The end of 2020 registered the signature of the Italian Ministry of Health at the State-Region Conference on the guidelines and rules related to visits, consultations, reports and remote assistance. Six years after the approval of the national guidelines and probably thanks to the emergencies caused by the Covid-19 pandemic, with this decision the telemedicine finally becomes an integral part of the National Health Service, thus ending a series of “do it yourself” experiments. The ratification, which now moves on to the implementation phase of the regions, marks a historic decision for our country, which can now include telemedicine among the Essential Levels of Assistance.
Let’s see in detail how this decision will change the Italian healthcare.
HOW AND WHERE TO USE TELEMEDICINE
Four types of services have been established. These services, assimilated to traditional diagnostic or therapeutic services, will integrate the new health practices of the National Health Service by indicating the criteria for the inclusion of telemedicine in clinical and care practice.
The first type of service is related to health emergency, in which telemedicine is used for a series of useful activities, for example exchanging information between rescuers and health facilities such as EKG, vital parameters or images, as well as carrying out teleconsultations: the speed of intervention offers a great advantage especially for pathologies, such as stroke and heart attack, which are particularly time-dependent.
The second sector concerns the control of cardiovascular, respiratory, endocrinological and metabolic diseases, as well as rare diseases, psychiatric diseases and psychological discomforts, autoimmune diseases, disabilities, and clinical conditions of surgical interest.
The third area concerns the accessibility to diagnostic services and continuity of care, which refers to the provision of health services without moving the patient and thus guaranteeing control and monitoring even remotely. Telemonitoring is possible both through medical remote control, which consists of a series of contacts for the control of the patient’s clinical picture through video calls, with the sharing of clinical data, and through remote monitoring, which allows the remote detection and transmission of vital and clinical parameters by means of sensors that interact with the patient, such as that of so-called “assistive technologies”.
Finally, the fourth area concerns medical certification. Particularly interesting, if we wanted to give an example, is the ratification of what was already often the case in the private sector in terms of medical teleconsultation: a medical act in which the professional interacts remotely with one or more doctors to dialogue, also through a video call, about a patient’s clinical situation, based primarily on the sharing of all clinical data, reports, images and audio-videos regarding the specific case. Teleconsulting professionals can also take place in asynchronous mode, as well as in real time.
THE RULES TO PERFORM TELEMEDICINE
Although the doctor-patient relationship will not always be able to take place exclusively remotely, telemedicine can cover a wide range of reasons that can stay behind the doctor visits. In this case, however, there is a difference from traditional visits that must be taken into account: it is necessary for the patient or a family member to give preventive adherence and availability to telematic contact, in order to facilitate interaction with the doctor, an interaction that can be both documentary and informative.
The connection must take place in real time, in which it must be allowed to see the patient and interact with it and possibly, if necessary, also with the support of the care-giver. The era of improvisation and botched solutions ends: healthcare companies will now necessarily be called upon to adapt and to focus on qualified professionals and skills that to date, in most cases, they do not possess. Upstream, it will be necessary to have the figure of Health Manager of Telemedicine who will be the guarantor, according to the directives of the document, to ensure all the transparency and meticulous reporting of the operations.
To give another example, the systems of the Single Health Reservation Centres will have to ensure the management of the agendas by ensuring the possibility of booking the services provided in a traditional or even remote way, a method that is considered as any other place of delivery. The decision on how it is to be delivered will then be made by the specialist and not left to the counter operators.
TO RECAP
To sum up what it has already been reaffirmed, the new rules on telemedicine in Italy will cover four main areas:
- health emergency
- control of pathologies of particular importance
- continuity of care
- medical certification
This is certainly an important step forward in the field of e-health for our country. The future of healthcare has arrived, but for this to be at the service of health, it is necessary to rely on highly qualified and selected operators.