Thursday, 14 July 2016

ClinicSpeak & PoliticalSpeak: should internet access be a basic human right?

Are you ready to dispense of face-to-face consultations with your neurologist? #MSBlog #ClinicSpeak #PoliticalSpeak

"As a follow-on to our group clinic posts, here is another one on a major disruptor to the antiquated Victorian model of healthcare delivery, Telemedicine. The state of the art review in this week's NEJM is very good read and tell us where we are heading with telemedicine."


"We are in the process of setting-up our own telemedicine clinics and I see no reason why once we get the format of the group clinics sorted out we can't take them online and deliver them via a telemedicine format. For example, last night I did an MS education webinar to Latin American neurologists via the internet using Adobe's webex platform. Although there were a few glitches the software has matured enormously and we were able to have a very good question and answer session at the end of my talk. I see no reason why a group clinic can't be run using the same platform."

"The one thing the article below addresses is the so called 'digital divide', i.e. the group of people who are disenfranchised and don't have access to the internet. What do we do about those people? I think this needs a political solution and the government should enact legislation defining internet access as an essential utility and mandating local authorities to set-up digital access and training programmes for all British citizens. This legislation should also ensure that the whole country has high-speed broadband. If healthcare in the UK is meant to free at point of access and equitable and healthcare is increasingly being delivered via the internet then everyone needs access to the internet." 

"The biggest challenge we face in teleneurology  is replacing the laying on of hands, or the clinical examination, with a remote examination. I am sure this can be done, we simply need to think laterally. Can we assess the functioning, or malfunctioning, of the nervous system using telemedicine? We have started to develop apps to just this. We have recently been awarded a priming digital health grant to develop an app to assess visual function. This one of the most exciting projects I am involved in at the moment and we will need to come back to you for help us assess the utility of the app when we go into beta testing mode."

"We have entered a brave new world of telemedicine and teleneurology. Those of us who don't adopt telemedicine may find ourselves becoming a dinosaur."

an old-school clinician
Dorsey & Topol. State of Telehealth. N Engl J Med 2016; 375:154-161. 

Telehealth is the provision of health care remotely by means of a variety of telecommunication tools, including telephones, smartphones, and mobile wireless devices, with or without a video connection. Telehealth is growing rapidly and has the potential to transform the delivery of health care for millions of persons. Although several reviews have examined the historical use and effects of telehealth,1-3 few articles have characterized its current status. Here we examine the trends of telehealth, its limitations, and the possibilities for future adoption.

7 comments:

  1. A remote neuro-exam is a great idea. How soon will you have it ready for general use?

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  2. Another point will you be able to see and assess patients in other countries?

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  3. I am not sure I like the idea of "virtual clinics" particularly with the intention of replacing a face-to-face review. Where is the human factor? How am I supposed to trust someone who can't even be bothered to walk down to a clinic to see me? I would question whether that person had any interest at all in my outcome? (I appreciate this is not the intention, but may be how it comes across).

    As an additional resource (ie. group clinic setting); yes I can see how this would be valuable, however I think you need to be cautious around how much becomes electronic.

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  4. I think that telemedicine is a classic 'paving the cow paths' what are the parts of the Victorian model? Adaptive Q&A with physical exam combined with testing. The remote physician asking the questions, must be model-able. If we could catch medical conditions earlier, our current medications would improve outcomes.

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  5. LOVE THE PICTURE! LOL.

    "Old school clinician" (cracking me up!)

    Not too many months back I was involved in some rather heated exchanges about Telemed. My initial reaction to Telemed being an MS patient was "Oh no no no". MS is simply too complex to be reasonably managed in even its most rudimentary aspects than is possible via a disconnected medium such as the World Wide Web (now deemed the InterNut).

    For the common cold or cut, abrasion, light "How To's" I could see its value.

    I was quite against the idea in respect to chronic diseases or complex conditions.

    Right around that time my fiance' started getting MSU into facebook. I actually sent him off to FB to learn "the face of MS online." I figured, he has me learning programming by doing with his "You have to write code to write code" (Bah!) I figured same.

    It did not take long at all for him to end up in trouble.

    Within that same week we had a meeting of some clinicians one of which showed him some VERY scary data. US Deaths (MS specific) related to online patient to patient exchanges.

    Long story short in going over all things Telemed in THAT RESPECT ALONE it can be a game changer across chronic disease and complex conditions.

    Its one thing to say, "So sorry you have such cognitive fatigue. Things will get better" .vs. "I stuff CO-Q 10 or MitoQ down my throat." Resulting perhaps in a patient with Cardio issues to have more problems or bile duct blockage etc.

    Even if Telemed were to say, "You have MS. Dont do anything without first consulting your care team as it can be dangerous".

    Hearing that from a physician creates that moment of pause.

    So, now I am "Yes to Telemed."

    That led to there are no standards for records access, workflows, complex data types on and on. But, thats another discussion.

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  6. I've noticed my neurologist when I go to face to face consultations they are already assessing me when I first walk in the room and are making notes.
    How my walk is, my EDSS, my speech, my posture when seated, how well I look as a whole, who I came to the appointment with, how I answer questions - memory/cognition etc, am I shaking, having tremors. Some of these would be harder to assess without being with the patient in person.

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    Replies
    1. I agree Trixie, I have most of my GP appointments by telephone. When I eventually saw her face to face she said she'd never seen me have such problems walking. This wasn't something new. The whole person consultation is missing and we end up being treated by body parts. My neurologist has stepped in a few times for illnesses not directly MS but have an impact on it.

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