Telemedicine was conceived as a possible solution to the main problems currently facing public health. It does not replace traditional medical practices but can facilitate the population's access to local care, make up for the lack of medical personnel and improve access to isolated establishments or communities. Telemedicine focuses primarily on the digital provision of medical services for patients. It is quite different from telehealth, which covers all healthcare and technology.

The health situation in recent months has favored the rapid development of telemedicine and, more particularly, video consultation. Telemedicine has proved effective in dealing with the challenges posed by COVID-19. It has also helped to meet the needs of many patients during this difficult period. Online and video consultations have become quite common, which was not the case before the start of the pandemic. This trend is going to stay and the NHS will expect all primary care providers to have Telemedicine services available.

Telemedicine involves:

• Real-time consultation hours via chat, telephone, or video conference
• Asynchronous (also store-and-forward) evaluations
• Forwarding of medical images to specialists
• Prescription issuance without a personal appearance

Telemedicine has become essential in private medical practice. We will look at some of the best ways to apply the telemedicine model safely and effectively in your private medical practice.

Telemedicine in Complete Safety

You should always be confident about carrying out a thorough clinical assessment and agreeing on the best management plan with your patient using this consultation model.

Authenticate Securely / GDPR

When you connect to a computer system to which you have access rights, you must authenticate yourself. Whatever devices available, use at least two authentication modes to ensure access security (password, SMS code, smart card, etc.). Two-factor authentication is one of the basic principles of computer security.

Ensure the Identity of Your Patient

In the event of a teleconsultation, in particular, when the patient is not visible (telephone, Internet teleconference without video image, e-mail, delayed messages, etc.), you must use reasonable means to ensure your patient's identity. This will allow you to retrieve the data from the medical file, attach a report of the consultation, recontact your patient if there is an interruption in the remote consultation, and avoid fraud, especially when issuing a prescription electronically or without eye contact.

Inform and Obtain Patient Consent

Before the online consultation, you must inform the patient orally or in writing about the progress and its particularities about face-to-face consultations. The more the online consultation impacts advising or examining the patient, the more the information should be complete.

The information should have the presence of possible alternatives, the possibility of being accompanied, the confidentiality of exchanges, the computer processing of personal data, the protection and security of health data, the cost of the consultation, and the remains at a charge. It must be simple, clear, and complete so that the patient can freely consent or not to the use of telemedicine.

It may be accompanied by an information leaflet given to the patient. The collection of the free and informed consent of the patient or, where applicable, of his legal representative, remains necessary for any medical interaction. This includes remotely via information and communication technologies.

Don’t Rush- Introduce Yourself to the Patient

Patients generally expect to talk to a doctor. However, in call centers, notably organized by insurance companies, patients are mainly put in contact with nurses or medical assistants.

Patients should be explicitly warned if the interlocutor is not a doctor for the sake of transparency and trust. Remote consultation is a medical opinion dispensed remotely by a doctor. In contrast, we can think of an online consultation as an act of telemedicine administered by any other health professional. Take time to introduce yourself to the patient, build a rapport, and give room for questions.

Adapt Your Practice to the Reason for Consultation

You cannot perform all medical procedures can remotely, even with recent means and technologies. As remote consultation limits the clinical examination, it is your responsibility to adapt your practice to ensure patient safety at all costs. You must be attentive to the history, clinical signs, and overall context.

After having assessed the risks, it is up to you to suggest to the patient what to do. You can refer him/her to a face to face within a timeframe appropriate to the situation. You can also offer remote care, including or not the prescription of 'additional examinations and treatments. The evaluation of the degree of urgency is a central point of online consultation. It is an element that the patient may not able to appreciate himself.  Change the mode of the consultation where necessary.

Use a Rag Rating System

This can be an effective tool in ensuring the safe delivery of care services through telemedicine.  You can use color codes to rate different kinds of patients or illnesses. A perfect example is as follows:

• Red- For patients over the age of 70 and are at high risk of severe chronic disease. They are patients who must have an initial call or video consultation with a doctor before a face-to-face visit.
• Amber- For patients over the age of 50 with comorbidities. These patients may need enhanced PPE used in case of a face-to-face consultation. An initial video consultation may be sensible.
• Green- For low-risk patients under the age of 50. Most of them have recurring medical problems that can be directed straight to a face-to-face consultation.

This will help protect the staff and reduce infection risks, especially now as we see COVID and an endemic disease in our community going forward.

What Criteria for the Choice of Technology?

The number of technology solutions available to healthcare professionals has increased with the pandemic. Regarding video consultation,  you can use solutions that are not specific to telemedicine or solutions exclusively for medical use. If you want to initiate a teleconsultation activity, you must find out about the different possibilities available to your patient as well as their level of expertisie in technology (again think RAG rating).

The existence of instant messaging, the ability to send an attachment such as a prescription, invite a third party to the consultation, integrations into the computerized medical record, and online billing solutions are many possibilities that can influence the choice.

The COVID-19 pandemic has rapidly accelerated the development of telemedicine and, more particularly, the video consultation. Video consultations may be often requested by patients. Healthcare professionals who care for patients remotely should be trained to acquire the knowledge necessary to practice quality remote medicine.

Under these conditions, the main limitations of remote consultation are less numerous than one might imagine. The need for a physical examination or a technical gesture, communication difficulties (language or cognitive disorders), and inadequate remote consultation equipment.

You should familiarize yourself with all the basics of telemedicine to apply it effectively in your private medical practice and works with a system of structured total triage to embed it into your daily practice protocols and processes.

Summary

Telemedicine is now on the threshold of full acceptance. COVID-19 has forced healthcare providers to use them, accelerating a development that could continue even after the pandemic has subsided. It’s high time you learn all the basics and utilize them in private medical practice.

Mr Giles Davies MB BS BSc. MD FRCS