Take your smartphone, the specialist who follows you reads the tests you have performed and modifies or confirms the therapy you are taking. Or again, if needed, turn on the camera, measure your pressure, blood sugar or other values and send the data to the doctor, who checks your health conditions in real time. It’s called telemedicine, and as well as being extremely useful it is also very promising especially in the case of chronic pathologies such as heart disease or diabetes, or for young patients who have little time available but are familiar with technology: in these cases, in fact, visits o routine clinical check-ups can be performed remotely with excellent results.
The Emilia-Romagna Region continues to invest in telemedicine, as demonstrated by the organizational model for the implementation of telemedicine services recently approved by the Council, with the aim of setting up 20,000 computer workstations dedicated to these services in the area. The project is part of the implementation interventions of the objectives of the PNRR (Mission 6, Health) and of the Complementary Plan; the Region will have a directing, coordinating and monitoring role, while the Health Trusts will take care of the start-up and operational implementation of the activities. The drafting of the organizational model follows a plan, positively evaluated by Agenas (National Agency for Regional Health Services) last March, which identified regional needs starting from data on the current health conditions of the regional population.
“As a Region we have presented to the ministry both the plan of needs and the organizational model, because we were among the first to believe in telemedicine, which we are already experimenting with success today – explains the councilor for health policies, Raffaele Donini – . It is a service appreciated by the youngest, by those who live outside built-up areas, by those suffering from chronic pathologies, and in the latter case in Emilia-Romagna we are talking about almost one citizen out of two. In many cases, these are diseases with which one can live long and serenely, but which must in any case be monitored – continues the commissioner -. Without stress or hours of traffic with telemedicine, patients will be able to have their health checked by the doctors who follow them, directly from their home or from local centres. This is not the future, it is already our present”.
The telemedicine services to which the model refers are televisits, teleconsultations, medical-health teleconsultations, teleassistance and telemonitoring. The regional objective for telemonitoring is to ensure that approximately 12,000 highly complex patients with care needs are taken care of. Televisits and teleconsultations could involve up to 1.2 million people, i.e. all citizens with at least one of the chronic pathologies considered.
The distribution on the territory of the stations
The regional model envisages the distribution of 5,000 workstations in community houses, in particular in specialist, nursing, public health outpatient clinics, family counseling clinics, community paediatricians, general practitioners’ offices and free-choice paediatricians, spaces dedicated to patients. 100 workstations will be dedicated to the territorial operations centres, another 100 to the continuity of care units (former medical guard). 1,000 workstations will be available for integrated home care, 300 for the palliative care network, another 2,500 for general practitioners’ surgeries and free-choice pediatricians outside community homes, 8,000 for hospital surgeries and polyclinics. The last 3,000 stations will be assigned to other territorial structures. Naturally, in order to use the service, the patient must be informed of her rights, also with the involvement of the caregiver when necessary: that is, she must know what the service consists of, which structures will be involved, which information will be processed.
The schedule
The Regions must await the ministerial decree which will distribute the resources through Agenas. The resources will be distributed both on the basis of the needs and objectives expressed by the regional telemedicine plans, and taking into account the regional telemedicine project just drafted. The goal is to purchase the equipment by the beginning of next year in order to be able to activate the services in the spring of 2024 and to have remotely monitored 12,000 people by the end of 2025.
Telemedicine services
During the televisit, the professional interacts remotely, in real time, with the patient, even with the support of a caregiver or social-health worker who is close to the patient. The possibility of exchanging clinical data, medical reports, images, audio or video relating to the patient must be guaranteed. It is not an exclusive means of conducting the relationship between doctor and patient, but can be integrated, for example, with telemonitoring for the detection of biological parameters. Usually follows a first visit made in the presence, which has allowed the doctor to already formulate the diagnosis. The decision to carry out a specialist visit is not the responsibility of the person prescribing it, but of the doctor who delivers it. The outcome does not differ from that of an ordinary visit: the patient may be stable, urgent access to diagnostic-therapeutic services may be necessary, further investigation may be necessary for which the specialist prescribes the services he deems appropriate. The report is sent to the FSE and if necessary shared with other doctors.
The medical teleconsultation takes place between various professionals who discuss the clinical situation of a patient by exchanging clinical data, reports, images and audio-video files. The presence of the patient is not always essential. The purpose of the teleconsultation is to share the medical choices with respect to a patient by the professionals involved in the care pathways: think of the case of a family doctor, an emergency room doctor or a prison doctor who requests a consultation of a specialist.
Medical-health teleconsultation is a health activity, not necessarily medical but in any case specific to the health professions, which takes place remotely and is performed by two or more professionals with different skills. The healthcare professional consulted via video call provides the other, or others, with indications for making decisions or for the correct continuation of the clinical assistance or rehabilitation process. Teleconsultation can be carried out in the presence of the patient, or in a deferred manner. It requires the ability to exchange data in real time.
Teleassistance, on the other hand, aims to facilitate the correct performance of assistance activities, which are mainly carried out at home directly by the patient or by whoever assists him, remotely guided by a healthcare professional such as a nurse, a physiotherapist, a speech therapist or a midwife. Teleassistance is mainly programmed and repeatable on the basis of specific patient support plans.
Telemonitoring is carried out through technological tools that allow the doctor to monitor the parameters, the progress of the therapy and in general the state of health of the patients outside the hospital structures. The parameters are detected independently by the patient, or with the help of a caregiver, and sent to the professional. Telemonitoring detects and remotely transmits vital and clinical parameters, continuously or intermittently, by means of sensors that interact with the patient. In this way the parameters are controlled over time, reducing the need for outpatient checks. Recipients of telemonitoring can be, for example, people with diabetes or heart failure.