The Journal of mHealth Vol 2 issue 5 (Oct) | Page 34

Teletriage vs. Telediagnostics

Teletriage vs.
Telediagnostics
Dr. David Whitehouse, Chief Medical Officer – UST Global
David is the Chief Medical Officer at UST Global where he uses his extensive clinical and health systems experience and insights to help UST clients understand the significance, influence and possibilities of technology advances;
from the impact of big data on analytics and prediction; of ubiquitous sensors and the quantified self-movement
on advancing concepts of “expert patients” and in home capabilities; of micronetworks and social networking on
everything from gauging satisfaction to improving communication and resource allocation among providers, patients,
their families and community care givers; to the impact of mobile applications on just in time information, enhanced
communication and the use of avatars to put a trusted advisor in every home.

The digital health revolution offers to
transform the routine ‘pain points’ of
care into ‘bliss points’ of compassion,
caring, assurance and high quality care.
This is to be delivered conveniently, at a
lower cost, and securely with an ease we
never imagined. Along the way we have to
shift some of our opinions and embrace
the possibilities in a way that looks for
solutions not barriers to change.
In the old days the doctor came to the
house, however house calls are now very
much a thing of the past (although concierge medicine seems to be on the rise).
Practices have changed over time – Let’s
imagine a typical scenario; these days,
symptomatic patients go to the doctor’s
offices or clinics, generally during office
hours (often the same office hours as
a working person which means leaving work). The patient then waits to be
seen, often with no absolute conclusion
- frequently follow up tests are required;
which means further delays and once the
lab work is finally received the patient still
needs to call for a prescription and then
generally go and wait in a pharmacy for
the necessary medicines. In rural settings
access is often harder still, so that the
threshold of symptoms becomes even
greater - add inclement weather conditions and the visit can become impossible.
The epitome of a broken system for me
has always been a child in the dead of
winter who gets an ear infection. The
parent bundles up the struggling screaming child, who now thoroughly wrapped
won’t easily fit into the car seat – meaning more chaos. It is then to the doctor’s
office to sit among other infected children, exposed to now new pathogens;
only to get a prescription and start all
over again in the pharmacy line.

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However, now with the growth of the
smartphone and its inbuilt camera, along
with the adaptability to use apps and add
on technologies to create an entire platform, there is the ability to change this
equation.
Whether it is a snap on EKG capability
like AliveCor, an otoscope from Cellscope, or ophthalmoscope from iExaminer, or even a remote kiosk with rudimentary X-ray - The physical exam at a
distance is here!
Most importantly these solutions allow
the physician and the patient to converse; freeze pictures of an ear drum
or a rash, discuss what the doctor sees,
look together at the medical record and
past history, even invite a second opinion
from the same location as the doctor or
completely separate.
When these capabilities first came out we
saw the growth of separate secure health
networks like CISCO’s, designed with
broad bandwidth for fear that images or
sounds would be degraded. The interesting thing about this is that the remote
places, where one might most need
these new telemedicine capabilities, are
actually the least likely to have access to
broadband.
Patient convenience and patient access
was suddenly hostage to concerns about
poor quality medicine and misinterpretation of data. The solutions ballooned in
cost and in some countries, where I have
consulted, telemedicine, which started
first in the medical centers, were linked
to remote sites using extremely expensive and often too expensive technology.
Yet while 3G and 4G capabilities require
the disassembling and reassembling of

mHealth Summit Feature - November 8-11, 2015

large files they do work in these remote
settings; and for face-to-face remote
consultations are completely adequate.
So I began to ask a question - to which
I have been amazed how many people
pause before they answer - Are you interested in telediagnostics or teletriage?
By way of example, if we were to look
at a teleradiology image are we conferring at the level of trying to pin down
a diagnosis? In which the integrity of
that image has to be of the quality as if
I was in the room with the original. Or,
is this teletriage? Where I cannot completely make a diagnosis as to a mass or
an effusion but I certainly know enough
to know that the patient needs follow-up
in an equipped diagnostic center.
While regulatory bodies may worry
about the use and misuse of my apple
otoscope, if my GP in the middle of
winter says “You know what, I really
am not getting a clear enough picture to
make a diagnosis, you will have to come
in” I am no worse off than before. But,
if the doctor says “No need to come in,
it is clearly an ear infection. I will call
ahead to the pharmacy who can run an
instant test on the likely pathogen so we
pick the correct antibiotic”, then I am
way ahead of the game.
Sometimes in urban settings traffic
can make access to the nearest medical
center as complicated as a remote rural
setting, and in such instances telemedicine and teletriage can help make the
world safer.
Telediagnostics, second opinions, and
consultations make the whole referral
world simpler.