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A review: Impact of Internet on online medical
consultancy platform
XXX-X-XXXX-XXXX-X/XX/$XX.00 ©20XX IEEE
Madhawa Munasinghe
Department of Information Technology
General Sir John Kotelawala
Defence University
Ratmalana, Sri Lanka
35-it-0044@kdu.ac.lk
Ms.D Gunasekera
Department of Information Technology
General Sir John Kotelawala
Defence University
Ratmalana, Sri Lanka
dgunasekara@kdu.ac.lk
Dr. (Mrs.) N Wedasinghe
Department of Information Technology
General Sir John Kotelawala
Defence University
Ratmalana, Sri Lanka
nirosha@kdu.ac.lk
Abstract— The Internet was historically a permanent
source of medical data; it was use in later days for private
appointments with patients. Since that, applications that
offer medical services have become a prominent method in
the market. An online consultation has secured a eminent
place on the market and individuals are tend to make
anmake an online visit rather than physically visiting a
medical facility. This research reports on online medical
consultation literature from different sources and surveys
and reports. According to the previuosprevious works,
reports and surveys; the convenience, change in disease
trends, cost-effectiveness, confidentiality and second
opinions are the different factors that led to a sudden
increase in online medical consultation According to
research papers I have studied, people are moving away
from the telehealth experience, which makes people feel
annoyed. When people make their own decisions based on
the future in seconds, the tendency towards online
consultancy will increase rapidly. (Abstract)
Keywords— Virtual health, E-health, Onlineonline medical
platforms
(key words)
I. INTRODUCTION ( HEADING 1 )
Online health care consultation has become
increasingly common and is seen as a possible solution to
scarcity of health care services and inefficient delivery of
resources. However, several online medical consultation
sites fail to attract and retain customers who are willing to
pay. Furthermore, the additional difficulty for health care
professionals on the web is to stand out in a crowd of
doctors who are able tocan offer similar services.
Many individuals have turned to online web portals
with the approach of broadband and video conferencing to
get an online consultation. UThe use of this technical
advancement has many benefits, including cost savings,
convenience, accessibility, and improved privacy and
communication for both the doctor and the patient. This idea
is for patients from various parts of the country or many
nations with a range of medical needs. Patients can choose
or be assigned to any doctor who is available on the web for
specialist / general duty. They are not constrained either by
past learning or by geographical closeness to a specific care
provider.
Online medical consultation has been more available in
modern times, and COVID-19 has made it more relevant
than ever. For validation of this technique within plastic
surgery, further in-depth research is required. There is a
clear need of standardize medical consultation procedures,
channels, encryptionencryption, and data storage while
retaining the quality of treatment and a critical role in social
distancing. In 21st century, some doctors and surgeons have
been secretly rethinking and reinventing medicine. These
pioneers, who are also working together with laboratories,
are testing new technology, ranging from software to
robotics, which can revolutionize the medical environment –
providing improved results, lower costs, greater
accessaccess, and convenience.
The goal of this review article is to investigate the
possible reasons behind the beginning of a new era of
consultation, the online medical consultation.
II. BACKGROUND STUDY
According to the findings, when introducing an e-
consultation service, there are 10 steps to be followed,
including finding key stakeholders, selecting a site,
beginning with a pilot, and developing the product and
processes. Prior to going live with the device, ensuring the
privacy and security aspects must be completed. It is
necessary to understand who the participants are, payment
problems, and build on ongoing feedback. Finally, it should
be an early planned task rather than an afterthought to
prepare for sustainability if the implementation is successful
in your area.
A. Establish essential working relationships (clinical
champions, regional support, partner in technology)
A project of this nature requires (1) clinical champions,
consisting of family physicians and specialists, to promote
the need and effectiveness of the system, (2) buy-in in the
health region to provide support for infrastructure and
human resources, and (3) technical/e-health support to
encourage the development, maintenance, and technical
support of the system. A significant part of the necessary
facilities and assistance could already be set up through a
hospital or a local/regional health network. To reduce the
financial and technological burdens of preparing and
implementing the infrastructure/platform to host the e-
consultation application, look to collaborate with other
organizations.
B. Choose a Platform for the E-consultation System
Technology designed to promote contact between doctors
and collaboration is advancing. In order to allow
sustainability and scalability, device selection should be
based on existing local infrastructure, and this is encouraged
by ensuring that key stakeholders are part of the initial
project team. In clinical practices, several distinct types of
computer systems are used. It is also difficult to find an
application able to integrate seamlessly with different
systems. It is not expected that more integrated business
solutions will arrive for some time through multiple
healthcare organizations.
C. Start Small and Build
Starting with a small group will allow you to recognize
many of the challenges that are incredibly difficult to
navigate before the system is sufficiently large. This
approach will be helped to design the system based on the
requirements of the user and test several iterations of the
form, analyses workflows, and recognize the privacy,
liability, and remuneration concerns of users.
D. Design the e-Consultation Form and workflow design
The e-consultation framework can be based on a wide range
of ways of consultation. Many of the users favored formats
that would be similar to the way clinicians completed their
current consultations, enabling them to ask a free text
question, to insert files and free text options for more patient
data
E. Ensuring the privacy and security requirements
When using internet-based healthcare information-
sharing programmes, security is of the utmost concern. If
the right to privacy is not followed, the electronic
transmission of patient information may jeopardize patient
rights. Therefore, it is important to adopt to security
requirements when implementing to E-consultation service.
F. Determination of workflow
The e-consultation system workflow must integrate as
smoothly as possible into the normal workflow of the
physician to ensure participation. Minimizing the time for
device use is critical. The physician should be able to file or
complete a request for consultation within the specified
time.
G. Participants—keeping physician engagement simple
The success of e-consultation would finally be measured
by physician involvement. It is also difficult to hire
physicians for ventures of this kind. The first critical move
in hiring physicians is to solidify clinical champions within
the project team, as their relationships and ability to
campaign for the system would have the most important
impact on the involvement of physicians.
H. Determining aspects of payment and responsibility
This step is involved in determining the rates of the
consulters. This should be analysed and set up by
considering face-to-face consultation rates. Long-term
payments for this form of virtual medicine service would
need to be funded at the local level by contracts for
physician payment systems.
I. Construction of continuous quality feedback
It was important to receive feedback and deliver a service
that participants would find valuable and actively involved.
In addition to receiving input from physicians, device
effectiveness can be calculated by constantly monitoring use
and performance. The creation of the e-consultation form
would also allow its users to determine the effect of the
service.
J. Plan for a pilot move to a sustainable programme
The transition from e-consultation to a sustainable
programme comes with the realization that it is important to
obtain support for the related costs. Once the framework has
been built, the sustainability of e-consultation mainly needs
the help of human resources. For project planning and
management, information technology-related tasks such as
system updates, and end-user technical support, which
includes help with system troubleshooting and login
information recovery, continuous staffing is required. Funds
for ongoing physician engagement-related functions, such as
hiring and training, are also required.
III.
RESEARCH METHODOLOGY
This paper strictly followed the principles of PRISMA
statement to ensure methodological rigor of the systematic
literature review. The literature searches resulted in 105
articles, which were then initially screened based on the
titles and abstracts. The inclusion and exclusion criteria
waswere followed in the screening process resulting in the
exclusion of 75 articles. The remaining 30 articles were then
reviewed in full text, and an additional 18 articles were
excluded because they did not primarily discuss the subject
Fig 1. E- SocnultationConsultation service steps
criteria on online consultation platforms. The resulting 12
articles, discussing healthcare applications, met the
eligibility criteria.
IV. FINDINGS AND DISCUSSION
According to Umefjord in 2006, for many reasons, the
Internet-based Ask the Doctor Service was consulted for
with the primary assessment. It includes assessment of
medical condition, disappointment with previous physicians,
the desire for a second opinion, a desire for deeper medical
knowledge, the choice to be confidential, to have important
or embarrassing questions, or to obtain medical advice from
a relative, such as comfort and saving time.
As per the study of Yang, Yefei, and Zhang in 2019,
online healthcare services offer an efficient way to ease
hospital demand, and in recent years, their popularity among
patients has risen dramatically. The efficacy of such
channels depends on whether, through numerous online
consultations, appropriate connections occur between
patients and physicians. By examining the behaviours of
77,248 patients on an online healthcare platform spanning
the period 2014-2015, the study found that the response
time, interaction scope, and service content significantly
influenced the subsequent consultation behaviours of the
patients during the first consultation. In different times, the
effects of doctor response time, service content, and depth
of interaction on patient satisfaction are also distinct. Our
results provide managerial insights into handling the
continuous appointment habits of patients and improving
their satisfaction by considering the time scope and type of
service.
It has been confirmed that customers are in favour of
OMC services. Researchers from the University of
Pittsburgh (USA) reported in an evaluation study that eVisit
services provided patients with benefits in terms of access,
speedspeed, and comfort, without raising the risk of
inadequate or insufficient treatment (Albert et al., 2011).
More than 90% of eVisit patients reported that during the
eVisits, their health issue was thoroughly discussed,
concluding that it is an acceptable alternative to office visits.
The same study indicates that further research is needed to
equate eVisit findings with office visits for related medical
conditions and to analyses the experiences of providers. On
the other hand, questions about the protection and efficiency
of OMC procedures are being raised.
In Australia, a report found that only 29% of the study
population (young people) were able to engage in a video
consultation on their sexual health problems, while 63%
chose telephone consultation (Garrett et al., 2011). Despite
its recorded achievements globally, another study found a
slow adoption of tele psychiatry in Australia (Smith et al.,
2012). A recent press release by the Royal Australian
College of General Practitioners (RACGP) suggested that
certain OMC providers' service delivery model brings more
complexity to doctors who may have to diagnose the patient
without completely knowing the medical and social context
or being able to conduct a physical examination (RACGP,
2012).
In 2010, the pilot programme of the Mayo Clinic eVisit
announced that their online consultation service was used in
patients aged 4 days (for diaper rash) to 86 years (for
insomnia and hypertension) (Adamson and Bachman, 2010).
OMC is an idea that is positive. Several US publications
have stated that high patient satisfaction levels have been
found to be feasible for eVisits (Mettner, 2009, Albert et al.,
2011, Adamson and Bachman, 2010). Internet-based video
consultations in areas such as emergency psychiatry and
paediatrics have been successfully performed in Australia
(Moffatt et al., 2010, Richardson et al., 2009).
The editor of the Health Management Technology
magazine reported in 2006 that healthcare customers often
wanted to be able to communicate electronically with
doctors the way they now do with the rest of the world,
particularly for non-urgent matters that do not require a
face-to-face visit to the office (Blair, 2006). Demand from
patients living in remote areas, from aged and disabled
patients, and from patients with chronic diseases is expected
to be drawn to OMC. Young and internet-savvy individuals,
and workers with inflexible working conditions, may also be
preferred. Telemedicine/OMC/eVisit academic studies have
cited many benefits for patients, such as improved comfort
and accessibility to health care, decreased travel and waiting
time to see a doctor, and a more cost-effective mode of
delivery (Moffatt and Eley, 2011, Albert et al., 2011, ATA,
2012, Moffatt et al., 2010).
Hundreds of site links ranging from free ask-the-doctor sites
to highly prestigious sites with advanced diagnostic tools
and multi-interactive options are returned by a basic internet
search of 'online doctor' or 'online medical consultation.'
Worldwide, OMC may be unevenly available. To correlate
with local factors, the countries of operation for OMC sites
may need further research. Factors may include the size of
internet networks, the recognition of professional bodies and
the availability of reimbursement schemes, not to mention
cultural and linguistic factors that may have a major effect
on the rise in OMCs. (Al-Mahdi, et al., 2015)
V. CONCLUSION AND RECOMMENDATIONS
The delivery of health care services online is becoming
more popular and provides patients with a new platform
which is also an improved access options for health care
services. However, several online medical consulting sites
struggle to attract and maintain customers who are willing to
pay. also an additional difficulty for health care
professionals on the network is to stand out in a crowd of
doctors who can offer equivalent services. A lack of
telehealth experience could be a cause for patients' utter
frustration. It can fail on either side of internet access or in
Fig 2. Data Extraction
terms of a low level of treatment from the doctor's side. In
this review, a user-friendly interface is recommended so that
the patient can attach all test results and prior treatment
history, including medications, as it will assist the doctor to
give appropriate advice. Moreover, instead of listing all the
available diagnosis to the patient, list differential diagnosis
can be suggested to the patient. Prevention should be the
main point of online discussion instead of treatment.
The global risk on everyone's health and well-being
dictates that it is important to continuously monitor and
update ethical codes of ethics and regulatory mechanisms
not just to address online medical practitioners, but also
other actors that promote this commercial operation.
Appropriate ethical guidelines and legislation should
therefore be targeted in the stream of online medical trade,
among others, at technologists, distribution specialists and
credit card companies. A fundamental concept that governs
the behaviour of all commercial organizations should be the
need to protect customers from the possible adverse effects
of online consultations. In addition, preparation is
recommended before beginning to carry out text-based
Internet consultations. Priority should be given to
developing ethical standards. In conclusion, the purpose of
this review article is to discuss the potential reasons behind
the beginning of a new era of online medical consultation.
Overall, complying with critical security criteria, such as the
confidentiality of patient records, the accuracy of diagnosis
reports, and the provision of healthcare facilities, is a major
challenge in implementing such a system.
ACKNOWLEDGMENT (HEADING 5)
This research wouldn't have been able to successfully
complete without the inspiration and guidance of many kind
souls. Their contribution and support is acknowledged and
gratefully appreciated in utmost grace. Ms. D Gunasekera
and Dr. N Wedasinghe have given their attention and their
valued opinion in conducting research which has been a
great help. The heartiest thanks goes to everyone who helped
in this endeavor.
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80.
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