statistics. We used systematic content analysis to qualitatively code open-ended responses, double coding at least 25%.Results247 providers (50.3%) responded to the survey. Seventy-nine per cent were confident in their ability to deliver excellent clinical care through VV. In comparison, 48% were confident in their ability to troubleshoot technical issues. Most clinicians (87%) expressed various concerns about VV. Providers across specialties generally agreed that VV reduced infection risk (71%) and transportation barriers (71%). Three overarching themes in the qualitative data included infrastructure and training, usefulness and expectation setting for patients and providers.DiscussionAs healthcare systems plan for future delivery directions, they must address the tension between patients’ and providers’ expectations of care within the digital space. Telehealth creates new friction, one where the healthcare system must fit into the patient’s life rather than the usual dynamic of the patient fitting into the healthcare system.ConclusionTelehealth infrastructure and patient and clinician technological acumen continue to evolve. Clinicians in this survey offered valuable insights into the directions healthcare organisations can take to right-size this healthcare delivery modality.

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Challenges of Telemedicine during the COVID-19 pandemic: a systematic review

Cited by 122 publications

References 51 publications

Remote care in UK general practice: baseline data on 11 case studies

Remote care in UK general practice: baseline data on 11 case studies

Evolution of the digital operating room: the place of video technology in surgery

Twenty-first century house calls: a survey of ambulatory care providers to inform organisational telehealth strategy

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