Telemedicine in the COVID-19 era: the new normal

Transitioning to Telehealth Services in a Pediatric Diabetes Clinic During COVID-19: An Interdisciplinary Quality Improvement Initiative

COVID-19 necessitated a rapid shift to telehealth for psychologists offering consultation-liaison services in pediatric medical settings. However, little is known about how psychologists providing these services adapted to using telehealth service delivery formats. This report details how our interdisciplinary team identified declining psychosocial screener completion and psychology consultation rates as primary challenges following a shift to telehealth within a pediatric diabetes clinic. We utilized the Plan-Do-Study-Act (PDSA) quality improvement framework to improve screening and consultation rates, which initially declined during the telehealth transition. Screening and consultation rates dropped initially, but recovered to nearly pre-pandemic levels following three PDSA intervention cycles. During implementation, challenges arose related to the feasibility of patient interactions, interdisciplinary collaboration, patient engagement, and ethical issues. Clinics shifting psychology consultation-liaison services to telehealth should prioritize interdisciplinary communication, elicit perspectives from all clinic professionals, leverage the electronic health record, and develop procedures for warm handoffs and navigating ethical issues.

Retinopathy of prematurity screening: A narrative review of current programs, teleophthalmology, and diagnostic support systems

PURPOSE

Neonatal care in middle-income countries has improved over the last decade, leading to a "third epidemic" of retinopathy of prematurity (ROP). Without concomitant improvements in ROP screening infrastructure, reduction of ROP-associated visual loss remains a challenge worldwide. The emergence of teleophthalmology screening programs and artificial intelligence (AI) technologies represents promising methods to address this growing unmet demand in ROP screening. An improved understanding of current ROP screening programs may inform the adoption of these novel technologies in ROP care.

METHODS

A critical narrative review of the literature was carried out. Publications that were representative of established or emerging ROP screening programs in high-, middle-, and low-income countries were selected for review. Screening programs were reviewed for inclusion criteria, screening frequency and duration, modality, and published sensitivity and specificity.

RESULTS

Screening inclusion criteria, including age and birth weight cutoffs, showed significant heterogeneity globally. Countries of similar income tend to have similar criteria. Three primary screening modalities including binocular indirect ophthalmoscopy (BIO), wide-field digital retinal imaging (WFDRI), and teleophthalmology were identified and reviewed. BIO has documented limitations in reduced interoperator agreement, scalability, and geographical access barriers, which are mitigated in part by WFDRI. Teleophthalmology screening may address limitations in ROP screening workforce distribution and training. Opportunities for AI technologies were identified in the context of these limitations, including interoperator reliability and possibilities for point-of-care diagnosis.

CONCLUSION

Limitations in the current ROP screening include scalability, geographical access, and high screening burden with low treatment yield. These may be addressable through increased adoption of teleophthalmology and AI technologies. As the global incidence of ROP continues to increase, implementation of these novel modalities requires greater consideration.

Neural perceptron & strict lossless secret sharing oriented cryptographic science: fostering patients' security in the "new normal" COVID-19 E-Health

Patients' data security is an open challenge on any telemedicine system. The challenge has been extended enough in this unprecedented corona virus led pandemic. COVID-19 has brought abrupt adaptations in medical sciences. To reduce corona virus transmission, quarantine yourself and opting for online services is mostly apt even during "New Normal" second wave of COVID-19. The emergence of telemedicine is a significant contribution in the medical sciences. Relevant online security and challenges are the contemporary and relevant challenges in COVID-19 E-Health. The objective of this proposed technique is to reinforce the technical safeguards to the electronic health system against the tricksters. Perceptron based session key and modified logistic map based intermediate key were proposed. A strict lossless secret sharing has been proposed to protect patients' clinical reports and data. Participation of all the recipients is bare essential in regenerating the original report. Simple mathematical operations were carried out to develop the secret shares. Electing the head of the recipients has also been included here. Different secret shares were encapsulated with the proposed frame structure. The chaotic sequences in the ranges of r = [0.41,0.53], r =  [0.61, 0.66], and r = [0.91, 0.99] on the initial values x = 3.64, 3.81, and 3.88 respectively were noted under this technique test. An appropriate correlation between the proposed encryption and cryptographic time, and proposed decryption and cryptographic time were found. Such values were r _ec = 0.989929 and r _dc = 0.988828 respectively. Myriad mathematical tests likes of statistical randomization, brute force, graphical analysis, performance time, etc. were carried on the proposed technique. Their results have proved our efficacy in fostering the patients' data transmission in "New Normal" COVID-19 E-Health.

Spillover Effects of COVID-19 on Essential Chronic Care and Ways to Foster Health System Resilience to Support Vulnerable Non-COVID Patients: A Multistakeholder Study

OBJECTIVES

Little empirical research exists on how key stakeholders involved in the provision of care for chronic conditions and policy planning perceive the indirect or "spillover" effects of the COVID-19 on non-COVID patients. This study aims to explore stakeholder experiences and perspectives of the impact of COVID-19 on the provision of care for chronic conditions, evolving modalities of care, and stakeholder suggestions for improving health system resilience to prepare for future pandemics.

DESIGN

Qualitative study design.

SETTING AND PARTICIPANTS

This study was conducted during and after the COVID-19 lockdown period in Singapore. We recruited a purposive sample of 51 stakeholders involved in care of non-COVID patients and/or policy planning for chronic disease management. They included health care professionals (micro-level), hospital management officers (meso-level), and government officials (macro-level).

METHODS

In-depth semi-structured interviews were conducted. All interviews were digitally recorded, transcribed verbatim, and thematically analyzed.

RESULTS

Optimal provision of care for chronic diseases may be compromised through the following processes: lack of "direct" communication between colleagues on clinical cases resulting in rescheduling of patient visits; uncertainty in diagnostic decisions due to protocol revision and lab closure; and limited preparedness to handle non-COVID patients' emotional reactions. Although various digital innovations enhanced access to care, a digital divide exists due to uneven digital literacy and perceived data security risks, thereby hampering wider implementation. To build health system resilience, stakeholders suggested the need to integrate digital care into the information technology ecosystem, develop strategic public-private partnerships for chronic disease management, and give equal attention to the provision of holistic psychosocial and community support for vulnerable non-COVID patients.

CONCLUSIONS AND IMPLICATIONS

Findings highlight that strategies to deliver quality chronic care for non-COVID patients in times of public health crisis should include innovative care practices and institutional reconfiguration within the broader health system context.