FEATURE
Telehealth in the COVID era It’s a technology that has been around for 20 years, but now telehealth has come into its own.
The all-encompassing COVID-19 pandemic has disrupted the world like nothing before it, yet it’s the pressure on primary health services and public health systems that have been most disrupted.
of dedicated video conferencing systems was prohibitive – over $30,000 a unit – whereas now, these tools are free (Zoom, Skype, FaceTime etc) if you have a compatible device.
With stringent stay-in-place, quarantine and social distancing orders in place, the role of telehealth has never been greater, which has been reflected in the Federal Government providing $100 million of Medicare funding for bulk-billed telehealth consultations.
Distance between a clinician and patient may have been the initial primary rational for telehealth, but this is no longer the case, says Professor Anthony Smith, Director of the Centre for Online Health at the University of Queensland.
The telehealth system, essentially video and some telephone consultations between clinicians and patients, could prove to be extremely effective in treating at-risk patients by reducing the possibility of community transitions of COVID-19, while offering a new paradigm of treatment that is potentially more convenient and cost effective. Although telehealth has been in use in Australia for almost two decades, the take up has not been representative of the system’s potential, but this is changing, particularly in primary health. The questions we need answers for are: Will telehealth become the new normal for primary care delivery?; and will the disruptive forces of COVID-19 be an opportunity for clinicians and the public to fully embrace its benefits?
Slow start Twenty years ago, telehealth was primarily used for specialist consultations on an ad-hoc basis, particularly with patients in rural or remote locations. Then the cost 24 | MAY 2020
Prof Smith has been researching and designing telehealth services for more than 20 years: “Telehealth has proven to be useful for everyone, regardless of location. We have established telehealth services to support patients living only a few kilometres from their hospital. “These people may normally find it difficult to attend their appointment because of frailty, other physical or mental health issues, transport costs, or lack of family support. Telehealth technology has changed this significantly.” Although the uptake of telehealth has been slow and fragmented in Australia, Prof Smith said this wasn’t without good reasons. “The lack of funding to support the costs of doing telehealth for patients and providers; availability of technical infrastructure, such as high-speed telecommunications and interoperable video-conference platforms; absence of revised workflow procedures; appropriate education and training; limited general public awareness; ineffective or no change-management processes, as telehealth is a disruptive process.”
Change management A salient determinant for acceptance of disruptive technologies is effective change management, he said. “Some clinicians seem to adopt telehealth quickly, while others are resistant. It’s important to consider change-management strategies which support clinicians and patients during this process. “Learning from experience is important. We often find that once clinicians have been involved in telehealth, the process is much more acceptable to them. “It’s also important to acknowledge that telehealth is not appropriate for all consultations. There will always be a need for appointments that require a physical assessment or specialist procedure which can’t be done remotely. Of course, the decision to do telehealth should be based on the clinical requirements.”
Telehealth & COVID-19 With the unprecedented disruptive changes due to COVID-19, such as social distancing, there has been a rapid adoption of telehealth, which has validated the benefits of the system for clinicians and patients alike, Prof Smith said. “Patients can access services more conveniently from their own home. Vulnerable patients, such as those aged over 70 with chronic health conditions, can have a telehealth appointment rather than waiting in a busy medical centre, among other people who potentially have the virus or other communicable health conditions. While clinicians are able to assess and manage patients without the risk of infection.”
MEDICAL FORUM | WOMEN 'S HEALTH ISSUE
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James Knox reports
