A Commentary on “Impact of the Coronavirus (COVID-19) pandemic on surgical practice - Part 1” (International Surgery 2020; 79:168-179) The Effectiveness of Telemedicine during the COVID-19 Pandemic

Abstract

Dear Editor, We read with great interest the article by Al-Jabir et al regarding the impact of COVID-19 pandemic on surgical practice. In this commentary we discuss the effectiveness of telemedicine during the COVID-19 pandemic, outlining the benefits and disadvantages of telemedicine, while also reviewing recently published data in Western China and the track and trace app implemented within the United Kingdom (UK) [1]. The COVID-19 pandemic has created the immediate need for alternate routes of communication and patient care, and thus, on March 17, 2020, NHS England issued a notice calling for the support of telephone or video-based consultations in healthcare trusts and providers. Telemedicine allows for work to be undertaken at home by healthcare professionals (HCP), reducing staff exposure to ill patients, preserving personal protective equipment and minimising the impact of patient surges on healthcare facilities. Patients at risk or those in isolation benefit by staying at home while still receiving medical care via video consultations. Elderly patients, who usually present with additional comorbidities, can continue their care at home, lowering their non-emergent hospital visits and reducing risk of infection. This provides a safer option for both HCP and patients while adhering to social distancing measures. Furthermore, it reduces carbon emissions associated with travel. There is also up to £20,000 of capital funding per NHS provider for support in purchasing necessary hardware required for video consultations [2]. Despite the many advantages, clear drawbacks still present within telemedicine, most notably patient access to technology (particularly in the elderly). NHS digital figures show that nearly 40% of individuals had no access to online consultations at all in 2019, limiting their access to adequate healthcare in an advancing telemedical society. Those with access may be unfamiliar with using it, leading to many untreated patients as a result. This creates a significant health inequality within society, benefitting the younger and more affluent population. Additional limitations include the inability to perform physical examinations online which could lead to missed diagnoses, and the inability to conduct biometric measurements introduces further challenges, particularly in first time assessments of new patients. Moreover, addressing sensitive topics is difficult and there are privacy concerns due to data breach issues, leading to potentially key information being omitted [3]. In shifting towards virtualized care in response to the pandemic, health care planners worldwide are drawing from China’s experiences. West-China Hospital of Sichuan University has developed a new telemedicine system conducted by multidisciplinary teams aimed to provide video consultations for vulnerable patients. There is evidence to suggest that this may have improved diagnostic accuracy of more complicated cases and improved the treatment for severe and critical cases in Western China, all at a reduced cost. Online services were also utilised to reduce the number of patient visits and overcrowding in hospitals. Educating medical staff has been facilitated through the use of remote consultation networks, portals and smartphone apps delivering tele-education helping to implement prevention and control measures. The employment of telemedicine in Western China serves as evidence that it is capable of providing effective and efficient healthcare to patients, setting an example to other countries [4]. Attempts at telemedicine in the UK have not been as successful; concerns have been raised over the effectiveness of the NHS Test and Trace service, aimed to monitor and contain COVID-19 spread. Between 28 May and 3 June 2020, approximately 8117 COVID-19 positive patients entered their details onto the app, but only 5407 (67%) were contacted, suggesting one-third of those who tested positive for COVID-19, and therefore their contacts, were not traced [5]. The need for multiple organisations, such as Sitel, Capita and Synergy CRM, caused issues. For the app to function, the organisations had to work in unison, meaning when systems became disconnected, the app's function was severely impaired. Additional issues include delays in resetting passwords for clinical caseworkers, long waiting times, unanswered emails and the removal of the helpline number for HCP to access basic training. One of the main priorities of the NHS long term plan is to increase the use of digital technologies in delivering healthcare. One platform that will be used is ‘Attend Anywhere’, a secure web-based platform with a single, consistent entry point for video consultations available on multiple devices, providing patients with easier access [2]. Despite current limitations of telemedicine, it has huge potential to increase the efficiency of current healthcare systems. As technology improves and we become more experienced in treating patients with the use of telemedicine, many of these drawbacks can be either removed or reduced. Sources of funding No funding received. Ethical Approval Ethical approval was not required for this letter. Research Registration Unique Identifying Number (UIN) N/A. Author contribution Hassan Mustafa was lead author on this letter. Mohammad Alradhawi, Mustafa Al-hussein and Aliakber Dewji contributed equally to the preparation of the manuscript. Guarantor Hassan Mustafa. Provenance and peer review Uninvited Commentary, internally reviewed. Declaration of Competing Interest No conflicts of interest.