Contexte. La pandémie de la COVID19 (maladie à coronavirus) a entrainé une réorganisation rapide des services de santé en mars 2020, au Québec et dans le monde. La télésanté, qui ouvre de larges perspectives pour faciliter l’accès aux services de santé, a gagné en popularité durant cette période. Les systèmes de soins de différents pays ont mis sur pied des solutions de télésanté ; plus particulièrement des programmes de téléconsultation afin de maîtriser l’afflux des patients dans les centres de soins de première ligne, de gérer le nombre de lits disponibles et de limiter les contacts pour éviter la propagation du virus. Plusieurs travaux actuels décrivent le potentiel d’utilisation de la téléconsultation dans le contexte de la COVID-19 dans les soins médicaux et infirmiers, mais très peu dans les autres types de soins dispensés par d’autres professionnels de la santé. Objectifs. Cette étude vise à apporter des connaissances sur l’utilisation et la perception des professionnels de la DSM, ayant utilisé la consultation à distance durant la pandémie de la COVID-19 au Québec. Notamment à travers les facteurs qui ont influencé son utilisation. Nous ferons ressortir aussi les avantages et contraintes perçus de cette modalité de prestation de soins. Méthodologie. Le devis mobilisé pour atteindre cet objectif est une étude de cas qualitative descriptive, exploratoire et rétrospective. Cette recherche est basée sur l’analyse de 16 entrevues individuelles semi-structurées réalisées auprès de personnes affiliées à la direction des services professionnels d’un centre hospitalier universitaire au Québec. Ces entrevues ont été réalisées avec les professionnels qui ont recouru à la téléconsultation durant la crise de la COVID-19. Elles ont fait l’objet d’une analyse de contenu à l’aide du logiciel QDA Miner 5 selon une approche thématique émergente. Résultats. Au terme de cette étude, l’analyse des résultats montre une évolution de la perception des professionnels de la téléconsultation pendant la pandémie de COVID-19 et une nette augmentation de son utilisation. Les répondants ont partagé divers avantages perçus et améliorations à apporter. Les principaux bénéfices perçus concernaient l’amélioration de la continuité des soins, une meilleure observance du traitement par les patients et la personnalisation des soins par l’accès au milieu de vie des personnes. Les obstacles les plus importants étaient le réseau internet et l’augmentation de la charge de travail. Un modèle hybride de prestation de soins est en train d’émerger. Conclusion. L’expérience des répondants par rapport à la téléconsultation s’avère particulièrement positive, et ce, malgré les contraintes mineures rencontrées en contexte de pandémie de COVID-19. Ces résultats permettront d’élaborer des stratégies pouvant les aider dans leur pratique au-delà du contexte de COVID-19. / Background. The COVID 19 (coronavirus disease) pandemic led to a rapid reorganization of health services in March 2020. Telehealth, which opens great prospects for facilitating access to health services, gained in popularity during this period. Healthcare systems in different countries have developed telehealth solutions; more specifically, teleconsultation programs to control the influx of patients into primary care centers, manage the number of available beds and limit contacts to prevent the spread of the virus. Several current studies describe the potential for the use of teleconsultation in the context of COVID-19 in medical and nursing care, but very little in other types of care. Objective. This study aims to provide knowledge on the use and perception of DSM professionals, having used remote consultation during the COVID-19 pandemic in Quebec. In particular through the factors that influenced its use as well as the perceived advantages and constraints. Methods. The design used to achieve this objective is a descriptive, exploratory, and retrospective qualitative case study. This research is based on the analysis of 16 semi-structured individual interviews conducted with people affiliated with the professional services department of a university hospital in Quebec. These interviews were conducted with professionals who used teleconsultation during the COVID-19 crisis. They were subjected to content analysis using QDA Miner 5 software using an emerging thematic approach. Result. The results show that the main perceived benefits focused on improving the continuity of care, better adherence to treatment by patients, and personalization of care by having access to people’s living environment. The biggest barriers were the Internet and the increased workload. Conclusion. The experience of respondents with teleconsultation is particularly positive, despite the minor opposites encountered in the context of the COVID-19 pandemic. These results will make it possible to develop strategies that can help them in their practice beyond the context of COVID-19.

Bakgrund: Vårdronden genomförs dagligen av vårdpersonal tillsammans medpatienter inneliggande på slutenvårdsavdelning. Syftet med vårdronden är att tillgodose patientens behov av vård och behandling och kan inkluderaundersökningar, prognos, planering och undervisning av personal. Den digitalautvecklingen sker även inom sjukvården och ställer nya krav på vården och erbjudersamtidigt nya tekniska möjligheter. Syfte: Syftet med denna kartläggande litteraturöversikt är att identifiera typer av eHälsointerventioner som används i vårdronden inom slutenvården samt att studera hur vårdronden inom slutenvården har utvecklats med hjälp av eHälsointerventioner. Metod: För att svara på studiens frågeställning genomfördes en scoping review för att kartlägga litteratur inom detta område. Data hämtades från två olika databaser där sexton artiklar svarade på studiens syfte och uppfyllde inklusionskriterierna. En tematisk analys genomfördes därefter för att analysera artiklarna. Resultat: Fyra teman samt åtta underteman identifierades: konsulter på distans, deltagande i virtuella vårdronder, ny teknik och utbildning. eHälsointerventioner har medfört ökad patientsäkerhet, minskat bristen på specialistkompetens, minskat avståndet mellan patient/specialist, ökat delaktigheten för anhöriga, minskat smittspridning och stärkt det interprofessionella samarbetet i samband medvårdronden. Slutsats: Vårdronden har utvecklats genom nya arbetssätt vilka möjliggjorts av ny teknik med exempelvis robotar och virtuella glasögon. Geografiska avstånd kan minskas med hjälp av virtuella vårdronder, vilket även ställer höga krav på tillgången på internetuppkoppling och personal med uppgift att koordinera de nya arbetssätten. eHälsointerventioner har potential att stärka patientsäkerheten, bidra till en mer jämlik vård och minska resursbristen inom slutenvården. / Background: Wardrounds are carried out daily by healtcare staff in the inpatient ward. The purpose of the wardround is to meet the patient´s needs for care and treatment and include examinations, prognosis, planning and teaching of staff. The digital development also takes place in healthcare and places new demands on care and at the same time offers new technical opportunities. Purpose: The purpose is to identify types of eHealth interventions that are used in the wardround in inpatient care and to study how the wardround in inpatient care has developed with the help of eHealth interventions. Method: To answer the study´s question a scoping review was carried out to survey literature in this field. Data were retrieved from two different databases where sixteen articles responded to the purpose of the study and met the inclusion criteria. A thematic analysis was then carried out to analyze the articles. Results: Four themes and eight subthemes were identified. Consultants ondistance, participation in virtual wardrounds, new technology and education. eHealthinterventions have resulted in increased patient safety, reduced the lack of specialistcompetence, reduced the distance between patient/specialist, increased the participation of relatives, reduced the spread of infection and strength enedinterprofessional cooperation in connection with the wardround. Conclusion: The wardround has developed through new working methodsmade possible by new technology, for example robots and virtual glasses. Geographical distances can be reduced with the help of virtual wardrounds, which also places high demands on the availability of an internet connection and staff with coordinating the new working methods. eHealth interventions have the potential to strengthen patient safety, contribute to more equal care and reduce resource shortagesin inpatient care.

Contexte : La pandémie de COVID-19 a créé un besoin urgent d’agir pour réduire la propagation du virus et pour diminuer la congestion des services de santé, pour protéger les soignants et les aider à maintenir une qualité et une sécurité des soins satisfaisantes. Les plateformes de télésoins et de télésurveillance sont rapidement apparues comme des solutions potentielles. C’est ainsi qu’au Centre hospitalier de l’Université de Montréal, trois plateformes ont été mises en place : 1) une téléassistance (Telecare-Covid) apportée par des infirmiers et des médecins par des appels téléphoniques ; 2) une application de télésurveillance (CareSimple-Covid) qui permet un suivi à distance du patient à domicile, et; 3) une plateforme de téléconsultation (React- Teleconsultation) pour réaliser des consultations visuelles entre professionnels et patients. Objectif : Le but de cette étude est d’évaluer du point de vue des patients et des professionnels de santé utilisateurs des trois plateformes de télésanté mises en place pour les soins et le suivi à distance des patients atteints par la COVID-19, les dimensions suivantes : (1) la satisfaction sur la qualité et la sécurité des soins prodigués par les plateformes technologiques; (2) l’engagement des patients et le partenariat dans les soins lors de l’utilisation des plateformes technologiques; et (3) le rôle et la pertinence des plateformes technologiques en matière d’utilité, d’avantages et de limites. Méthode : Deux études transversales ont été réalisées entre juillet et septembre 2020. La première a été réalisée auprès de patients ayant utilisé une des deux plateformes Telecare-Covid et CareSimple-Covid. Des questionnaires ont été soumis par téléphone aux patients. Les données collectées ont été analysées à l’aide de statistiques descriptives et d’une analyse de test t. La deuxième s’intéresse à l’utilisation par les professionnels de Telecare-Covid et React- Téléconsultation. Les données ont été recueillies par courrier électronique auprès des professionnels de santé. Nous avons mené une analyse de statistique descriptive grâce au logiciel SPSSã et STATAã. Ainsi, certains tests spécifiques ont été appliqués tels que le t-test et celui de Fisher pour comparer les différentes perceptions des utilisateurs sur certaines dimensions étudiées. Résultats : Parmi les 85 patients qui ont utilisé les deux plateformes, 51 (60 %) ont participé à la première l’étude. Pour la deuxième étude, 1 545 professionnels de la santé ont été invités à participer et 491 (31,8 %) ont répondu au sondage. De manière générale, les résultats des deux études ont montré que les perceptions des utilisateurs quant à la qualité et la sécurité des soins offerts sur les plateformes de télésurveillance étaient positives pour l’ensemble des plateformes technologiques étudiées. Les principales caractéristiques très appréciées par la plupart des utilisateurs, que ce soit chez les patients ou chez les professionnels de santé, sont : (1) la facilité d’accès aux services et la proximité des membres de l’équipe de soins; (2) la convivialité des plateformes; (3) la continuité des soins prodigués et; (4) une gamme diversifiée de services offerts. Patients comme professionnels de santé utilisateurs de ces plateformes dans les deux études ont cependant identifié certaines limites techniques et ont soulevé certains problèmes, tels que l’importance de maintenir le contact humain malgré la distance, la sécurité et la confidentialité des données et la formation. Conclusion : Cette étude suggère que les plateformes de télésanté et de télésurveillance ont été bien accueillies par les patients et les professionnels de santé et les dimensions étudiées ont été globalement perçues positivement par l’ensemble des utilisateurs, même si certaines limites existent dont il faut tenir compte. Ainsi, pour contenir les limites et enjeux identifiés et pour améliorer ces trois plateformes et maximiser leur utilisation, un processus de développement collaboratif incluant patients, professionnels de santé, décideurs et fournisseurs/concepteurs de plateformes numériques est recommandé. / Background: The COVID-19 pandemic has created an urgent need for action to reduce the spread of the virus and reduce congestion in health services, protect caregivers and help them maintain satisfactory quality and safety of care. Telecare and telemonitoring platforms quickly emerged as potential solutions. Thus, at the University of Montreal Hospital Center, three platforms have been set up: 1) remote assistance (Telecare-Covid) provided by nurses and doctors by telephone calls, and 2) remote monitoring (CareSimple-Covid) which allows remote monitoring of the patient at home, and 3) a teleconsultation platform (React-Teleconsultation) to carry out visual consultations between professionals and patients. Objective: The aim of this study is to evaluate, from the point of view of patients and healthcare professionals who used three telehealth platforms for the care and remote monitoring of patients with COVID-19, the following dimensions: (1) satisfaction with the quality and safety of care provided by technological platforms; (2) patient engagement and partnership in care when using technology platforms; and (3) the role and relevance of technology platforms in terms of usefulness, benefits and problems, and limitations. Method: Two cross-sectional studies were carried out between July and September 2020. The first was carried out with patients who had used one of the two, Telecare-Covid and CareSimple- Covid platforms. Questionnaires were given to the patients by telephone. The data collected was analyzed using descriptive statistics and t-test analysis. The second focuses on the use by professionals of Telecare-Covid and React-Téléconsultation. The data was collected by email from healthcare professionals. The data were analyzed using SPSS software. Fisher analyzes were performed to compare perceptions of performance, safety and quality, issues and perceived problems among healthcare professionals. Results: Of the 85 patients who used both platforms, 51 (60%) participated in the first study. For the second study, 1545 healthcare professionals were invited to participate and 491 (31.8%) responded to the survey. In general, the results of the two studies showed that users' perceptions of the quality and safety of care offered on telemonitoring platforms were positive for all of the technological platforms studied. The main features highly valued by most users, whether for patients or healthcare professionals, are (1) ease of access to services and proximity to members of the care team; (2) platform usability; (3) continuity of care provided and (4) a diversified range of services offered. Both patients and healthcare professionals using these platforms in both studies have however identified certain technical limitations and raised certain issues, such as the importance of maintaining human contact despite the distance, security and confidentiality of data and training. Conclusion: This study suggests that the telehealth and telemonitoring platforms were well received by patients and health professionals and the dimensions studied were generally perceived positively by all users even if some limits exist and whose it is important to consider. Thus, to contain the identified limits and issues and improve these three platforms and maximize their use, a collaborative development process including patients, healthcare professionals, decision-makers and suppliers/designers of digital platforms is recommended.

Introducción: La pandemia por COVID-19 resaltó la importancia de un buen control glicémico de pacientes con diabetes mellitus tipo 2 para evitar complicaciones; sin embargo, también limitó el tratamiento y seguimiento de estos pacientes. En este contexto el uso de la telesalud fue promovido. Objetivo: Determinar la efectividad de la telesalud en el manejo de la diabetes mellitus tipo 2 en el Hospital Regional Lambayeque durante el año 2021. Materiales y métodos: estudio de cohortes retrospectivo, realizado en base de historias clínicas de pacientes diagnosticados con DM2 atendidos por teleconsulta de enero a marzo del 2021 que hubieran sido atendidos previamente de manera presencial y contarán con controles glicémicos. Resultados: Los pacientes con DM2 tuvieron una edad promedio de 60.73 ± 8.93 años, predominio del género femenino (70.7%), el 28.3% tenían más de 10 años de evolución y el 56.6% se trataba con antiglicémicos orales. La complicación más frecuente fue la neuropatía (46.5%) y la comorbilidad la IRC (18.2%). Solo 2-3% de los pacientes presentaron síntomas de hiperglicemia e hipoglicemia. En cuanto a las glicemias en ayunas obtenidas de manera presencial y por telesalud no tuvieron diferencia significativa. (p = 0.8) La hemoglobina glicosilada encontrada en el seguimiento presencial fue de 8.17 ± 2.34 y por telesalud fue de 8.53 ± 2.65, siendo significativa la diferencia entre ambas modalidades. (p = 0.021) Conclusión: El control glicémico obtenido por telesalud fue estadísticamente menor que el obtenido por vía presencial. (p=0.021) / Introduction: The COVID-19 pandemic highlighted the importance of good glycemic control in patients with type 2 diabetes mellitus to avoid complications; however, it also limited the treatment and follow-up of these patients. In this context the use of telehealth was promoted. Objective: determine the effectiveness of telehealth in the management of type 2 diabetes mellitus at the Lambayeque Regional Hospital during the year 2021. Materials and methods: retrospective cohort study, conducted based on medical records of patients diagnosed with DM2 attended by teleconsultation from January to March 2021 who had previously been attended in person and had glycemic controls. Results: Patients with DM2 had a mean age of 60.73 ± 8.93 years, with a predominance of women (70.7%), 28.3% had more than 10 years of evolution, and 56.6% were treated with oral antiglycemics. The most frequent complication was neuropathy (46.5%) and comorbidity CKD (18.2%). Only 2-3% of the patients presented symptoms of hyperglycemia and hypoglycemia. Regarding fasting glycemia obtained in person and by telehealth, there was no significant difference (p = 0.8). The glycosylated hemoglobin found by telehealth was 8.53 ± 2.65 and in the face-to-face follow-up it was 8.17 ± 2.34, the difference between both modalities being significant. (p = 0.021) Conclusion: The glycemic control obtained by telehealth was lower than that obtained in person. (p=0.021)

Objetivo: Identificar los factores asociados al nivel de satisfacción del Personal Médico en la implementación de Telesalud en el Hospital Regional Lambayeque (HRL) durante el 2021. Materiales y métodos: Estudio analítico, observacional, transversal realizado en el HRL, se le realizó un cuestionario de 29 preguntas donde se evaluó la satisfacción de los pacientes y del proveedor en la implementación de Telesalud, además de características sociodemográficas y laborales a 75 médicos que realizaron Telesalud en el primer semestre del 2021. Resultados: El 50% de los participantes se clasificó según el P50 como satisfechos con la implementación del servicio de Telesalud. Se identificó asociación significativa con el tipo de dispositivo electrónico utilizado (p=0.001), con la plataforma empleada (p= 0.031) y con la conectividad a internet durante las teleconsultas (p=0.039). Entre el personal médico evaluado, el tener un contrato bajo la modalidad 728 se asoció con una reducción del 27% de la satisfacción con la implementación del mencionado servicio, en cuanto al dispositivo utilizado, el uso de computadoras portátiles se asoció con una reducción del 25% y una buena conectividad a internet se asoció con un incremento del 29%. Conclusiones: Se concluye que la implementación de Telesalud fue satisfactoria para el 50% del personal de salud del HRL, siendo una gran herramienta para la continuidad y la mejora del servicio de salud, pero aún con limitaciones para su correcto desarrollo por parte del usuario como del proveedor. Se identificaron como factores asociados a la satisfacción del servicio al tipo de contrato, el tipo de dispositivo electrónico utilizado y la conectividad a internet. / Objective: To identify the factors associated with the level of satisfaction of Medical Staff in the implementation of Telehealth at the Lambayeque Regional Hospital (HRL) during 2021. Materials and methods: Analytical, observational, cross-sectional study carried out at the HRL, a 29 question questionnaire was carried out where the satisfaction of patients and the provider in the implementation of Telehealth was evaluated, in addition to sociodemographic and work characteristics of 75 medical doctors. who carried out Telehealth in the first half of 2021. Results: 50% of the participants were classified according to the P50 as satisfied with the implementation of the Telehealth service. A significant association was identified with the type of electronic device used (p=0.001), with the platform used (p= 0.031) and with internet connectivity during teleconsultations (p=0.039). Among the evaluated medical staff, having a contract under the 728 modality was associated with a 27% reduction in satisfaction regarding the aforemented service, in terms of the device used, the use of laptop computers was associated with a 25% reduction. % and good internet connectivity was associated with a 29% increase. Conclusions: The implementation of Telehealth was satisfactory for 50% of the HRL medical staff, being a great tool for the continuity and improvement of the health service, but still with limitations for its correct development by the user and the provider. The type of contract, the type of electronic device used and internet connectivity were identified as associated factors with service satisfaction.

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The following literature review was intended to review current research studies related to diagnostic evaluation using Telehealth for young children aged 0-7 seeking a diagnosis of autism spectrum disorder (ASD). The analyzed research created a comprehensive guide on the quality, quantity, and state of Telehealth research for ASD evaluation will result. Through the synthesis of available literature, the strengths, and weaknesses of different models of Telehealth ASD evaluation were assessed. The results of this literature review found that there is evidence to support Telehealth’s use in some aspects of evaluation, but not as a stand-alone methodology. Further research is required to show that Telehealth methods of evaluation withhold the same reliability, quality, and validity as traditional ASD evaluation methods.

From the 1970s to the present time, the World Health Organization (WHO) explains the importance of health promotion in the world. The increased interest in promoting health and increasing health costs for the economies contributed to the recognition of health care as an important area of research. One of the most important aspects of these research currently is the Telehealth, using Information and Communication Technologies (ICT) to try to provide universal access to health. The use of Interactive Digital TV technology helps in accessing remote locations and creates the opportunity to distribute applications across their infrastructure. Dealing with the problems that arise from the convergence of these concepts is of great importance. The architectural description process helps in the development of applications and systems based on the referenced concepts. However, there are no frameworks to help the description of architectures for this particular domain. This paper proposes the ARCHealth an enterprise architecture framework created to assist the architecture development process in accordance with ISO/IEC/IEEE 42010:2011. The ARCHealth was based on the principles of primary health care, taking into account the main concerns of stakeholders and the specific area. / Desde a década de 1970 até o presente momento, a Organização Mundial da Saúde (OMS) expõe a importância da promoção da saúde no mundo. O aumento do interesse na promoção da saúde e os custos de saúde crescentes para as economias contribuíram para o reconhecimento dos cuidados à saúde como uma importante área de pesquisa. Uma das vertentes mais importantes dessas pesquisas atualmente, é a Telehealth, que utiliza das Tecnologias de Informação e Comunicação (TIC) para tentar prover acesso universal à saúde. O uso da TV Digital Interativa auxilia no acesso a locais remotos e cria a oportunidade de distribuir aplicações através de sua infraestrutura. Lidar com os problemas que surgem a partir da convergência desses conceitos é de grande importância. O processo de descrição de arquitetura auxilia no desenvolvimento de aplicações e sistemas baseados nos conceitos referenciados. Porém, não existem muitos frameworks que auxiliem a descrição de arquiteturas para esse domínio específico. Este trabalho propõe o ARCHealth, um enterprise architecture framework criado para auxiliar o processo de desenvolvimento de arquitetura em conformidade com a norma ISO/IEC/IEEE 42010:2011. O ARCHealth foi elaborado com base nos princípios de Atenção Primária à Saúde, levando em consideração as principais preocupações das partes interessadas e do domínio específico.