In April 2020 we published an article on telehealth examining the potential for virtual care initiatives to help with the complexities of the COVID-19 pandemic. It was by far our most read article for the year.
It stands to reason as in the intervening months, we’ve seen virtual care quickly normalised across the globe. Patients not wanting to expose themselves to the virus benefit from this model by accessing GPs in the safety of their home, while physicians reduce their risk of infection treating those in need.
So what is the future of virtual care? As vaccines are rolled out, will telemedicine disappear with the virus? And if not, what are the lessons that must be learned to ensure the best outcomes? At a recent virtual panel event hosted by PwC Australia, three physicians reflected on the year past and the road ahead.
COVID-19 didn’t just uplift virtual care, it supercharged it. As Professor George Braitberg AM, Executive Director of Strategy Quality and Improvement at Australia’s Royal Melbourne Hospital noted, at the beginning of the pandemic “only 20 percent of our outpatient visits were being done by telehealth, either by telephone or some form of telehealth platform.” During COVID-19, that number rose to 85 percent, he said.
With lockdowns and increasing numbers of healthcare professionals being exposed to the virus, hospitals and care providers had to figure out how to reach their patients under difficult and varying circumstances.
For Dr Tania Elliott MD, CMO of Virtual Care at Ascension Health in the US, the challenge has been in maintaining equilibrium. “We’ve had spikes in different places at different points in time and you see that reflected in the spikes in virtual care as some places open up and others shut down,” she said. “So it’s really been a balancing act to make sure we can turn our virtual care resources to the communities that are most in need at any given point in time.”
Elliott also sees a relative silver lining to the way the year has unfolded in the enhancements in technology and virtual care delivery. Across the world, the healthcare industry embraced telemedicine out of necessity in a matter of weeks. But embedding that success hasn’t been easy, she noted. “The challenge has been balancing the crisis response during a public health emergency, with leveraging the momentum. How do we harness the energy and excitement to create sustained change?“
By and large, patients adapted well to telehealth, and adoption for behavioural/mental health was particularly high, which, according to PwC analysis, has risen and stayed consistently so. Yet there are concerns among telehealth experts that despite the apparent success, built as it was, quickly and without the benefit of evidence-based data, there will not be time set aside to assess how well the model was implemented or how it could be better.
As Dr Shannon Nott, Clinical Director of the NSW Virtual Care Accelerator and Rural Health Director of Medical Services for Western NSW Local Health District articulated, “Evaluation often becomes an afterthought, and particularly during COVID-19 with people having to move so quickly into the telehealth state, not all had robust plans around how to evaluate outcomes.”
“It’s important that we look at opportunities where we’ve added value, added a level of care that we hadn’t been able to previously. We need to evaluate that, we need to make sure that we’re learning lessons so we’re not recreating the wheel down the track. We need to integrate research evaluation, monitoring and evaluation at early stages of development of models of care, and review those models of care continuously so that we can continue to improve the quality that they are providing.”
Elliott agrees on the importance of measuring the success of virtual programs, and backing them up with clinical outcomes. Her biggest worry is that the healthcare industry will run out of time, and that the data collected from the pandemic will be taken at face value, equated with the use of virtual care in a non-pandemic setting.
“Making conclusions from that data is not really a fair fight because our ambulatory clinics were closed. We implemented things on the fly without any sort of training and infrastructure. It’s not an apples-to-apples comparison.” Instead, she believes physicians need time to integrate virtual care delivery modalities into routine care. Only then can real results be analysed and conclusions drawn.
Pleasingly, early and anecdotal evidence shows that the experience of virtual healthcare services has made a difference to patients and clinicians alike.
“There’s really strong patient satisfaction. Virtual care can help increase stickiness and patient engagement. And there’s literature to support that,” said Elliott, adding that there is a logical sense to patient satisfaction being higher when their time is respected and virtual visits can be done from the ease of their home. And this comfort, of course, is not superficial. As healthcare professionals know, it can provide better clinical outcomes.
For example, The Royal Melbourne Hospital has trialled virtual care for rural patients with early onset dementia. They found that without the stress of travel, waiting times and a confronting hospital setting, patients improved on cognitive tests. Indeed, said Braitberg, “we found that we were actually providing a barrier to the care of our patients by asking them to present physically.”
For physicians too, in a profession where burnout can be all too common, the virtual healthcare experience has proven beneficial. The ability to work from home and avoid lengthy commutes appeals to doctors as much as it does to anyone else, leading to potentially greater quality of life. But also, it has led to greater patient relationships.
“There’s a comfort level,” Elliott explained. “They’re seeing into my home and I’m seeing into their home, and there’s something nice about that as opposed to plucking me out of my home and the patient out of their home and interacting in a stark environment where care is episodic. We’re leveraging technology to be able to remove access barriers and improve relationships and rapport with patients.”
These stories also highlight something that all three telehealth experts believe to be key in going forward: the need for integration. To be successful — providing better total quality of care — virtual initiatives must sit within greater efforts.
“Virtual care within itself should not be this stand alone thing in healthcare. We need to move into being able to have this be business as usual, embedded within a toolkit of abilities and ways that clinicians can work towards a health system achieving strategic outcomes,” Nott said. “How do we move forward into the future? And how do we refresh our strategies so that virtual care programs of work address broader healthcare strategies?
This includes addressing the need for associated infrastructure. Observed Elliott: “We are essentially still operating in a brick and mortar space. We need the time to develop the infrastructure, to train our clinicians, to train our staff, to shift a model that was fully structured around in-person care, and then offload some of that to virtual visits.”
All three are clear that integrating virtual care is about working more efficiently. For example, instead of a patient having multiple physical visits, they could be consolidated to make the best use of both the patient and doctor’s time — combining tests, specialists and services — with the rest taking place virtually.
Working in partnership with other health services will also be important, believes Braitberg. “Moving forward, community and primary care needs to be a strong partner in anything we do in developing virtual care. It’s not just what they do in their sphere and we do in ours. It has to be connected.”
Utilising the same spirit that the world’s healthcare providers embodied to find a vaccine for COVID-19, the hope is that by sharing findings and data from telemedicine initiatives, the services it provides will become more common and provide even greater outcomes.
“We truly believe virtual care can increase access and healthcare equity, improve the way that we deliver care and enable efficiencies that we never even thought of,” Elliott said. “And we really believe that for the right patients it will improve the total quality of care as well.”
It’s a belief that’s hard to argue with.
Our next virtual health webinar will take place on the 23rd of March, 2021, please register to attend.
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