Hospital-based autonomous pre-clinical screening of COVID-19: An emergency triage using a vital signs recording system, Paris-Ile de France region.

Background: The COVID-19 pandemic has had a dramatic toll worldwide on the populations but also has been essentially supported by the existing public health system, particularly hospital-based emergency wards and intensive care units. In France, the first cases were identified on the 24th of January 2020. The first epidemic sprout emerged in the Eastern part of the country and spread in two weeks towards the center to the Paris-region where it peaked on the 14th of April 2020. In Paris and the region around it, the intensity of the epidemic has increased significantly to have a strong impact on all public and private hospital systems in a few weeks. During France's 2020 COVID-19 epidemic, a private hospital went into a major organizational change of its Emergency Department which mainly included the use of a Telemedicine Booth for vitals automatic recording during triage procedures.Purpose: The purpose of this study is to share a unique exerience centered on the use of a Telemedicine Booth as a screening process during an epidemic. Researche design: The present study is a case report describing the organizational scheme adopted by the hospital and discusses the data of 1844 patients that attended the facility over a month and the results of a questionaire survey adressed to the Emergency Department personnel.Study sample: The study population is the population that Data where collecte.Data collection and analysis: Quantitative activity indicators' data were collected with a specific triage register, patient management software and the Telemedicine Booth activity software and were analysed with basic statistics. Results and Conclusions: Among the 1844 patients, 766 were engaged in an automated triage process supported by a Telemedicine Booth. Patients' clinical characteristics are comparable to those found in international literature during the COVID-19 pandemic. The use of the Telemedicine Booth as a screening process facilitated patients' flow. It usefully participated in the patient rapid orientation, relieving the hospital emergency department, actively contributes in a safe and secure environment highly trusted by the hospital staff and health workers. To our knowledge, the Telemedicine Booth use as a screening process during an epidemic constitutes the first contribution to such an innovative approach.

Correction: A Teleconsultation Device, Consult Station, for Remote Primary Care: Multisite Prospective Cohort Study.

[This corrects the article DOI: 10.2196/33507.].

A Teleconsultation Device, Consult Station, for Remote Primary Care: Multisite Prospective Cohort Study.

BACKGROUND: Telemedicine technology is a growing field, especially in the context of the COVID-19 pandemic. Consult Station (Health for Development) is the first telemedicine device enabling completely remote medical consultations, including the concurrent collection of clinical parameters and videos. OBJECTIVE: Our aim was to collect data on the multisite urban and suburban implementation of the Consult Station for primary care and assess its contribution to health care pathways in areas with a low density of medical services. METHODS: In a proof-of-concept multisite prospective cohort study, 2134 consecutive patients had teleconsultations. Consultation characteristics were analyzed from both the patient and practitioner perspective. RESULTS: In this study, the main users of Consult Station were younger women consulting for low-severity seasonal infections. Interestingly, hypertension, diabetes, and preventive medical consultations were almost absent, while they accounted for almost 50% of consultations with a general practitioner (GP). We showed that for all regions where the Consult Station was implemented, the number of consultations increased as GP density decreased. The study of practitioner characteristics showed GPs from metropolitan areas are motivated to work with this device remotely, with a high level of technology acceptability. CONCLUSIONS: The multisite implementation of Consult Station booths is suitable for primary care and could also address the challenge of "medical deserts." In addition, further studies should be performed to evaluate the possible contribution of Consult Station booths to limiting work absenteeism.

Medical semiotics in the telemedicine era: The birth of telesemiotics.

BACKGROUND: Telemedicine and videoconferencing distance examination are new and growing swiftly. Distance alters the patient-physician diagnostic context interfering with the traditional methods used to collect and interpret medical signs, introducing new constraints and opportunities. This study is an early contribution to the exploration of the changes in medical semiotics introduced by telemedicine. OBJECTIVE: The main objective is to characterize the impact of telemedicine on medical semiotics and to analyze its consequences on distance medical examination. METHODS: On empirical bases, an inductive reasoning was built on the observation of telemedical practice and personal experience analysis and supported by the research of existing models and literature. RESULTS: The impossibility to touch the patient is the main constraint of telemedicine. While history taking and listening to the patient's symptoms depend on videoconferencing technology, for physical inspection, two main options exist: a helper-mediated physician-patient interaction and a direct physician-patient interaction without third-party intervention. In the latter case, the physician has to rely either on devices and-or on the patient becoming the physician's hands. This enhances the physician-patient partnership in the diagnostic process increasing the role of communication and means that the diagnostic tests usually performed by the physician need to be transformed to allow self-execution. Paradoxically, modern distance examination imposes a return to classical semiotics and puts the patient at the very core of the examination process through his/her active participation. The live use of connected medical devices and the direct access to computer facilities offer new opportunities for improved signs gathering and synchronous medical collaboration. CONCLUSION: We define telesemiotics, a special branch of medical semiotics mostly centered on self-performed physical examination, improved physician-patient communication and the use of computer facilities, that needs to become an integral part of medical training. It is hypothesized that the multiplication of empowered patients, actors of their own health, physically and intellectually participating in the diagnostic process, may lead to deep positive public health and societal repercussions.