The Surgeon Will Skype You Now

摘要

Technological advancements over the past century have granted clinicians the opportunity to incorporate the use of telemedicine in their practice. The term telemedicine is defined, according to the American Telehealth Association, as “the use of medical information exchanged from 1 site to another via electronic communications to improve a patient's clinical health status.” The field has progressed from the use of telephones to voice-over internet protocol (VoIP) and video (ie, Skype). Telemedicine is commonly used in developed nations and now encompasses an expansive range of technology and applications, including digital video conferencing systems. In May 2015, the US Department of Agriculture announced $19 million for the development of distance learning and telemedicine programs, investing into the growth of healthcare systems in rural communities.1 Several centers have reported excellent outcomes in medical specialties across different states and is gaining increasing support across the US and worldwide.2–4 However, a key question remains unanswered; is telemedicine safe for use in our patients? ADVANCEMENTS IN E-CLINIC Physician–patient consultation has traditionally been face-to-face, allowing for hands-on, 3-dimensional assessments, treatment, and follow-up. However, this consultation model is not without disadvantage. Patients have to travel to the point of care, which has great costs in terms of time, cost, convenience, and economic productivity. With the advent of VoIP telephony, digital video compression, and rapidly improving network infrastructure, telemedicine is employed as an adjunct, or even an alternative, to the traditional face-to-face appointment. Most notably, it has found use within emergency stroke medicine, where rural teams can receive advice from specialists in tertiary centers to deliver early thrombolysis.2,3 Recently, telemedicine has begun to become adopted in the surgical setting, with both outpatient and inpatient telemedicine consultations being increasingly described.5 The technology used to deliver this type of care varies considerably from a simple notebook computer equipped with a webcam, right through to robotically-assisted platforms with the ability to measure vital signs using complex telemetry systems. Regardless of platform, patient safety is paramount. Current evidence for telemedicine identifies highly successful outcomes of its application in perioperative care and outpatient clinic within different surgical subspecialties. However, evidence is of mixed quality and at high risk of selection bias. We performed a systematic review of video telephony systems in surgery and identified 10 heterogenous studies presenting highly favorable results within surgical subspecialties.2,3,6–13 The participants of these studies were largely young and familiar with the use of technology, which highlights a possible selection bias that will invariably occur in adopting internet-based technologies in clinical practice. ADVANTAGES Telemedicine has a number of unique advantages. Improved access and convenience is advantageous for both patients and healthcare professionals. Access from remote regions is the key strength. Well-designed systems allow regional centers to consult with tertiary units for specialist input, delivering timely assessment and reducing inappropriate transfers. There is also evidence telemedicine significantly reduces unplanned clinic attendance.9 One fifth of the US population is estimated to live in rural areas, where patients must travel great distances to reach appropriate healthcare facilities.1 For instance, over half of the population of Mississippi live in rural communities, where healthcare can be remote and thereby difficult to access. Here, interclinician advice and remote clinics delivered to rural community health centers has great potential benefits for patient care. In these patient populations, telemedicine systems reduce the cost, time, and great travelling dista