The term “telemedicine,” which was first coined in the 1970s, literally means “healing at a distance” (Strehle, 2006). In 2010, the World Health Organization adopted a broader description of telemedicine as “the delivery of health care services… via the use of communication technology for the diagnosis and treatment of diseases” (WHO, 2010). Telemedicine technologies are currently used across numerous specialties, including “primary care, emergency services… psychiatry, and anesthesiology” (Bridges et al., 2021). The ongoing COVID-19 pandemic has seen individuals worldwide rely more heavily on such technologies to provide and receive healthcare while navigating lockdowns, social distancing, and labor shortages. And even as parts of the world tentatively reopen, the advancement of technologies and skillsets that allow people to engage with health systems from a distance continues. Anesthesiology is one of the fields that is seeing an increase in telemedicine opportunities worldwide.
Telemedicine encompasses a broad spectrum of possibilities, ranging from the more familiar use of the telephone for patient-doctor consultations to more experimental innovations like telesurgery, where surgeons use robotic instruments to perform surgery “at a distant site” (Field, 2005). Between these two ends of the spectrum lie myriad technologies and applications, from interactive video conferencing to “store and forward” technologies for the transmission of X-rays and other types of images (Field, 2005). There are even “facilitated visits,” in which patients use “a brick-and-mortar teleconsultation site with video and examination equipment operated by a trained staff member with data transmitted in real time to a physician in a separate facility” (Bridges et al., 2021). In fact, the first reported use of telemedicine in anesthesiology was a facilitated visit in 2004, during which 10 patients underwent their preoperative evaluations with the help of a nurse-operated video monitor (Bridges et al., 2021).
The preoperative, intraoperative, and postoperative periods offer three areas of potential growth for telemedicine in anesthesiology. Possible benefits of remote preoperative evaluations, which are important for confirming that a patient is cleared for surgery, include “cost savings to patients, convenience, and reduced day-of-surgery cancellation rates” (Bridges et al., 2021). In one Nebraska-based pilot study that introduced remote preoperative evaluation to the Department of Veterans Affairs (VA) health care system, staff anesthesiologists and patients offered largely positive feedback: 87.5% of patients felt that the use of telemedicine for virtual preoperative evaluations could save them time and money when it came to traveling to care centers or surgical clinics (Zetterman, 2011). And in terms of reducing day-of-surgery cancellation rates, which are often impacted by failure to comply with preoperative anesthesia evaluation, telemedicine assessments have similar efficacy to in-person preoperative clinics (Kamdar, 2020).
Bridges et al. also detail several successful intraoperative uses of telemedicine, including the use of a remotely controlled drug delivery system by anesthesiologists in Montreal for total intravenous anesthesia of patients in Italy (Bridges et al., 2021). And for anesthesiologists involved in postoperative patient care, remote monitoring of medical data has proven useful for analysis of vital signs and markers of postoperative complications (Safavi et al., 2019).
Prior to the expansion of telehealth technologies, distance, inadequate transportation, work schedules, and childcare responsibilities often posed significant barriers to health care. The ongoing coronavirus pandemic has pushed people towards remote work and functioning where possible, heightening the appeal of telehealth consultations even when in-person visits are available. And for the field of anesthesiology in particular, the introduction of telemedicine into the preoperative, intraoperative, and postoperative periods has potential to further advance the specialty. Still, “security of connection, data storage and encryption… and overall cost/savings analysis” are aspects of telemedicine in anesthesiology that will require further research and exploration (Bridges et al., 2020).
References
Bridges, K.H., McSwain, J.R. (2021, September). Telemedicine for Anesthesiologists. Anesthesiology Clinics, 39(3), 583-596. https://doi.org/10.1016/j.anclin.2021.04.006.
Bridges, K. H., McSwain, J. R., & Wilson, P. R. (2020). To Infinity and Beyond: The Past, Present, and Future of Tele-Anesthesia. Anesthesia and analgesia, 130(2), 276–284. https://doi.org/10.1213/ANE.0000000000004346
Field, MJ. Institute of Medicine (US) Committee on Evaluating Clinical Applications of Telemedicine. (2005). Telemedicine: A Guide to Assessing Telecommunications in Health Care. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK45440/.
Kamdar, N. V., Huverserian, A., Jalilian, L., Thi, W., Duval, V., Beck, L., Brooker, L., Grogan, T., Lin, A., & Cannesson, M. (2020). Development, Implementation, and Evaluation of a Telemedicine Preoperative Evaluation Initiative at a Major Academic Medical Center. Anesthesia and analgesia, 131(6), 1647–1656. https://doi.org/10.1213/ANE.0000000000005208
Russo, J. E., McCool, R. R., & Davies, L. (2016). VA Telemedicine: An Analysis of Cost and Time Savings. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 22(3), 209–215. https://doi.org/10.1089/tmj.2015.0055
Safavi, K. C., Driscoll, W., & Wiener-Kronish, J. P. (2019). Remote Surveillance Technologies: Realizing the Aim of Right Patient, Right Data, Right Time. Anesthesia and analgesia, 129(3), 726–734. https://doi.org/10.1213/ANE.0000000000003948
Strehle EM, Shabde N. (2006). One hundred years of telemedicine: does this new technology have a place in paediatrics? Archives of Disease in Childhood, 91(12), 956–959.
World Health Organization (WHO). (2010). Telemedicine: Opportunities and developments in member states. World Health Organization. https://www.who.int/goe/publications/goe_telemedicine_2010.pdf.
Zetterman, C. V., Sweitzer, B. J., Webb, B., Barak-Bernhagen, M. A., & Boedeker, B. H. (2011). Validation of a virtual preoperative evaluation clinic: a pilot study. Studies in health technology and informatics, 163, 737–739.