Opportunities in the cloud or pie in the sky? Current status and future perspectives of telemedicine in nephrology

Abstract

The use of telehealth to support, enhance or substitute traditional methods of delivering healthcare is becoming increasingly common in many specialties, such as stroke care, radiology and oncology. There is reason to believe that this approach remains underutilized within nephrology, which is somewhat surprising given the fact that nephrologists have always driven technological change in developing dialysis technology. Despite the obvious benefits that telehealth may provide, robust evidence remains lacking and many of the studies are anecdotal, limited to small numbers or without conclusive proof of benefit. More worryingly, quite a few studies report unexpected obstacles, pitfalls or patient dissatisfaction. However, with increasing global threats such as climate change and infectious disease, a change in approach to delivery of healthcare is needed. The current pandemic with coronavirus disease 2019 (COVID-19) has prompted the renal community to embrace telehealth to an unprecedented extent and at speed. In that sense the pandemic has already served as a disruptor, changed clinical practice and shown immense transformative potential. Here, we provide an update on current evidence and use of telehealth within various areas of nephrology globally, including the fields of dialysis, inpatient care, virtual consultation and patient empowerment. We also provide a brief primer on the use of artificial intelligence in this context and speculate about future implications. We also highlight legal aspects and pitfalls and discuss the ‘digital divide’ as a key concept that healthcare providers need to be mindful of when providing telemedicine-based approaches. Finally, we briefly discuss the immediate use of telenephrology at the onset of the COVID-19 pandemic. We hope to provide clinical nephrologists with an overview of what is currently available, as well as a glimpse into what may be expected in the future.

Understanding the Impact of Initial COVID-19 Restrictions on Physical Activity, Wellbeing and Quality of Life in Shielding Adults with End-Stage Renal Disease in the United Kingdom Dialysing at Home versus In-Centre and Their Experiences with Telemedicine

“…Some of the alternatives suggested by participants in the present study included video conferencing rather than telephone calls, using remote clinics every other appointment or the use of remote clinics when there is no concern, with the option of face-to-face when the patient had something to discuss, as well as an opt-in mechanism for remote care. The findings from this study lend support to the use of remote clinics within the clinical management of people with ESRD receiving HHD or ICHD in the future, however, lessons can be learnt from delivery during the current pandemic and enhancements made [ 68 , 69 ]. This study also provides initial insight into patient feedback of using the MyRenalCare ® application which, although originally developed for HHD, may have potential use for the monitoring of people receiving ICHD, particularly on nondialysis days.…”

Kidney Care during COVID-19 in the UK: Perspectives of Healthcare Professionals on Impacts on Care Quality and Staff Well-Being

“…Additionally, remote appointments may have exacerbated existing challenges in clinician-patient communication for certain patient groups, those for whom English isn’t a first language and those with disabilities such as hearing loss [ 35 ]. Evidence in favour of incorporating telemedicine in kidney care has been available prior to COVID-19 [ 25 , 26 , 27 ]. Present findings show that some applications of telemedicine were considered appropriate and advantageous, mainly consultations with stable and well-managed patients and as a method of triage.…”

“…Telemedicine may have previously been perceived by HCPs and patients as a threat to traditional models of care. Its implementation required the deconstruction of traditional patient-clinician encounters in healthcare and redesigning of current models with boldness and vision [ 40 ], whilst real-life evidence on its effectiveness, particularly in kidney care, was limited [ 25 , 27 ]. Resistance to innovations for quality improvement is common in the complex healthcare systems [ 41 ].…”

“…The rapid innovation of services to tele-nephrology has moved much of the routine medical care away from hospital settings into patients’ homes [ 24 ]. Incorporating telemedicine in kidney care has been a priority prior to the COVID-19 pandemic but the efficacy and safety of this has yet to be determined particularly for those patients with advanced kidney disease [ 25 , 26 , 27 ]. Despite this, there appears to be good acceptability of telemedicine in kidney care for patients and their significant others, an important component in the adoption and delivery of service innovations [ 28 , 29 ].…”

Digitale Nephrologie

“…Telemedizinische Blutdruckmessung ist ebenfalls beschrieben [ 46 ]. Technologie zur Auswertung des Urinstix via Smartphone ist bereits kommerziell erhältlich und hat sich zur Verlaufskontrolle bei Glomerulonephritis während der COVID-19-Pandemie als ausgesprochen hilfreich erwiesen ([ 47 ]; Abb. 1 ).…”