The promise of telehealth in the care digital revolution

Telehealth represents the digital transformation that’s currently underway in Australia when it comes to providing care. Technological advancements resulting in faster internet connectivity, high-configuration smartphones and secured mobile payment systems — coupled with increasingly busy lifestyles and growing healthcare costs — have resulted in the growth of telehealth services and a shift in the market towards taking the care to the patient, rather than the patient to the care.

The COVID push

Yeo Tee Joo, Assistant Professor at the National University Heart Centre Singapore, said, “[we] most definitely will be able to see a lasting digital shift”.

In Australia, as in other markets, COVID-19 has provided telehealth a ‘kick’, said Robyn Gallagher, Professor of Nursing at the Faculty of Medicine and Health at Sydney Nursing School (University of Sydney).

She cited the example of a public hospital in Dubbo, NSW, where she recommended the adoption of fitness activity trackers and a simple goal-based health app in November 2019. Her suggestion was rejected. Now, however, with changes wrought by the pandemic, the cardiac unit at the hospital has converted completely to telehealth and its cardiac rehab staff are “absolute proponents”.

“It is not perfect and it does not suit some people yet, but it supports a lot of people very well,” Gallagher said.

Equity of access

Telehealth is proving to be effective in two key ways: it is helping bring down costs and enabling the delivery of healthcare services and expertise to the country’s remote and rural areas.

Australia’s per capita expenditure on healthcare goods and services in 2017–2018 stood at $7485,¹ among the highest in the world.² Broader adoption and provision of telehealth services and consultations can lower costs for healthcare systems and patients. Telehealth allows healthcare systems to better optimise finite resources such as personnel and time, lowering overheads. From patients’ perspectives, it reduces travel time and expenses, particularly for those requiring medical assistance outside of large cities.

West Moreton Health in Queensland introduced a program in 2016 that incorporates technology, home support and education to help with early intervention. Since its implementation, the hospital has seen the number of potentially preventable hospitalisations of chronically ill patients decline by 28%, and a 53% decrease in hospital emergency department visits.³

The second key benefit is that telehealth helps overcome the barriers of distance and reach. Some areas of the country can be up to seven hours away from a metropolitan hospital, so virtual clinics are held, and virtual consultations offered.

“In the case of any chronic disease, telehealth allows patients to access expert health professionals for expertise and assessment. There are huge areas that have very poor healthcare professional coverage in rural Australia — telehealth can be a game changer in that regard,” Gallagher said.

By providing greater access to health professionals through telehealth, patients can benefit from continuity of care, which has been associated with better medical outcomes such as lower mortality rates.⁴

Changes that will stick

It isn’t just governments, healthcare providers and patients that stand to benefit from the wider adoption of telehealth. Companies, too, are taking notice.

Health and benefits leader Neil Narale said corporate investment in the future of health, including digital health solutions, is set to grow over the next five years, as employers view digital health as a critical way to improve employee morale and engagement, and increase productivity.

He added that the growth of telehealth services will help organisations contain costs. With the industry’s evolution, telehealth providers may seek to offer more solutions that will further impact costs over the long term.

Dr Yeo explained that remote rehabilitation options are also being recommended by many large cardiology institutions, but there is no consensus yet on its efficacy given that there is currently insufficient clarity on how risk assessments of patients can be made.

“Real-time monitored rehab is the eventual goal,” Dr Yeo said.

Challenges remain

For telehealth adoption to stick, there are multiple variables such as software, hardware and funding that must be considered, Dr Yeo said. A broader shift towards telehealth also requires investment in training. From the patient’s standpoint, the availability of relevant hardware — such as laptops, tablets or smartphones with reliable internet connections — and the know-how to use it can be limiting factors and create uncertainty and stress among patients.

Inability to access the internet in rural areas is a key impediment. For telehealth use to become more common, investment must be made in infrastructure in rural areas to enable easier and affordable access to data connectivity, through the laying of fibre-optic networks, expansion of mobile and satellite services, as well as data plans by service providers.

A greater limiting factor is resistance to change among patients and healthcare staff. The healthcare industry is notorious for its reluctance to change, so shifts in mindsets are important for telehealth adoption to be maintained.

Whether we will see the wide-scale adoption of telehealth is out of the scope of individual institutions, according to Dr Yeo, who said governments must play a lead role in terms of infrastructure provision and the right legislation, particularly around cybersecurity.

Cyber threats have become a pressing concern in recent years, with cyber attacks such as those on Singapore’s SingHealth and the UK’s National Health Service exposing vulnerabilities. This underlines the importance of implementing cybersecurity measures, enhancing IT systems’ security and working with a trusted provider, particularly if patients are expected to buy-in to the benefits of telehealth.

Going forward

Industry experts believe many of the changes being witnessed will stick, despite the challenges seen today. This is because the adoption of telehealth brings several efficiencies the sector would not want to let go of.

Needless to say, telehealth uptake will be largely dependent on how self-sufficient the ecosystem is — particularly in terms of infrastructure, the training of medical staff and the willingness of patients to favour the virtual over the real.

References

1. Health expenditure Australia 2017-18. Australian Institute of Health and Welfare. 11 November 2019.
2. Current health expenditure per capita (current US$). World Health Organization Global Health Expenditure database.
3. Reducing hospital readmissions with remote patient care management. Philips.
4. Continuity of care improves patient outcomes. Australian Medical Association.

Learn more about Vocus at www.vocus.com.au/care.

*Andrew Twining is an industry specialist in health care.