Editorial article
Telemedicine and digital transformation in anesthesiology
Telemedicina y transformación digital en anestesiología
E. Méndez Arias
, A. Serrano Afonso
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Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
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Méndez Arias, A. Serrano Afonso" "autores" => array:2 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Méndez Arias" "email" => array:1 [ 0 => "mendezarias.esther@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Serrano Afonso" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Telemedicina y transformación digital en anestesiología" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">“The measure of intelligence is the ability to change” — Albert Einstein</p></span></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Telemedicine and anaesthesiology</span><p id="par0010" class="elsevierStylePara elsevierViewall">Telemedicine, a rapidly evolving service – particularly in the context of the current COVID-19 pandemic – is an efficient and cost-effective method of improving access to quality healthcare. The terms ‘telehealth’ (first coined in the 1970s) and ‘telemedicine’, though similar, should not be used interchangeably. Telemedicine is defined as “a service that seeks to improve a patient’s health by permitting two-way, real-time interactive communication between the patient and the physician at a distant site”, while telehealth refers to “the use of telecommunications and information technology (IT) to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance”<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. Telehealth, therefore, is a broader concept than telemedicine, and includes the use of information and communication technologies to collect and transmit patient data for the purposes of providing health education or ancillary healthcare services. The World Health Organization (WHO), in their definition of telemedicine, does not make such a distinction and includes both concepts in the term telemedicine, although their definition dates from 2010<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. We will refer to telemedicine throughout this article.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The paucity of articles on telemedicine in anaesthesiology is striking, and most of those published so far have been written by surgical teams, not anaesthesiologists. In 1999, Rollert et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> published a study performed by maxillofacial surgeons comparing the telemedicine preoperative evaluation of ASA < 3 patients. In the former, patients were in another room with a nurse, and in the latter they were in the same room with doctor. In the telemedicine interview, the clinical history and complementary tests were reviewed, and the nurse then performed an intraoral examination using a camera that transmitted the images to the specialist doctor, who viewed them remotely in another room. The purpose of this study was to evaluate the efficiency of telemedicine preoperative consultation, defined as the ability to perform general anaesthesia without the need for a face-to-face visit. They concluded that telematic consultations were as efficient as face-to-face visits.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The number of studies in telemedicine has increased since 2010, particularly global analyses of telemedicine in different anaesthesiology settings: teaching, preoperative evaluation, intraoperative consultations with other hospitals, and postoperative follow-up<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a>. Blanco et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> developed a new preoperative evaluation system in which the anaesthesiologist first evaluated the clinical history and complementary tests, and then decided on the need for a face-to-face visit during a telephone call. In certain procedures, the evaluation was carried out by a qualified nurse, who only consulted the referring anaesthesiologist if any doubts arose. The cohort study comparing this new system with the old approach, which consisted of a face-to-face visit with the anaesthesiologist for all surgeries, showed that telemedicine preoperative care optimised resources by reducing face-to-face visits and complementary tests without increasing the rate of cancellations. Similarly, Kamdar et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> showed that the implementation of a telemedicine preoperative evaluation improved patient satisfaction and saved costs without increasing surgical cancellations. In paediatrics, Conley et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> analysed the benefits of virtualising the entire perisurgical process, using the concept of the virtual paediatric perioperative home (VPPH). They showed that the VPPH can improve quality by providing multidisciplinary care while decreasing costs to paediatric patients, families, and hospital systems.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Some of the most important advances in telemedicine in anaesthesiology have involved the creation of digital tools, such as apps that help patients understand the perioperative process. Timmers et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> designed an app that provided information on postoperative care at home after total knee replacement. They showed that education via the app significantly decreased postoperative pain, improved physical functioning, quality of life, ability to perform physiotherapy exercises, and user satisfaction compared to standard patient education Similarly, Ke et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> offered patients the possibility of downloading an informative app for self-monitoring after a cesarean section. They analysed the usability of the app, the level of user satisfaction, and the percentage of patients who would recommend the app, and observed good ratings for all items.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Telemedicine has facilitated the remote delivery of medical services in many specialties, but it is unclear whether it would always be suitable for anaesthesiology. In the aforementioned studies, telemedicine was beneficial at various stages of the surgical process, but a more in-depth analysis of the limitations and ideal implementation of this technique is needed. The preoperative consultation can currently be performed via video call, telephone call and face-to-face consultation, all of which can be carried out by qualified nurses or anaesthesiologists. Video calls are more productive because they can provide non-verbal information and could be used to assess the airway<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>, although no studies have yet confirmed this. For all these reasons, we need to establish adequate preoperative pathways based on the particular characteristic of the hospital, the surgery, and the patient. Some digital solutions have been created, such as mobile apps for patient follow-up at every stage of the surgical process, although user satisfaction and quality of care would be improved if were able to provide a more comprehensive approach, more individualized care, and services such as econsultation. These services also need to comply with data processing regulations, licensing requirements, and must pass a cost-benefit assessment. These are some of the issues that warrant further exploration and research<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Digital transformation and anaesthesiology in the 21st century</span><p id="par0035" class="elsevierStylePara elsevierViewall">Both the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy and individual anaesthesiologists have a duty to embrace digital transformation while maintaining the scientific quality of the services provided. However, digital transformation is not the same as digitization. Anaesthesiology department have already started to introduce digitization tools into their daily practice, but digital transformation involves going beyond the mere adoption of digital technologies. Digital transformation consists of using available digital tools to provide solutions to a problem or to take a new approach to existing procedures. This will only be made possible if we take a systematic approach that factors in the complexity of care processes and facilitates translational medicine<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The aim of translational medicine is to enhance the interaction between disciplines. Areas such as biostatistics, bioethics, bioinformatics, epidemiology, pharmacology, genomics, proteomics or nanotechnology, among others, come together with clinical practice to achieve a common goal: to share needs and solutions to advance healthcare. This means including multidisciplinary teams in anaesthesiology departments and research groups to ensure the success of I&D + i projects. Digital transformation involves a continuous reappraisal of information and communication technologies. In the words of the WHO Bellagio eHealth Evaluation Group: “To improve health and reduce health inequalities, rigorous evaluation of eHealth is necessary to generate evidence and promote the appropriate integration and use of technologies”<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">As this digital transformation takes place, it is imperative that institutions share their knowledge, successes and challenges to improve the delivery of technology-driven care.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>. As a society, we have an obligation to move towards digital transformation not only in the aforementioned fields, but also in others, such as the use of artificial intelligence to create chatbots that answer patients’ question during the perioperative period, or the creation of tools that facilitate the evaluation and follow-up of patients with chronic pain, the management of big data in intensive care units to create automated action algorithms, the use of virtual reality and augmented reality for training specialists and residents and for educating patients and improving their experience of healthcare, 3D printing of medical devices, etc. We can achieve all these changes by taking inspiration from two great transformers of the last century: Albert Einstein, who said, "logic will get you from A to B. Imagination will take you everywhere", and Walt Disney, who said, “The way to get started is to quit talking and begin doing."</p><p id="par0050" class="elsevierStylePara elsevierViewall">The time has come to start imagining, devising, listening to, supporting, and implementing ideas, and in so doing, transform anaesthesiology as we know it. To begin with, anaesthesiology services should have already identified processes that can benefit from digital transformation, either because they are inefficient or because they can be improved by taking a new approach. Anaesthesiology services should encourage new ideas and proposals, from both within and outside their department, however implausible they may seem. They should also start to forge alliances with the aforementioned disciplines that will help implement this transformation. In the medium term, these alliances should take the form of hiring specialised staff from other fields, or providing recurring services that, together with the ideas put forward, converge in the digital transformation of many current healthcare processes. Some of these projects will fail in the long term, but others will end up providing solutions and/or improvements to current processes. In the next few years, this transformation will turn the practice of anaesthesiology as we know it into the anaesthesiology of the 21 st century.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Telemedicine and anaesthesiology" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Digital transformation and anaesthesiology in the 21st century" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Méndez Arias E, Serrano Afonso A. Telemedicina y transformación digital en anestesiología. Rev Esp Anestesiol Reanim. 2022;69:1–3.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Kichloo" 1 => "M. Albosta" 2 => "K. Dettloff" 3 => "F. Wani" 4 => "Z. El-Amir" 5 => "J. 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Mañoso Noriego" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2012.05.039" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2012" "volumen" => "59" "paginaInicial" => "350" "paginaFinal" => "356" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22784647" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development, implementation, and evaluation of a telemedicine preoperative evaluation initiative at a major academic medical center" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.V. Kamdar" 1 => "A. Huverserian" 2 => "L. Jalilian" 3 => "W. Thi" 4 => "V. Duval" 5 => "L. 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