Why telehealth must Zoom beyond video calls to fulfil its potential
The telehealth sector has seen more favourable regulatory change in the last few weeks than it has seen in the last decade, courtesy of COVID-19. However, unless we realise this is a 6-month, industry-wide “proof-of-concept” that needs to deliver real outcomes, it can all be undone as quickly as it was implemented.
The COVID-19 pandemic has accelerated the need to deliver quality healthcare while minimising in-person contact for the benefit of healthcare practitioners and high-risk patients. This urgent need has led to governments around the world, including the United States and Australia, to quickly enact regulatory change and facilitate greater access to telehealth consultations and services. The subsequent demand for these services has skyrocketed with healthcare systems having seen a 10 to 20-fold increase in virtual appointments. Teladoc, the largest virtual care provider in the US, is now reporting over 100,000 appointments weekly.
This shouldn’t be surprising, as individuals (high-risk or otherwise) opt to check-in with their doctor from the comfort of their couch as opposed to sitting in a waiting room full of coughing and sniffling patients. Similarly, physicians and allied health practitioners are trying to juggle avoiding infection with filling vacated timeslots as less urgent patients postpone appointments.
Dr. Zoom will see you now…
When we think of telehealth our minds often leap to images of a sleek videoconference between patient and clinician, essentially a virtual appointment. This mental image has a few issues, not least because currently an overwhelming proportion of “telehealth appointments” are via traditional phone calls or text messages, not a videoconference.
Furthermore, most regular appointments for clinicians are not simply a matter of a quick conversation with the patient via video chat. For patients living with chronic conditions visits to their clinician will be accompanied with physical examination, measurements of critical bio-markers, reviews of medications and a detailed patient history. Whilst all of these are certainly possible using remote technology, they do require more than just sending a patient a Zoom link.
If we consider a video appointment to be synonymous with telehealth, we are forgetting one of the major lessons we’ve learned in traditional healthcare, that appointments are only one very small part of a patient’s health journey. More and more, we are realising that it’s what happens during the 99% of a patient’s life when they are not in an appointment, that has the biggest impact on health outcomes.
Does taking traditional healthcare “to the cloud” improve outcomes?
The promise of telehealth is the same as traditional healthcare, to deliver on the triple aims of; improving patient experience, improving health outcomes, and improving the cost of care — through greater convenience, access and efficiency. However, simply moving appointments to the virtual realm does not guarantee better outcomes or greater cost efficiency, even if it is more convenient. Ultimately, to deliver on the true promise of telehealth we need do more than Zoom links and Skype calls.
Telehealth needs to provide patients and clinicians with digital platforms and tools that help patients better manage their health between appointments, as well as provide the data required to add insight to clinicians and empower patients during appointments. The challenge here is the same as the challenge in traditional healthcare — we have a lot of fantastic interventions (both digital and traditional) — but it’s extremely difficult to get patients to engage with them outside of the clinical setting. It’s going to be harder still if there is no clinical setting at all.
It’s always been relatively easy to get a patient to take their medication in hospital, yet more than half of patients struggle to take medication as prescribed at home. A similar number of patients only ever complete their prescribed physiotherapy exercises when they are in front of their physiotherapist. And let’s not forget the many cutting-edge IoT-connected medical devices (from Fitbits to Blood Pressure monitors to CPAP machines) collecting dust in a drawer.
This is a pattern we see time and time again in healthcare — we have a fantastic, shiny, new intervention that is proven to work — but we just can’t engage patients to use it. This shouldn’t be surprising because we humans are terrible at making small behavioural changes for a long-term payoff. Especially when the payoff is unknown, uncertain, unquantifiable for most of us. But the answer to this problem isn’t just taking traditional healthcare and moving it to the cloud, or a Zoom meeting, or a monthly subscription model.
Engagement, not downloads drives outcomes
To truly deliver on the promise of telehealth in improving outcomes, we must solve the fundamental challenge of driving engagement outside the clinical setting. How do we cut through the thousands of competing priorities for an individual’s time and attention during the course of their daily life? How do we ensure the right decision for an individual’s health isn’t just convenient, but actually appealing? How do we do this day after day, month after month so that these interventions achieve the stellar results they promise in controlled clinical trials? Or so that great outcomes with early-adopters can be repeated for the majority to follow?
Until we can answer these questions, while telehealth might look different to traditional healthcare, we shouldn’t expect the outcomes to be any different. Engagement is required to deliver meaningful behavioural change and intervention uptake by both patients and clinicians. It’s not dialling into a virtual appointment that drives better outcomes, but whether the patient listens, acts on and continues to act on the instructions provided by the clinician.
If we are now requiring clinicians to treat patients via virtual appointment, we must accept that in general we are asking them to do so with fewer data points than they would get face-to-face. Even the highest-speed internet and seamless video chat is not the same as being in a room with a patient. In fact, it’s this very concern that saw many clinicians reticent to adopt telehealth before the pandemic forced their hand. But that’s OK, because if there’s one thing the telehealth revolution has promised it is data, data, and more data?
We often talk about data as if it’s the holy grail of telehealth. However, this conveniently ignores that this data will need to come from patients compliantly logging measurements and symptoms, despite the fact we know patients who need the most help tend to disengage from clinical instructions when they walk out of (or hang up on) a clinic. Can we really expect patients to diligently log their blood pressure in a telemonitoring platform when they skip their medication every second day? A telemonitoring platform for a clinician is only as powerful as the data and insight it can provide, and that insight is incredibly limited if there are no data points.
Why does all this matter?
A solution to engaging of patients beyond the appointment (virtual or otherwise) has never been more important. Not just because it improves patient outcomes. Not just because it improves the clinician experience. But because right now we have a 6-month opportunity where telehealth is a must-have when it’s previously been a nice-to-have, with all the lovely reimbursement codes that go along with that. However, if we can’t demonstrate that telehealth genuinely delivers better outcomes, improves patient and clinician experience and drives greater cost efficiency there’s no guarantee it will stay this way once we get out the other side.
Let’s not allow this opportunity to truly revolutionise the way we deliver healthcare go to waste simply because we lacked the imagination to solve genuine problems in traditional healthcare, and instead merely transposed the status quo to the digital realm.