Dr. Bill Lewis.- La telemedicina ha prometido transformar la asistencia sanitaria desde los albores de las telecomunicaciones.
Las últimas décadas lo vieron pasar del ámbito de la ciencia ficción a la realidad funcional. Pero permaneció al margen de la atención médica, progresando de manera constante, pero aún lejos de su potencial prometido. Luego vino el COVID-19, y con él, la tormenta perfecta de la telemedicina: una crisis de salud nacional que demanda niveles sin precedentes de atención y distanciamiento social, un sistema de atención de la salud extendido hasta el límite y la adopción casi universal de métodos y tecnologías de trabajo remoto. Y así, parece, ha llegado la telemedicina.
¿Pero lo tiene? ¿Dónde nos encontramos? ¿Estamos realmente en el camino hacia la telemedicina eficaz y disponible universalmente? ¿Y qué impacto tendrá en la misión de un plan de salud de brindar acceso a la atención?
Esta serie de cuatro partes examina el estado de la telemedicina en Estados Unidos, el viaje que nos trajo aquí y el camino que tenemos por delante. A lo largo de esta serie, examinaremos las siguientes ideas: 1.- Antes que existiera el COVID, existía la Telemedicina. 2.- El efecto COVID: ¿durará?. 3.- Telemedicina hoy: ¿Qué está pasando?. 4.-Telemedicina hoy: ¿Qué viene? En última instancia, buscamos responder a la pregunta ¿ya llegamos a ese punto?
Antes que existiera el COVID, existía la Telemedicina
A menos que sea un conocedor de la industria que ha estado vigilando de cerca la telemedicina, es probable que le sorprenda que haya más de 60 programas especializados de telemedicina disponibles a principios del 2020. La mayoría de la gente se sorprende de la amplitud de los programas. Pero la verdad es que la telemedicina estaba en buena forma en 2020, mucho antes de que COVID-19 la pusiera en el centro de atención. En 2018 y 2019 se realizó un esfuerzo concertado para registrar cuentas de clientes y proveedores. Gracias a ese esfuerzo, la telemedicina logró al menos cierto nivel de penetración en casi todas las especialidades y subespecialidades médicas. Algunos de estos programas de especialidades no son grandes, algunos tienen base en universidades, muchos son comerciales, pero el hecho de que ahora haya penetración en todas estas especialidades es impresionante. Pero, como veremos, la penetración de la especialidad es solo una pequeña parte de la historia de la telemedicina.
Cuatro obstáculos para la adopción de la telemedicina
Durante mucho tiempo ha habido cuatro obstáculos que han ralentizado la adopción generalizada de la telemedicina, incluso después de que se hayan resuelto en gran medida muchos obstáculos tecnológicos. Estos obstáculos todavía estaban muy presentes en 2020, pero la industria hizo un progreso constante en la resolución y / o solución con soluciones alternativas.
Obstáculo n. ° 1: los proveedores se resistieron a la adopción
La gran mayoría de los médicos no deseaba ejercer la telemedicina, y por una buena razón: toda su capacitación se basa en proporcionar un examen práctico para establecer un diagnóstico y, para muchos, no creían que podrían administrar medicamentos sin él. Por comprensible que sea su posición, esta aversión a la telemedicina es una barrera importante para la adopción. Pero a medida que la industria implementó programas de telemedicina en sistemas de salud y prácticas grupales en los últimos años, mis colegas y yo hemos encontrado enfoques que ayudan a abordar las preocupaciones de los médicos y aumentar la adopción.
Alistar campeones
En la mayoría de las implementaciones de sistemas de salud en las que he estado involucrado, hemos sembrado la adopción eligiendo «campeones» o adoptadores tempranos. Suelen ser médicos más jóvenes, «expertos en tecnología», un poco nerds, que aman la tecnología y están más que felices de liderar la carga de la telemedicina para sus empresas. Pero incluso con este enfoque, generalmente implementaríamos la telemedicina solo para el 5% al 10%, y ocasionalmente el 20%, de los proveedores de una organización. El 80% restante más se mostró muy reacio. (Encuesta de médicos y consumidores de Amwell 2020).
Educar a los proveedores (médicos)
Un paso esencial en cualquier implementación de la telemedicina, tanto para los primeros en adoptar como para los detractores, es educar a los médicos sobre cómo realizar un examen eficaz facilitado por el paciente. Los educamos sobre cómo enseñar a los pacientes a palpar, cómo mirar en diferentes ángulos, realizar pruebas de rango de movimiento, observar la marcha y, por supuesto, el estado mental general y las señales visuales del nivel de enfermedad del paciente. El objetivo es mostrar a los médicos cómo realizar un examen virtual eficaz y convencerlos de que la «buena« medicina que sea apropiada para la gravedad de la enfermedad se puede administrar de forma remota. Para continuar con más información sobre el tema consulte la Fuente: Health leaders.
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