Telemedicine and home care. From online visits with the doctor to remote control of patients. Here are the new guidelines

by Luciano Fassari

How the online visit with the doctor will work, all about the remote monitoring of therapies and the control of the vital and clinical parameters of patients through sensors but also the remote evaluation of the correct use of aids, orthoses and prostheses during normal life activities conducted within the home or work environment. Here is what the decree provides. THE DOCUMENT

26 APR

Home care will also be provided through the tools of Telemedicine. This is the provisions of the decree of the Ministry of Health envisaged by the NRP which contains the organizational guidelines for the ‘Digital model for the implementation of home care’.

The provision that will now be submitted to the Regions outlines the organizational model for “the implementation of the various telemedicine services in the home setting, through the rationalization of the processes of taking charge and the definition of the related operational aspects, allowing the provision of services through multi-professional teams according to the provisions of current legislation, even at a distance “.

The fundamental components of the home organizational model, to which the guidelines refer, are:

– the home assistance service, which guarantees the continuity of assistance in the manner indicated by the national and regional legislation in force;

– the planning of home access, developed over the entire week in accordance with the aforementioned legislation, taking into account the clinical-care complexity of patients;

– the home care service integrated with remote telemedicine services.

The activation of a “telemedicine path” can take place:

– from the home setting: all the actors of the territorial assistance (each for their own competences) can identify and propose the patient for whom the use of telemedicine tools is adequate and useful for the integration of home care, and can do it directly or, if necessary, after evaluation in the Multidimensional Evaluation Unit (UVM), also making use of the ADI Operations Center where present and of the COT, depending on the local organizational model; this last modality is opportune when it is necessary the intervention of different operators and the connection between several services and settings;

– from the hospital setting: it is the staff of the facility, the doctor in liaison with the case manager of the discharge procedure, according to what emerges from the rest of the document, the case manager would be a nurse.

The suitability of the patient / caregiver to be able to use telemedicine services and services must be established on a case-by-case basis, assessing for the single type of service:

– the possibility for the patient / caregiver to access technological systems and infrastructures that meet at least the minimum technical requirements for a correct and safe use of the service or service;

– the minimum competences and skills that the patient must possess, in order to be able to use the technological platforms in an appropriate way, also taking into account any additional support he may receive from the caregiver.

In general, the following are essential requirements for the activation of the home care pathway supported by telemedicine tools:

– the participation by the interested party in the home pathway and in the activation of the telemedicine service in which more professional figures can operate;

– the identification, suitability and training of the patient and / or caregiver (s);

– the adequacy of the social aspects of the family context, the home environment and the support network;

– the structural suitability of the living environment related to the clinical picture also in relation to the use of equipment.

Here are the tools of Telemedicine:

TelevisionThe television activity is a health act in which the doctor interacts with the patient remotely and can give rise to the prescription of drugs, or to further clinical investigations. This act therefore allows the transfer of health information without making the patient move, thus ensuring the continuity of care and allowing the therapeutic choices and the progress of the clinical picture to be assessed from time to time.

In the home environment, the services provided through television are aimed at:

– at the follow-up of a known pathology;

– upon confirmation, adjustment or change of current therapies;

– the anamnestic evaluation for the prescription of diagnostic tests, or staging of a known or suspected pathology;

– the verification by the doctor of the results of the tests carried out which can be followed by the prescription of any further information, or a therapy.

Medical teleconsultation
It is a medical act in which the professional interacts remotely with one or more doctors to communicate, even through a video call, about the clinical situation of a patient, primarily based on the sharing of all clinical data, reports, images, audio -videos concerning the specific case. All the aforementioned elements are shared electronically in the form of digital files suitable for the work that doctors in teleconsultation deem necessary for the proper performance of their work. The teleconsultation between professionals can also take place in asynchronous mode, when the patient’s situation allows it safely. When the patient is present at the teleconsultation, then it takes place in real time using the operating methods similar to those of a television and is configured as a multidisciplinary visit.

Medical-health teleconsultation
It is a health activity, not necessarily medical but in any case specific to health professions, which takes place at a distance and is performed by two or more people who have different responsibilities with respect to the specific case. It consists of a request for support during the performance of health activities, followed by a video call in which the health professional consulted provides the other, or others, with indications for making a decision and / or for the correct execution of assistance actions aimed at to the patient. The teleconsultation can be carried out in the presence of the patient, or in a deferred manner. In this activity, direct interaction through video calls is paramount, but it is always necessary to guarantee, if necessary, the possibility of sharing at least all the clinical data, the reports and the images concerning the specific case. It is an on-demand but always scheduled activity and cannot be used to replace rescue activities.

It is a professional act pertaining to the relative health profession (nurse, / physiotherapist / speech therapist]etc.) and is based on the remote interaction between the professional and patient / caregiver by means of a video call, to which it can be added if necessary sharing of medical reports or images. The professional who carries out the remote assistance activity can also use suitable APPs to administer questionnaires, share images or video tutorials on specific activities. The purpose of remote assistance is to facilitate the correct performance of assistance activities, which can be carried out mainly at home. Teleservice is mainly programmed and repeatable on the basis of specific patient support programs.

It allows the remote detection and transmission of vital and clinical parameters in a continuous way, by means of sensors that interact with the patient (biometric technologies with or without applied parts). The set of technologies at home, customized according to the indications provided by the doctor, must be constantly connected to the software system that collects the sensor data, integrates them if necessary with other health data and makes them available to the operators of the telemedicine service in based on the organizational methods established. In any case, the data must always be recorded locally at the patient’s premises and made available when necessary, for a greater guarantee of safety. The telemonitoring system, which can be integrated by medical remote control and supported by specialist teleconsultation, is always included within the telemedicine system which in any case guarantees the provision of the necessary health services to the patient. The aim of telemonitoring is to control the trend of the detected parameters over time, allowing both the detection of parameters with greater frequency and uniformity than previously possible, and the reduced need for the patient to perform outpatient checks in person.

Remote control
The medical remote control allows remote control of the patient. This activity is characterized by a rhythmic series of contacts with the doctor, who puts the progress of the clinical picture under control, by means of the video call in association with the sharing of clinical data collected from the patient, both before and during the same video call. This is for pathologies already diagnosed, in situations that allow, however, the conversion to the traditional check-up in times suited to guaranteeing the safety of the patient and in any case always under the responsibility of the doctor who performs the procedure.

It consists in the remote provision of services and services intended to enable, restore, improve, or otherwise maintain the psychophysical functioning of people of all age groups, with disabilities or disorders, congenital or acquired, transient or permanent, or at risk to develop them. It is a healthcare activity pertaining to healthcare professionals, it can be multidisciplinary and, when this constitutes an advantage for the patient, it can require the collaboration of caregivers, family and non-family members, and / or teachers. For the completion of treatments aimed at protecting the health of citizens, like any “traditional” rehabilitation intervention, the telerehabilitation services are complementary with other care, rehabilitation, assistance or prevention services, implemented themselves in presence or in telemedicine. The services and tele-rehabilitation services can be used from any assistance and / or educational place where the patient is located (e.g. health facilities, health or social-health residences, penitentiary institutions, family homes, residential communities, schools, training institutes, universities, community settings or community-based workplaces, domicile). For some of them it is also possible to use them on the move, or from places that are not ordinarily pre-established for rehabilitation. Telerehabilitation activities also include those aimed at remotely assessing the correct use of aids, orthoses and prostheses during normal life activities conducted within the home or work environment.

Luciano Fassari

April 26, 2022
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