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This US cohort study looked at whether the shift from face-to-face to virtual mental health service delivery is associated with the risk of suicide-related events. The results suggest that offering virtual mental health care in addition to in-person care may reduce suicide-related events.

When the Covid-19 pandemic started, video consulting became standard practice for many GPs, who became rapidly acquainted with the technology for video calls. Doctors worked on improving their video consulting technique, not knowing for how long they might have to limit in-person consultations. Now that vaccination has reduced the risks of face-to-face appointments, the vast majority of GP practices rarely use video consultation, and fewer than 1% of consultations were conducted this way in England in May 2023. In this BMJ article, GP Helen Salisbury looks at the reasons for this decline in the use of video calls, arguing that face-to-face consults allow for a more accurate and safe diagnostic process and facilitate building rapport between healthcare professionals and patients.

The Remote by Default research study, a collaboration between the Universities of Oxford and Plymouth and the Nuffield Trust, has been exploring how technology can be harnessed to support excellent primary care. Using workshops, interviews, and focus groups of clinicians, service users, and other stakeholders, they have begun to map the multiple interacting influences on the choice of consultation modality.

This Rapid Evidence Scan from Moore et al. examined the effectiveness of virtual hospital models of care. While no reviews evaluated a complete model, tele-healthcare only and tele-healthcare with remote telemonitoring interventions demonstrated similar or significantly better clinical or health system outcomes including reduced hospitalisations, readmissions, emergency department visits and length of stay, compared to usual care, including those delivered without home visits or face-to-face care. The use of the Internet showed mixed but promising results. The strongest evidence was for cardiac failure, coronary heart disease, diabetes and stroke rehabilitation. Nurses played a central role in home visiting, providing telephone support and education. However, the studies were heterogenous and the results should be interpreted with caution.

The Doctor Will Zoom You Now was a rapid, qualitative research study designed to understand the patient experience of remote and virtual consultations. The project was led in partnership with Traverse, National Voices and Healthwatch England and supported by PPL. The study engaged 49 people over 10 days (June 22nd – July 1st 2020) using an online platform, with 20 additional one to one telephone interviews. Participants were also invited to attend an online workshop on the final day of the study. Using insight from the key findings from the research, this website provides useful tools and tips for getting the most out of your appointment.

This article describes how 55 international and national participants participated in an event that focused on strengthening patient safety within telemedicine through resilience on 16 August 2018 at the Health Innovation Centre of Southern Denmark in Odense, Denmark. 

Clinical negligence claims are often built upon a lack of adequate documentation of what was said and allegations that patients have not been properly counselled about risks and alternatives. Elizabeth Thomas explores in this HSJ article what this means for the increasingly significant role of telemedicine and the steps which can go a long way in reducing the burden on patients and the public purse

The results of Digital Health Intelligence’s first survey of CNIO Network members provides a ’state of the nation’ insight into nursing and allied health professional leadership in healthcare IT. This webinar offers a chance to learn about some of the key findings of the survey and to hear from senior nursing figures on their thoughts about what it means for where we go next. This webinar will be of interest to: anyone currently working in a nursing/allied health professionals (AHP) clinical informatics role those who aspire to develop their career in this area those who are seeking to set up such a role within their organisation those currently working with CNIOs/AHP informatics leads. Attendees will learn: more about how CNIO/AHP informatics roles are currently set up in the NHS – time commitment, reporting structures etc what the profile is of those holding such roles about possible challenges in connections between CNIOs/AHPs in informatics roles and CCIOs and CIOs thoughts on whether the CNIO/AHP informatics role should be formally recognised further views from senior leaders on the future of these roles.

Telemedicine and telephone-triage may compromise patient safety, particularly if urgency is underestimated. This paper from Haimi et al., published in BMC Medical Informatics and Decision Making, aimed to explore the level of safety of a paediatric telemedicine service, with particular reference to the appropriateness of the medical diagnoses made by the online physicians and the reasonableness of their decisions.

Telehealth has become more entrenched as a healthcare provision mechanism in response to COVID-19. This Dissent Magazine article cautions its effectiveness long term due to its potential to be established as a profit centre for healthcare organisations.

Telemedicine has potential to address inequity in healthcare but not until certain barriers are addressed. This article from Joanna Pearlstein in Wired discusses how physicians and care organisations have to be creative and rely on partnerships and local resources, such as school district hot spots or public library broadband access, to make the system reliably work for all their patients.

In this month's Letter from America, Lorri Zipperer discusses cautions and capabilities associated with healthcare technologies. Letter from America is a Patient Safety Learning blog series highlighting new accomplishments and patient safety challenges in the United States. This is Lorri's last blog in the series and we'd like to thank Lorri for sharing her insights with us over the last 12 months. Read here all the Letter from America blogs I had been trying to get my Mom to do video calls on her computer for a decade. Pushback and inexperience with new technologies just didn’t give her the confidence she needed to step over that line. A lack of trust in the systems to work right and in her ability to navigate the hiccups minimised her willingness to give it a shot. And then along came covid. Due to necessity and front-line assistance (my sister and niece get a hat tip here), Mom finally began to see how beneficial the tools were for improving her state of mind and increasing our awareness of how she is from a long distance during the lockdown. There also has been hesitancy in healthcare to fully embrace communication technologies that can optimise and energise processes. Uncertainty and optimism are certainly warranted in the use of electronic mobile connections in healthcare and the devices that support it. These new approaches touch facets of training, appointments, personal health monitoring and overall system reliability. Beyond the changes necessitated by the pandemic, the need to embrace new technologies in healthcare is now essential and will be for the future despite expected challenges to universal adoption. The covid pandemic has motivated healthcare to broaden its vision of the potential for remote technologies. Now telemedicine, telehealth, telecoaching, digital therapeutics and mobile patient outreach has become absolutely necessary. They are here to stay. Changes in reimbursement policies have provided coverage for telehealth services that, before the pandemic, was much more restrictive. While patients and physicians may appreciate the convenience of this “new normal”, there are quandaries associated with its uptake. At a time when relationships are so vital to our lives, having technology to either build them (granted in a new way), inform them (via a new set of communication tools) or damage them (dependent on the willingness, system robustness and comfort of the individuals involved) is worth considering. For example, worries about diagnostic accuracy, limitations of the virtual physical exam, concerns about privacy, usability and the loss of the person-focus of patient/physician communication. The effectiveness of telemedicine and telehealth is also impacted by health literacy, access to reliable networks and patient comfort with using digital tools. Physicians and care organisations have to be creative and rely on partnerships and local resources, such as school district hot spots or public library broadband access, to make the system reliably work for all their patients. On another level, Dissent Magazine discusses a range of economic concerns stemming from the accelerated adoption of telehealth, including the primary worry that services have the potential to be structured as profit centres shifting the focus of decisions toward stakeholder and executive compensation rather than effective care. Then there are questions surrounding the apps and tools patients are using to make decisions about their health. Dr. Google has known weaknesses. Patient-facing diagnostic apps, wearables and symptom trackers, while showing promise still require appropriate risk evaluation before patients should fully trust them to track and manage their health without clinician guidance, and protect against worry and overuse of health services. The Skeptical Cardiologist shares reasons to resist the temptation to rely on, for example, the blood oxygen monitoring accuracy of a much anticipated product for reasons that include lack of reference to primary data and cost. Use of symptom trackers could proliferate as patients remain hesitant to visit physicians due to covid concerns. One project from Georgetown University was forthcoming about its rapid development strategy when sharing the results of a covid symptom tracker pilot test. Areas covered included size of the beta test (48 students), use of unique identifiers to address privacy concerns for both patients and organisations involved, access to condition-relevant patient-centered educational information and instructions to seek medical care should symptoms indicate that necessary step. It is this sort of transparency that aids the healthcare community and patients to appropriately select and trust tools to manage symptoms and situations for public and personal health safety. Voice activation technologies, so convenient for getting the latest news and listening to music, are seen as having great potential in healthcare monitoring as well. Voice characteristics are being explored as a diagnostic indicator. As covered recently in Nature, vocal biomarkers can track mental status, pulmonary function and coronary distress. But a myriad of factors could affect verbal characteristics reducing voice as a reliable mechanism for diagnosis. While promising, teasing out these differences in vocal diagnostics is still an emerging opportunity being explored in the US and around the world. Also, the use of voice-activated technologies in certain care settings can impact the privacy of the patient and may therefore not be suitable. On a systemic scale, the growing dependance on technologies leave patients, clinicians and organisations vulnerable to purposeful or accidental incidents or outtages, such as cyberattacks, that create disruptions and compromise patient safety. Recently a large health system in the US was crippled due to a ransomware attack. Patients needed to be rapidly moved to another out of system facility to ensure their safety. Experts caution that this is not the last of these situations and advise systems to train their staff and create awareness to recognise the early signals of a cyberattack to quickly reduce the extent of the damage and corresponding interruptions to healthcare services. Mom is now expanding her use of technology to make life better. She is exploring her first streaming service and becoming comfortable with its capabilities to binge on popular programmes. Who knows if that will lead the way to virtual visits with her cardiologist, or being able to track her vital signs from across the country and her personal use of a smart watch to monitor her heart? Let’s hope for all moms and other patients the adoption of technologies in the health space can be folded into our daily lives with minimal harm and negative disruption.

Dr Steve Barker is joined by Ronald Weinstein, Director/Founder, Arizona Telemedicine Program, and Jeffrey Dunn, Founder/CEO, Redivus Health, to discuss the future of telemedicine within the patient safety and quality improvement space. Telemedicine has become a significant area of investment in recent years and the panelists predict that, in the future, user experience, consolidation, customisation based on relevance to the user, robotics, and health literacy will become top priorities.

Although millions of patients with cancer around the world face delays in diagnosis and treatment because of the diversion of resources during the COVID-19 pandemic, there is a growing expectation that telemedicine may play a central role in easing the backlog. This Lancet Digital Health article explores how telemedicine will be key as healthcare systems move forward in tackling the backlog in not only cancer treatment but also diagnosis, and how augmented intelligence (AI) could be used to help to optimise its use.

Healthcare organisations including regulators, royal colleges and faculties have issued a set of principles to help protect patient safety and welfare when accessing potentially-harmful medication online or over the phone. The jointly-agreed princsiples set out the good practice expected of healthcare professionals when prescribing medication online. This information is for all healthcare professionals with prescribing responsibilities. It sets out the shared high level principles of good practice expected of everyone when consulting and or prescribing remotely from the patient. The principles are underpinned by existing standards and guidance from professional and system regulators. Healthcare professionals should continue to follow guidance from regulatory bodies and take clinical guidance into account in their decision making.

These top tips set out by the Royal College of General Practitioners, are for clinicians conducting telephone consultations to assess and advise patients concerned they may have COVID-19 (Coronavirus).