Introduction of the Services
Tele-counselling: General hospital specialist or exceptionally a GP requests the opinion of the tertiary hospital specialists on a clinical case. The service can be provided in various ways:
o Asynchronously (secure e-mail type interaction). The requesting professional sends the query to the tertiary hospital specialists and waits for a reply. The maximum delay in replying to a query must have been agreed beforehand between the requester and the tertiary hospital. Both the request and the counsellor's answer make use of standard forms, agreed among all the actors involved in the tele-counselling. Such forms must contain all the clinical and anamnesis information needed to provide effective feedback through tele-counselling. Moreover, such forms must be validated through digital signature according to EU and national regulations. Results from diagnostic procedures (e.g. X-Ray, lab results, ECG, etc.) as well as excerpts from the patient's clinical records can be attached to the form. As an alternative, temporary remote access to the patient's clinical records can be provided to the specialist using an adequate authentication procedure.
o Interactively (through video-conferencing facilities). In this case, the healthcare professionals can talk and see each other and thus share information about the patient. They are even able to work on the same item while being at different hospitals ('whiteboard' feature), seeing e.g. where the other has put the cursor. This mode normally requires booking an appointment with the tertiary hospital specialist, unless standby or emergency arrangements are in place between the requesting party and the tertiary hospital.
Virtual referral: General hospital specialist, highly specialised nurse or exceptionally a GP carries out a virtual referral with the tertiary hospital specialist while the patient is in his/her clinic. This service normally requires booking an appointment with the tertiary hospital specialist, unless standby or emergency arrangements are in place between the requesting party and the tertiary hospital.
Tele-laboratory: This service enables tests, which are usually done inside a clinical laboratory, to be carried out in practically any place thanks to portable analysis equipment which can be checked remotely. Data transmission and a PKI infrastructure guarantee the authenticity, confidentiality and legal value of the data transmitted.
Telecare: This comprises all those services which connect the patient directly to a specialist for the latter to remotely monitor her/his condition. These services are applied to situations in which the physical proximity of patient and specialist do not provide any extra benefit (e.g. dialysis, blood glucose level; etc.) or where the proximity between the two is not easy to obtain.
Shared clinical records: A referring general hospital specialist and tertiary hospital specialists will have access to the same set of patient's clinical records during a virtual referral or during the entire stay of the patient in the tertiary hospital. This will allow the referring specialist not to lose touch with his/her patient.
