STRENGTHEN TELEMEDICINE AS A RESPONSE

We share the experience of two CAHI Fellows with practices related to Telemedicine, in a challenging context and that there are new alternatives for action in the health area.

The emergency generated by COVID-19 has plunged the global population into uncertainty, demanding high levels of creativity and resilience to face a challenge for which it seems that no one was prepared.

A growing trend, in which what is being developed in the areas of health and education has been especially relevant, is to raise the need to accelerate and deepen the digital transformation, since virtual communication channels have become in the best possible way to keep interactions between people and systems working.

Within the CAHI Fellows Network, various Telemedicine initiatives coexist in implementation, as a way of responding to the challenges imposed by social distancing and quarantine measures, which stand out for their development potential and the impact they are already having on the practice of medicine.

We will know two of them in the following lines: the one developed by Hans Ardón in several Central American countries, and known as Drsbee; and the one implemented by Dr. Marco Antonio Ferrandino of the Day Hospital, the National Center for Pain Control and Palliative Care of Costa Rica.

DrsBee and the digital prescription

The DrsBee platform has existed long before COVID-19 arrived in the region, as a form of safe and effective interaction between doctors and their patients, as well as a direct line of communication for the medical prescription and acquisition process. medications quickly and effectively.

In Costa Rica, for example, the system has the endorsement of the College of Physicians, which confirms the high level of trust that this proposal has generated. In the current context, the larger-scale implementation of this technological solution has facilitated the delivery of prescriptions and medicines, through agreements established with pharmacies.

The process is simple: the doctor who has an account on the platform Drsbee access the system through a password, after which you can create medical prescriptions digitally, information that reaches the patient directly through their mobile phone, so that it is the patient who decides to which pharmacy to send their purchase request and coordinate the distribution of your medications.

In the context of COVID-19, the operation of the digital system and logistics coordination ensure that patients with other risk conditions remain at home. This also reduces the incidence of people arriving for medical consultations or emergencies, at a time when it is essential that hospitalization spaces are more available.

The current situation has made this type of system more necessary and the possibility of its successful implementation more evident, in processes that were already under development within the framework of telemedicine. Additionally, the system allows to identify, with constantly updated data, the interactions of the various components of the drugs, generating alerts and indicating to the health professional about these possible reactions so that they can find alternatives when generating the prescriptions.

At the moment, DrsBee is implemented in the private sector, with a vision and plans to be adopted by the public sector, which requires moving towards a process of technological updating for its proper functioning. For now, the largest presence of this system is in Costa Rica, with implementation plans in the short and medium term for Panama, Guatemala and El Salvador.

As Hans Ardon, CEO of DrsBee, points out: "The need for virtualized care has been evidenced today and it is something that we believe will continue in clinical practice, because we have understood that we must be prepared for contingencies such as the current one and that we can maintain the services and the relationship of the doctor with his patients with the support of a digital platform. "

From teleconsultation to remote patient management

Dr. Marco Antonio Ferrandino, Coordinator of the National Center for Pain Control and Palliative Care Day Hospital, shares his experience in another dimension of telemedicine.

It indicates that for some years they have been conducting teleconsultation and attending to their patients with the support of devices such as tablets and mobile phones, with a high level of effectiveness thanks to the logistical coordination that accompanies the constant exchange of information by digital means.

This team has undergone significant evolution and the demands of response to COVID-19 have accelerated this process. Today, they have set the goal of remote patient management by monitoring their vital signs in real time.

As indicated by Dr. Ferrandino: “Our challenge is to provide virtual care in real time to people with terminal illnesses. The most important thing is the monitoring of the patient's vital signs, continuously or on a regular basis, with established alerts that allow us to anticipate destabilization or decompensation, which can be treated without the need for the patient to have to be transferred to the hospital. "

It also explains that the implementation has been relatively simple, through a kit of digital equipment that is sent to the patient's relatives or caregivers; When they are installed to monitor their vital signs, the data goes directly to the specialist or the medical team in charge of the case, so that they can do an adequate follow-up.

There are many advantages that this system has, such as that each specialty can adapt the signs that are measured and the establishment of alerts according to the condition and specific needs of each area. In addition, all complementary doctors, nurses and therapists access the same information that arrives in real time and leaves a record of the evolution that allows the generation of graphs over time.

There are also various challenges, such as the availability of equipment to serve a greater number of patients, the logistical coordination necessary to respond to each case based on the data generated, and the technological structure and for connecting the equipment to digital information exchange channels.

Having identified these challenges, telemedicine practices have taken center stage at a time of great demands on healthcare professionals.

Telemedicine is here to stay

Medical care at a distance and through digital channels is today a necessity, as it becomes an alternative to the needs imposed by COVID-19. For many experts it is a practice that has been expanding and that will be established for the future.

There seem to be many advantages for citizens: speed and immediacy of care, interaction with the general practitioner and specialist from home, digital files to which all medical professionals involved can access, historical record of care and indicated medications, interconnection between all the moments of the process until the medicine reaches the patient's home, possibility of monitoring a person's condition and vital signs in real time, among many others.

The challenges of this transformation of health care are also multiple, one of them is the protection of patient data, which must always be handled with confidentiality and a maximum ethical sense. In addition, there is also the process of adapting the doctor, who must give space to a different form of care, as well as allow automated information systems to assist him in the diagnosis and determination of the best treatment in each case.

Although these challenges are not small, it seems that with a long-term vision the benefits that can be generated justify the commitment to this change towards strengthening telemedicine: in addition to the immediacy of care, there is what this practice contributes to the purpose to achieve greater equity in access to quality health care. It is clear that, with their implementation, these technological advances can facilitate a standardization of the quality levels of medical care, and offer access to specialist doctors to the population in rural areas with difficult access.

The trend around the world appears to be clear: healthcare appears to increase in scope and efficiency when supported by automated information systems and digital communication processes.