Table 1.
Organizational aspects of the 4 main use cases (patients' teleconsultation, healthcare professional teleconsultation, telemonitoring, teleassistance).
| Patients' teleconsultation (“televisita”) | Healthcare professionals' teleconsultation | Telemonitoring | Teleassistance | |
|---|---|---|---|---|
| Description | Patient Teleconsultation refers to interactions between a clinician and a patient to provide diagnostic or therapeutic advice through electronic means. According to Italian legislationa, patient teleconsultation is only allowed to monitor patients who have already been diagnosed with a condition/disease during a in-person appointment. A teleconsultation could have numerous goals, such as: • Follow-up of a previously known condition. • Adjusting or changing therapy. • Taking a medical history and clinical evaluation for the prescription of medicines or diagnostic exams. • Sharing with other relevant professional updates on the patient's medical journey/diagnostic pathway. |
Healthcare Professionals' Teleconsultation is a medical procedure in which the healthcare professional interacts remotely with doctors and colleagues to discuss the patient's clinical case. During this process, it is possible to share all the relevant data, reports, images, audio-visual material, regarding the specific case. | Telemonitoring enables medical professionals to gather vital and clinical parameters remotely and patients to transmit them via body sensors that interact with the patient (biometric technologies) The remote technological set is personalized according to the physician's specifications. The patient must be constantly connected to the software that collects data from the body sensors. The clinical data is combined with other relevant data, and then shared with all the various stakeholders involved in the patient's care process. | Teleassistance can be considered as a hybrid between telehealth and telemonitoring. It is a professional act pertaining to the related health profession and is based on the remote interaction between the professional and patient/caregiver by means of a video call, which can, if necessary, be added the sharing of data, reports or images. The professional who performs the telehealth activity can also use suitable apps to administer questionnaires, share images or video tutorials on specific tasks. The purpose is to facilitate the proper performance of care activities, which can be mostly delivered at home. |
| Prescriber | General practitioners, health authority doctors, and medical specialists could request a teleconsultation through a prescription. This service may be provided to all patients (even those with non-complex management) and it does not require a multidisciplinary evaluation or individualized care plan. | In the IHC setting, general practitioner, pediatrician, health authority doctors, health professionals or specialist prescribe a teleconsultation. This service could also be extended to patients with non-complex management, and it does not require a multidisciplinary evaluation or individualized care plan. | In the IHC setting, telemonitoring may be deemed necessary by a general practitioner, pediatrician, health authority doctors or specialist. Telemonitoring always requires a clinical pathway that has the following defined: number of eligible patients, available telemonitoring tools, minimum set of monitored parameters, threshold values, selection of data to be reported in the clinical documentation, alarm management pathway, as well as professionals for the management of interventions (call of the referring nurse or physician, home access of the healthcare professional, televisita—i.e. patient's teleconsultation, emergency room activation). | General practitioners, health authority doctors, and medical specialists could request teleassistance through prescription. This service may be provided to all patients (even those with non-complex management) and does not require a multidisciplinary evaluation or individualized care plan. |
| Activation and provision | The responsibility for activating the process lies with the COT, general practitioners, pediatricians, and specialists. The teleconsultation will be provided by healthcare professionals, which will be able to annotate the outcome of the consultation in the EHR. | As this type of teleconsultation consists in an interaction between healthcare professionals, the activation may be direct (even through shared agendas) when communications pathways are pre-established. Otherwise, the activation can be done indirectly through the COT, or the operations center of the IHC setting, that is the control room of the IHC service. | In the case of patients already under the care of an IHC service, the activator is the control room, if present. In the case of patients moving between different settings, where the coordination of different specialists and competences is needed, the activator is the COT. The Center for Telemedicine Services following: Telemonitoring service (such as access to the portal, setting, threshold values, etc.), technical assistance and second level help desk service (technical support) in case of need (through channels, times and days defined). | The activators of the teleassistance services are: the aforementioned health professionals, the COT, and the IHC Operations Center (where present). Activation of the service should be planned appropriately based on agendas, observations shared with the health professionals involved, and managed directly by them or the IHC Operations Center where present or COT. The providers, however, are the health professionals. |
| Technical support and information shared | There is minimum basic equipment required to support the teleconsultation. During and before the visit, it is important to always ensure the possibility to share real time clinical information, data, medical reports, images, and video. Patients' information must be available in the EHR where healthcare professionals may retrieve or store data and information. When patients do not meet the requirements of both clinical and technical compliance to perform the teleconsultation, the medical appointment must be done in-person. | In order to initiate a video call, basic technological equipment is necessary. Tools facilitating the consultation and sharing relevant clinical documentation (reports, images, etc…) are deemed essential. Patients' information must be accessible to the IHC service. | Telemonitoring is feasible thanks to specific set of certified technological devices, connected to a central portal to receive and properly store the obtained data. Portal and data access must be allowed by the physician that prescribed the telemonitoring and by the equipment involved in the clinical pathway. The relevant information contained in the portal and useful to taking care of the patient at home are: - Data periodically detected by the telemonitoring system. To guarantee patient's continuity of care, this data may be reported in the home care folder, with an automatic import. - Periodic evaluation of the telemonitoring system, performed by the general practitioner (or pediatrician) that has the management of the case. | The instrumentation provided for teleassistance consists of devices for recording, data and image storage, software for data and image exchange, video and vital parameters, medical devices and sensing sensors. Additional possibilities are provided by linking and consultation of data or information detected during the service itself. The information present in the teleassistance portal is: • data periodically surveyed by the professional. • data periodically self-detected and entered by the caregiver. • documents: reports and notes of the various visits/interventions performed, assessments by the health professionals, or by the physician in charge of the case and of the actions taken (diet update, drug therapy update or other, based on changes in the health status due to the disease). |
IHC, Integrated Home Care. aPiano nazionale di ripresa e resilienza Missione 6: Salute Componente 1 (M6C1): Reti di prossimita', strutture e telemedicina per l'assistenza sanitaria territoriale. Investimento 1.2.3 La telemedicina a supporto dei pazienti nell'assistenza sanitaria territoriale. Linee guida per i Servizi di telemedicina. Requisiti funzionali e livelli di servizio (Allegato A).