In its national guidelines, the Italian Government’s Ministry of Health provides the definition of Telemedicine as “meaning a way of providing healthcare services, through the use of innovative technologies, in particular Information and Communication Technologies (ICT), in situations where the healthcare professional and the patient (or two professionals) are not in the same place. Telemedicine involves the secure transmission of medical information and data in the form of text, sound, images or other forms that are necessary for prevention, diagnosis, treatment and subsequent monitoring services for patients. Telemedicine services must be in line with existing diagnostic/therapeutic healthcare services”. The definition goes on to specify that telemedicine does not in any way replace the traditional healthcare service, and the related personal doctor-patient relationship, “but is integrated with it to potentially improve its efficacy, efficiency and appropriateness. Telemedicine must also comply with all the rights and obligations under any healthcare act”.

By 1997, the WHO (World Health Organization) had already defined how it should look. “The delivery of healthcare services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities”.

The global pandemic starting at the end of 2019 linked to COVID-19 (see FOCUS) has made the need for a radical change in medical care even more urgent.

Telemedicine has different healthcare purposes:

In relation to the social fabric, telemedicine gives administrative areas the possibility to increase equity of access to social and healthcare services, especially for those who are geographically isolated, thanks to the service’s flexibility of delivery and use. In this way, continuity of assistance in the area is guaranteed, at the same time allowing resources to be allocated where they are most needed, without wasting valuable professional time on simple physical supervision. Finally, teleconsultation can offer significant support to emergency mobile services, with the use of remote clinical resources, even directly on board ambulances.

Telemedicine, COVID-19 and post-pandemic

Terms such as “monitoring” and “distancing” have become familiar when talking about health protection, particularly following the spread of the COVID-19 virus from the end of 2019. Apps to track people’s movements and the need to manage discharged or asymptomatic patients with telehome methods, if not fully resolving issues, have put them at the centre of the debate.

Telemedicine is also very effective in preventing the collapse of emergency service management, as was observed above all during the early months of the spread of the pandemic. For example, for asymptomatic positives, it allowed us to measure the parameters we learned were the most evident manifestations of the virus infection and its most aggressive. These include above average body temperature, respiratory rate and oxygen saturation, and heart rate related to respiratory rate. Home monitoring can help with taking prompt action where the condition worsens. Similarly, it is advisable to continue monitoring patients after they are discharged, since they are considered recovered, the aforementioned parameters in the full recovery stage can then be observed.

Another issue dramatically brought to the fore throughout 2020, was the care of patients with emergencies not related to COVID-19. With intensive care units at full capacity, it was not possible to treat cases such as heart attacks in a timely and appropriate way. Monitoring of this category of patients is also essential when the relationship between hospital and patient is rendered impossible for various reasons. In general, the emergency accelerated the transformation of telemedicine from an emergency tool to one used routinely.

The Life Sciences sector is growing rapidly. The relationship between treatment and disease, between doctor and patient is heading for a radical change. The next challenge is the transition from the traditional medical approach to 4P medicine.

Predictive : with diagnostic processes and cutting-edge technological tools, it is possible to prevent diseases and limit their effects.

Preventive: to support and promote adequate prevention processes with a specific focus on the individual’s well-being.

Participatory: where the patient can interact, discuss and choose what action to take following the logic of prediction and prevention.

Personalised: to respond in the most detailed and effective way possible to the physical, physiological and clinical characteristics of the patient.

In 2013, the world of digital information already stood at around 98% of all information produced globally. In healthcare, the annual growth rate of generated data has reached 48%. Medical records are often include videos, images, texts and audio files that support research of the patient’s clinical profile. In the same way, increasingly advanced diagnostic programmes go hand in hand with the affirmation of BigData and IoT, opening up the possibility for everyday objects such as clothing, smart home systems, vehicle technology and smartphones to collect data on the health of the body, such as heart rate, glucose levels, blood pressure, body temperature and then transmit this crucial information via the internet.
 
BigData has put the delicate issue of data processing and analysis at the centre of the debate. Thanks to a new research approach, with cognitive analytics and machine learning systems, algorithms can process an impressive amount of data, but in order for it to have value and be readable to extract valuable information, it is necessary to refer to the skills of data science specialists. Precision medicine, used in diagnosis, will increasingly encourage the use of in-depth sectoral knowledge to treat diseases, prevent epidemics and improve people’s quality of life and life expectancy. The 4 P’s are, indeed, the objectives to aim for.
 
Medicine is changing rapidly. From a system focussed on disease management to a molecular and systemic approach typical of systems biology, which studies living beings as structures in evolution. In particular, we are trying to understand genomics better to evaluate the dynamic system changes. From mathematics-statistics to bioinformatics, up to biomolecular disciplines, the idea is to collect the digital behaviours of patients and users, and to work with the data for a preventive purpose. Technology’s continuous growth is the additional tool which will make this possible.