Telemedicine in the Era of COVID-19

Abstract

Update This article was updated on September 18, 2020, because of a previous error. On page 3, the legend for Figure 2 that had read “External rotation of the hip can be measured by having the patient sit in a chair facing the camera and rotating the hip with the knee bent at 90°” now reads “Rotation of the hip can be measured by having the patient sit in a chair facing the camera and rotating the hip with the knee bent at 90°.” An erratum has been published: J Bone Joint Surg Am. 2020 Oct 21;102(20):e121. With the onset of the COVID-19 pandemic, the shifting of clinical care to telemedicine visits has been hastened. Because of current limitations in resources, many elective surgeons have been forced to venture into utilizing telemedicine, in which the standards for orthopaedic examinations have not previously been fully developed. We report our experience with protocols and methods to standardize these visits to maximize the benefit and efficiency of the virtual orthopaedic examination. At the time of scheduling, patients are asked to prepare for their virtual visit and are given a checklist. In addition to confirming audiovisual capabilities prior to the visit, patients are given specific instructions on camera positioning, body positioning, setting, and attire to improve the efficiency of the visit. During the examination, digital tools can be utilized as needed. In the setting of outpatient injury evaluations, a systematic virtual examination can aid in triaging and managing common musculoskeletal conditions. With the rapid incorporation of telehealth visits, as well as the unknown future with regard to the pandemic, the utilization and capabilities of telemedicine will continue to expand. Future directions include the development of validated, modified examination techniques and new technology that will allow for improved interactive physical examinations, as we rapidly move forward into the realm of telemedicine due to unexpected necessity.

Early Peri-operative Outcomes Were Unchanged in Patients Undergoing Spine Surgery during the COVID-19 Pandemic in New York City

“…Although telemedicine has been previously shown to be cost-effective, its utility in the context of a pandemic is now clear [1,11]. Although virtual visits for new patients require modified physical examination techniques and pre-visit patient instructions, the capability to evaluate surgical wounds, respiratory symptoms, and a patient's general status make this interaction modality an essential tool that should be utilized across the surgical subspecialties for post-operative care [16].…”

COVID-19: The Changing Trend of Tele-consultations in a Private Tertiary Level Health Facility in Tanzania

“…Efforts to reduce cost barriers to accessing telemedicine should be a continuous one. 7 While recent clinical practice in high-income countries (HIC) has witnessed a rapid incorporation of telemedicine into conventional practice, 8,9 this cannot be said of sub-Saharan Africa health service delivery. Perhaps the capability of telehealth in SSA will be expanded in the immediate future, the uncertain trajectory of the current pandemic calls for an exploration of every avenue to stem the tide.…”

Clinical Analysis to the Cause of Hand Injuries and Its Countermeasures During the COVID-19 Outbreak and Work Resumption Period

“…Social distancing and self-quarantine aim to slow down the increase of new infections, thereby avoiding a surge in demand on health care systems 10 . Some measures such as telemedicine are recommended to reduce hospital visits for some mild injuries 11,12 . But even at the time of social distancing, patients with severe injuries require urgent treatments.…”