Telemedicine is often defined as the use of electronic information and communication technologies to provide clinical services to patients without an in-person visit. Although telemedicine and telehealth are terms which are often used interchangeably, there is actually a  distinction between the two. Telemedicine is indeed a subset of telehealth, which refers to a broader scope of remote healthcare services, which also includes non-clinical services such as administrative meetings and continuing medical education¹.
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How beneficial telemedicine can be has been recently demonstrated during the COVID-19 pandemic, as it allowed high quality medical care to be provided to patients at home, reducing the virus transmission among patients and clinicians. In America, since the onset of the pandemic, in conjunction with a liberalization of the virtual care rules by regulators, the percentage of US consumers that used telemedicine raised to 46%, compared to the 11% in 2019².

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But the benefits of telemedicine go beyond the pandemic use case. Telemedicine has been proven to be especially useful in underserved communities where there is a shortage or absence of adequate clinical care, such as in remote areas³.
At the same time, due to both infrastructural challenges (e.g. lack of access to broadband at home) and individual behaviours and preferences, the adoption of virtual care in rural areas has lagged behind urban areas⁴.
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Indeed, if on one side the promise of telemedicine is to deliver healthcare services eliminating distances, reducing waiting times and decongesting busy hospitals and clinics, technological, legal and ethical challenges can hinder the realization of these advantages. 

From the technology side, as already mentioned, it is not only necessary to have broadband internet access, but also for doctors to have the right tools (e.g. interoperable, integrated and even better artificial intelligence and machine learning powered software and platforms) for delivering high quality care at distance. Unfamiliarity with technology for both doctors and patients can also slow down the adoption of telemedicine.

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In terms of legal challenges, in many cases the issue is the absence of legislation and consequent regulatory uncertainty, combined with the major legal and ethical concern of data privacy, as there is an exchange of sensitive patient information. This again illustrates another difference between telemedicine and telehealth as some forms of the latter do not transmit patient specific medical information and therefore do not require a special level of security, such as the HIPAA. 

On the ethical side, concerns have been raised also regarding the different relationship doctor-patient once it is transferred online. However, this challenge could also be  a great opportunity to foster patient engagement and empowerment, while rendering the relationship more collaborative aiming at shared decision-making processes.


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What about telemedicine in the ophthalmology field?

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The exponential increase in the use of telemedicine is accelerating  the spreading of teleophthalmology as well. The increasing adoption is also pushed by the problem of not having enough ophthalmologists, with the American Association of Medical Colleges (AAMC) estimating a shortage of ophthalmology providers in 2025⁵, to cope with an aging population affected by chronic and degenerative eye diseases (e.g. glaucoma, age-related macular degeneration, cataracts).
It is indeed necessary to find alternative solutions to strengthen capacity in the face of diminishing resources while maintaining delivery of high-quality care.

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By allowing the decongestion of ophthalmology clinics, telemedicine can give the opportunity to ophthalmology providers to perform better patient screening and more complete data recording. Moreover, considering that chemical injury and trauma are prime emergencies in ophthalmology, having available ophthalmologists for timely intervention in emergency situations, can avoid delayed initiation of treatment and potential long term visual impairment⁶.
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Considering that most of the chronic and degenerative eye diseases can potentially be diagnosed early and monitored through technological devices and AI applications, telemedicine can also contribute to improving healthcare outcomes.
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Telemedicine and teleophthalmology are effective solutions to complement the traditional health care system in meeting patients’ needs. Their increasing adoption contributes, first of all, to upgrading the healthcare infrastructure and modernization of healthcare systems, which are necessary especially in the instance of future pandemics. Last but not least, telemedicine and teleophthalmology resonate with the vision of personalized and patient-centric medicine and ultimately with a better healthcare of tomorrow.

At RetinAI we are well aware of the role that teleophthalmology can play in reaching high quality Digital Precision Medicine, which is our ultimate vision. Therefore we are committed to continue working on creating software solutions that enable and foster the application of teleophthalmology and the benefits it brings to healthcare professionals and ultimately to patients.



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References:

1. Argy, O. and Caputo, M. (1999). Introduction to Telemedicine. Health Informatics, pp.227–233. doi:10.1007/0-387-21857-2_27.
2. McKinsey (2021). McKinsey on Healthcare: Perspectives on the pandemic. Selected articles from 2020 and 2021.
3. Nittari, G., Khuman, R., Baldoni, S., Pallotta, G., Battineni, G., Sirignano, A., Amenta, F. and Ricci, G. (2020). Telemedicine Practice: Review of the Current Ethical and Legal Challenges. Telemedicine and e-Health, 26(12). doi:10.1089/tmj.2019.0158.
4. McKinsey (2021). McKinsey on Healthcare: Perspectives on the pandemic. Selected articles from 2020 and 2021. 
5. Dang, S., Pakhchanian H., Flynn E., Raiker R., Khoo C., Belyea D. (2021). Estimating Patient Demand for Ophthalmologists in the United States using Google Trends. Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1724.
6. Sreelatha, O. and S Ve, R. (2016). Teleophthalmology: improving patient outcomes?. Clinical Ophthalmology, p.285. doi:10.2147/opth.s80487.