It has gone from a virus outbreak in one city to a global pandemic that’s locked people behind doors and changed the world. COVID-19 has become a definitive historic event, not just because it has globally impacted humanity simultaneously, but because it has introduced a ‘new normal’. Life can now be sliced in half – a look back at the world as it was, and a look forward into a curiously different world that has yet to decide what it will be. In the midst of this, technology has become the linchpin around which the world now swirls in order to achieve even the most basic tasks from behind locked-down walls and social distancing regulations.
One of these technologies has been around for more than 30 years. It has evolved steadily out of the depths of need, geography and distance and it has suddenly come into its own with the arrival of COVID-19. This technology is telemedicine. The value that this technology has brought to physicians and medical institutions in remote and rural areas cannot be understated. For years it has been refined into a seamless process that has applications in remote follow up, relief work and now, COVID-19.
As Dr. Carl Aschkenasi, a diagnostic radiologist specializing in teleradiology, points out, “…the rest of the world is learning what my everyday life is like.”
Teleradiology is a subset of telemedicine that’s seen significant investment due to its global applications and demand. Advanced and sophisticated, it provides a useful roadmap that can be leveraged by nascent telemedicine practices to deliver healthcare during the outbreak.
The rapid evolution of telemedicine
“Telemedicine started a long time ago,” says Aschkenasi, “perhaps as early as the 1900s, when rudimentary medical guidance was given over radio to ships at sea, and later with NASA medical personnel providing care to astronauts via radio and video links. It has evolved considerably since then.”
Telemedicine was rapidly adopted globally as it allows for the provision of some medical services in remote areas that are inaccessible by medical practitioners. As such, it has had a significant impact in the developing world but is also being used in parts of the USA to provide telemedicine services to rural areas of the country. This has led to applications of telemedicine across several specialties.
“In many rural hospitals it is prohibitively expensive to have a physician on staff so telemedicine has become an important part of hospital care, even in the critical care setting,” says Aschkenasi. “Entire intensive case units can be run remotely by physicians supported by on-site nurses who interact in real-time via videoconferencing to adjust tubes and lines, change ventilator settings, and even perform elements of a physical exam using digital stethoscopes which can transmit heart sounds to the doctor.”
Telemedicine has another added advantage on a round planet– time zones. Due to rapidly improving computer and networking technologies, a remote doctor in Australia can provide care with fresh eyes and a clear mind at 4 PM to a patient in New York at 2 AM. Thus telemedicine has resulted in unprecedented global collaboration, where international counterparts can step in when local professionals need to rest. These technologies have been further enhanced by the arrival of artificial intelligence (AI) and the astonishing capabilities of algorithms and deep learning and neural networks.
What teleradiology teaches telemedicine
“Radiology is a technology-heavy specialty so it’s no surprise that radiologists have been early adopters of new technology and led the way in terms of telemedicine and its subset of teleradiology,” says Aschkenasi. “Teleradiologists have to juggle intense workloads, diverse PACS and computer systems, and variances in scanners and workflows. This has meant that teleradiology platforms need to be PACS agnostic and that the radiologists have to be agile and adaptive – it’s a good petri dish for innovation.”
Teleradiology is fast-paced and diverse. Patients are based in varied locations with variable points of access and understanding. Technology and access are just as varied – connectivity and medical care can be extremely limited. This is further complicated by an environment that demands rapid turnaround of radiology reports that rely on the information provided and minimal if any, patient interaction. In the current shutdown, these are the qualities that are making telemedicine so valuable.
Physicians are a highly prized resource in the COVID-19 era and telemedicine not only affords them a measure of protection – social distancing – but it gives them the opportunity to care for patients that they would ordinarily not have been able to reach. The virus has also changed perceptions around telemedicine.
“The idea of a nurse in the USA having a Zoom conversation with a specialist in Tel Aviv would have been considered out of bounds in the past,” says Aschkenasi. “The idea that you could have an effective medical encounter on Zoom was dismissed. Everybody is on board now. This is further cemented by the need to protect the physician – this is a benefit of telemedicine that wasn’t really at the forefront before.”
COVID-19 has legitimized the remote provision of healthcare services to an unprecedented extent. It has taken telemedicine to a level never expected of it in the past and it may have changed the landscape forever.
The intersection of AI and telemedicine
“We have never had this technology before. We’ve never had this situation before,” says Aschkenasi. “There has never been such a powerful confluence of pandemic epidemiology and technology before.”
“At this time, medical professionals are working at high speed and with high volumes and this can lead to burnout and error, something we can ill afford right now,” says Aschkenasi. “This is where AI can really come into its own, as it can augment the performance of a physician, and ultimately an entire medical system. It’s another pair of eyes that never get tired. It can reduce errors, decrease turnaround times, and streamline processes. It’s invaluable in teleradiology, and will prove equally valuable in our critically overtaxed medical system.”
AI has the ability to improve physician performance synergistically, helping remote practitioners achieve a high-efficiency workflow while smoothing out some of the bumps in the road. Just as telemedicine is becoming an essential aspect of modern medicine, particularly in the COVID-19 era, so is AI becoming an essential technology to optimize physician performance and patient safety.
“AI reduces misses and increases our confidence as we move through high volumes of work,” concludes Aschkenasi. “It helps me to triage my own list and treat positive cases first, giving patients the urgent care they need. It also helps to smooth out our workflows – in my group it has made our workflow far more streamlined and this is of immense value in teleradiology.”
While teleradiology practices have seen decreased volumes due to the onset of the COVID-19 pandemic, some are predicting that once restrictions are lifted, outpatient imaging centers and hospitals will increase their operating capacity. Some are even saying that as a result, a surge in medical imaging may arise as early as mid-May. With this in mind, radiology departments and teleradiology practices will have to properly strategize for these increased workloads. AI solutions that aid radiologists with workflow efficiency are ripe for adoption as providers will encounter unprecedented demand on their services for rescheduled outpatients and patients with worsened clinical conditions.
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