Telemedicine is experiencing a second birth around the world: virtual doctor’s visits during lockdowns are one of the safest ways to consult patients and prevent the spread of coronavirus in clinics and hospitals. How does it work in Russia and in the world, and can such consultations be trusted?
“Now everyone suspects they have the coronavirus,” says Elena Lisitsina, a therapist at the private clinic network “Medsy” who has been consulting patients via video calls for several years. “98% of video calls are now related to this situation. In addition, people are isolated – for some, chronic diseases have worsened”.
“Medsy has calculated that the number of requests for video consultations has doubled during the lockdown. Most often, patients turn to therapists for help, says Elena Zhuravleva, the head of the company’s press service: “At the same time, the number of requests to pediatricians has decreased significantly. We believe that this is due to the fact that children stay at home, are less susceptible to viruses, and the home environment is beneficial to their health”.
In January 2018, the law on telemedicine came into force in Russia. According to the document, telemedicine technologies can only be used to conduct consultations on preventive measures, diagnosis and health monitoring of patients, as well as to make decisions on the necessity of a personal appointment. During the Covid-19 pandemic, deputies (led by the Chairman of the State Duma Vyacheslav Volodin) have introduced a new bill for consideration. “In a state of emergency and/or in the event of a threat of the spread of a disease that poses a danger to others, the government has the right to establish other features and procedures for providing medical assistance, including the use of telemedicine technologies,” the main article states. Doctors will also be given the right to prescribe treatment and make diagnoses remotely.
Therapist Elena Lisitsina regrets the lack of such a possibility. “At the moment, during the initial consultation, we cannot prescribe anything, we can only recommend some tests or analyses. If it’s an emergency call and urgent help is needed, I can advise the patient to take an aspirin, for example, and then call an ambulance. But such cases are rare. Sometimes a person tells me about their symptoms, and it’s clear that they have angina, and I really want to prescribe antibiotics, but I can’t. I invite them to make an appointment. It’s a pity that the patient can’t be treated immediately – like us, doctors who treat our relatives over the phone. We explain quickly, simply, and clearly what happened, why it matters, and what happens next. The number of offers should remain: Episodes End of story. Podcast Advertising.
“But it is important to understand that remote consultations have objective limitations,” says Dr. Janmurza Janmurzaev, a general practitioner and emergency room physician at the European Medical Center. “After all, a doctor cannot fully perform all diagnostic procedures. We emphasize to patients that no video consultation can replace a full examination. According to Dzhanmurzaev, this type of consultation is most suitable for patients who have already been examined, prescribed some treatment and want to get another specialist’s opinion. “But when it comes to the initial consultation, things aren’t so rosy: Based solely on complaints and history, without a thorough examination, it’s not always possible to understand exactly what’s going on. You can get a general direction, but the doctor always has an element of doubt. There are cases where it’s difficult to say anything specific and we have to make very big assumptions. Then I would say: based on your words, I can assume… We try not to draw categorical conclusions. There are sharp angles, but we tell the patient that the lack of clear recommendations is not the result of our incompetence,” Dzhanmurzaev explains.
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The clinic, he says, now uses special equipment for remote consultations. They are equipped with diagnostic modules that allow patients to take their own temperature, take high-resolution photos to diagnose skin problems, examine the external ear canals and eardrums, mouth and throat, and listen to the lungs and heart. The therapist adds: “If not every day, then every other day in the last few weeks, consultations are held with patients who have a device. This is necessary when, for example, a family of several people goes away for several months, but prefers to consult their family doctor”.
In April, a telemedicine center began operating in Moscow, where doctors consult patients with a confirmed diagnosis of Covid-19 via video communication, who are being treated at home rather than in hospitals. According to the Moscow City Government, the center’s doctors will be able to conduct up to 4,000 consultations a day.
France is one of the most advanced countries in the development of telemedicine. When the law on telemedicine was passed in Russia, the field had already been developing in the United States for 10 years. According to a study conducted by Dr. Christine Ray of the University of Pittsburgh and her colleagues at Harvard Medical School, people spend several hours visiting a doctor, including travel time and waiting for the appointment. Only 17% of that time, an average of 20 minutes, is spent actually communicating with a specialist. Experts have calculated that Americans spend about 2.4 billion hours a year visiting the doctor. Based on the average salary for 2016, this equates to $52 billion – the income of 1.2 million people. However, before the coronavirus, the majority of patients in the United States continued to schedule appointments in person. With the onset of the pandemic, major hospitals across the country began accepting patients via video communication more frequently.
“This is a watershed moment for telemedicine. Now we are seeing how it can be used in crisis situations,” says Dr. Mita Shah of Rush University Medical Center in Chicago. Dr. Stephen Parodi, an infectious disease specialist currently working in the field of telemedicine, is confident: “Telemedicine will be critical to controlling this pandemic.” In March, the U.S. Congress approved the allocation of $8.3 billion in additional funding for telemedicine: this amount will allow patients insured under the Medicare program (which applies to individuals over 65 years of age, but some people younger than that age, such as individuals with disabilities or those with amyotrophic lateral sclerosis, may also qualify) to access this service. CNBC reported that after the congressional decision, many hospitals installed equipment for online consultations overnight to keep as many healthy people at home as possible. San Francisco cardiologist Ethan Weiss, who used to see patients in person, said the video consultations were “much better” than he expected. He admitted that he would like to continue using telemedicine in the future, allowing people with less complex conditions to avoid unnecessary trips to the hospital and more vulnerable patients to receive more attention from their doctor. “We’re doing more video consults now than we did all of last year,” said John Brownstein, director of innovation at Boston Children’s Hospital, at the Online Innovation Summit in the Era of the Coronavirus. “I cannot imagine going back to the way things were. I think this situation has opened the eyes of our physicians, administrators and patients. It could be the basis for the development of medicine in the future.”
In March, according to Frost & Sullivan research, the number of requests for video consultations increased by 50%, and individual telemedicine service providers reported receiving 15,000 more requests per day than before the pandemic. Forrester analysts believe that the number of requests for video consultations with a physician in the United States could exceed 900 million this year due to the coronavirus. Video consultations with physicians are one way to help small practices, according to Dr. Bob Merry of New Jersey. In the regions of the country most affected by Covid-19, officials have asked medical professionals to reduce the number of non-essential visits. As a result, Dr. Merry schedules all appointments via video call: “This is literally a lifeline for small private practices, as well as a lifeline for patients who would otherwise go without care.”
A similar boost in telemedicine development has occurred in the United Kingdom, where, despite the availability of free online video consultations, until recently 95% of appointments were face-to-face. “We see that the use of video consultations can become a viable alternative to face-to-face appointments, especially in these times when people are trying to adhere to social distancing recommendations,” said Professor Martin Marshall, chairman of the Royal College of General Practitioners, according to the BBC. Patients are receptive to the introduction of new technologies, says Marshall, but the process of implementing telemedicine will be challenging for some clinics. “Some doctors have been using video communication to see patients for some time. However, there can be technical difficulties in remote rural areas far from major cities. And there will always be cases that require face-to-face consultations,” he adds. The British company Immedicare is working with the National Health Service to provide software for general practitioners to monitor patients in nursing homes. Company representative David Butler told the BBC that prior to the coronavirus outbreak, in 60% of cases, patients did not require additional testing after a video consultation with a physician. Butler claims that in normal times, the majority of nursing home patients (14% of cases) seek medical attention for falls, but most do not require a face-to-face examination. When asked what hindered the development of telemedicine prior to the coronavirus outbreak, Butler says inertia was probably the main factor: “Nursing homes have been taken care of by physicians in the same way for decades. And just changing that mindset, trying something new, takes time. And the situation with Covid-19 has of course accelerated this process. I am confident that we would have gotten there sooner or later anyway.
How to survive self-isolation. Tips from the older generation. Dr. Dan Bunstone, chief medical officer of Push Doctors, a company that provides telemedicine services, agrees: “The main problem is simply changing traditions, starting to use new formats. Our own experience shows that when doctors and patients still choose new technologies, they like it, it is convenient for them”. Now, during the pandemic, even a doctor’s visit to a nursing home can pose a threat: age is one of the most important factors in how a person copes with the disease, and the elderly are a high-risk group. “The risk I pose to the nursing home residents is significant. At the same time, they are our most vulnerable patients. The ability to monitor, consult and assess their condition via video call is an absolute breakthrough for us,” Dr. Paul Duffly, a general practitioner from Brighton, told the New York Times. According to Push Doctors, a UK-based company, the total number of coronavirus-related queries increased by 70% – both from patients and doctors, who were advised to conduct more teleconsultations to reduce the risk of virus transmission. “Because of the pandemic and the resulting need to maintain social distance, telemedicine has developed much faster. Almost overnight, we found ourselves in a situation where the majority of consultations with doctors are conducted remotely,” said BBC in the company. The following countries are considered the most advanced in the implementation of telemedicine: USA, Israel, Great Britain, France and the countries of Northern Europe, and yet a significant increase in requests – sometimes double – was unexpected even for them. In Russia, where the number of inquiries has also increased significantly, patients sometimes have doubts about the effectiveness of such approaches, several doctors told the BBC. Meanwhile, the results of studies published in the US in 2015 showed that patients with heart failure who sought video consultations were no more likely to die than those who went to in-person visits; treatment outcomes were the same for patients with mental health problems, addictions, and dermatological conditions. The study also showed that the ability to see a physician quickly had a positive impact on diabetes patients, who were better able to control their blood glucose levels, which in turn helped lower blood pressure and cholesterol. One of the main concerns expressed by experts is the confidentiality of patient data stored in the “cloud” in the case of telemedicine. Google has already tried to create a service called “Health” that allows users to upload their medical documents to servers in order to share them more quickly with doctors or have them available in case of emergency. The service promised not only to store the data, but also to analyze it and alert users to possible side effects from taking certain medications. However, in June 2011, the company shut down the service due to lack of popularity. The New York Times then suggested that patients were likely afraid to store their data on the servers of a large technology company without knowing how their confidential information would be protected.