Telemedicine and virtual respiratory care in the era of COVID-19

Abstract

The World Health Organization defines telemedicine as "an interaction between a healthcare provider and a patient when the two are separated by distance". The coronavirus disease 2019 (COVID-19) pandemic has forced a dramatic shift to telephone and video consulting for follow-up and routine ambulatory care for reasons of infection control. Short message service ("text") messaging has proved a useful adjunct to remote consulting, allowing the transfer of photographs and documents. Maintaining the care of noncommunicable diseases is a core component of pandemic preparedness and telemedicine has developed to enable (for example) remote monitoring of sleep apnoea, telemonitoring of COPD, digital support for asthma self-management and remote delivery of pulmonary rehabilitation. There are multiple exemplars of telehealth instigated rapidly to provide care for people with COVID-19, to manage the spread of the pandemic or to maintain safe routine diagnostic or treatment services. Despite many positive examples of equivalent functionality and safety, there remain questions about the impact of remote delivery of care on rapport and the longer term impact on patient/professional relationships. Although telehealth has the potential to contribute to universal health coverage by providing cost-effective accessible care, there is a risk of increasing social health inequalities if the "digital divide" excludes those most in need of care. As we emerge from the pandemic, the balance of remote versus face-to-face consulting, and the specific role of digital health in different clinical and healthcare contexts will evolve. What is clear is that telemedicine in one form or another will be part of the "new norm".

FIGURE 1

Shift to remote consulting in hospitals and primary care in the United Kingdom (UK) in response to the coronavirus disease 2019 pandemic. a) Hospital outpatient consultations; b) general practice consultations. Reproduced and modified from [22] with permission.

FIGURE 2

Growth in use of a United Kingdom (UK) National Health Service video-conferencing platform (Near Me) at the beginning of the coronavirus disease 2019 pandemic. Reproduced and modified from [81] with permission.

FIGURE 3

Percentage of countries reporting disruption to noncommunicable disease (NCD) services during the pandemic. This “snapshot” of the disruption to NCD care from a World Health Organization survey of 163 countries worldwide was conducted in June 2020, so represents the early impact of the pandemic. Reproduced from [19] under the Creative Commons Attribution ShareAlike 3.0 InterGovernmental Organization licence.

FIGURE 4

Remote consulting in a sleep apnoea service (Dumfries and Galloway, UK).

FIGURE 5

Telerehabilitation. Patients monitor vital signs using Bluetooth-enabled wearable monitors that transmit data to a cloud-based platform via an application installed onto the tablet. Health professionals can log in and see if the patient has uploaded data, and provide feedback [145].