The rules for online clinical engagement in the COVID era

Abstract

Coronavirus disease-2019 (COVID-19) has generated a need to rapidly increase online consulting in secondary care, an area in which it has previously been underutilised. We sought to review the guidance on conducting remote consultations and found that while there is a large amount of information about the implementation of remote consultations at an organisation level, there is a paucity of high-quality papers considering the guidelines for online consultations alongside practical advice for their implementation at the individual level. We reviewed guidelines from reputable medical sources and generated practical advice to assist practitioners to perform safe and effective video consultation. Additionally, we noted reports in the literature of a lack of transparency and resulting confusion regarding the choice of telemedicine platforms. We, therefore, sought to summarise key characteristics of a number of major telemedicine platforms. We recognised a lack of clarity regarding the legal status of performing remote consultations, and reviewed advice from medico-legal sources. Finally, we address the sources of these individual uncertainties, and give recommendations on how these might be addressed systematically, so the practitioners are well trained and competent in the use of online consultations, which will inevitably play an increasingly large role in both primary and secondary care settings in the future.

Telehealth in Rheumatology: The 2021 Arab League of Rheumatology Best Practice Guidelines

“…Using a proper triage system for telehealth in rheumatology, early detection, and early referral may improve disease outcomes, especially in diseases like rheumatoid arthritis (RA) where there is a limited window of opportunity for early management. By facilitating the application of the treat-to-target strategy in RA and other chronic diseases (such as gout for example), telehealth is likely to support adherence to therapy and maintaining treatment targets [23][24]. [7,22] However, higher-quality randomized controlled trials are needed to demonstrate the effectiveness of different telerheumatology interventions in improving disease outcomes.…”

“…Furthermore, the reasoning behind whether or not to assess the patient via teleconsultation should be clearly documented, and the patient's records should be updated accordingly. [14,24] The patients should be allowed to choose whether or not they want to engage with their rheumatologist via teleconsultation and to choose their telehealth provider without payers mandating the use of specified telehealth platforms or preferred providers with restrictive policies. [14] BPS 5: Patient's physical examination (LoE 2; LoA 7.77; Consensus 90.91%) Some parts of the physical exam might be performed remotely, like inspection and evaluation of the range of motion.…”

A Symposium on the Clinic of the Future and Telehealth: Highlights and Future Directions

“…The ongoing pandemic has had unprecedented effects on all aspects of medical care and the global healthcare system [3]. It has stimulated a rapid increase in Internet and telecommunication-based medical services previously underutilized by many medical departments [3].…”

“…The ongoing pandemic has had unprecedented effects on all aspects of medical care and the global healthcare system [3]. It has stimulated a rapid increase in Internet and telecommunication-based medical services previously underutilized by many medical departments [3]. Telemedicine has been defined as the use of telecommunication and information technologies to support healthcare delivery remotely [4].…”

Remote Consultations Versus Standard Face-to-Face Appointments for Liver Transplant Patients in Routine Hospital Care: Feasibility Randomized Controlled Trial of myVideoClinic (Preprint)

“…Practical implementation issues are often explored superficially in existing studies, and emerging evidence suggests that complexities exist in embedding digital technologies into routine care because of disruption to routines in traditional clinics [16]. Since the emergence of COVID-19, there has been a widespread switch to remote consulting (telephone and on the web) to provide clinical services while mitigating disease risk among vulnerable patients [17][18][19]. In accelerating the use of remote consultations rapidly, patients and health care professionals have been forced to undergo changes in health care delivery regardless of preference.…”