COVID-19, and the pandemic winds of change in healthcare

Our world has changed in recent months, and without doubt, COVID-19 has been a powerful disruptive force in many businesses. This is also true in the business of healthcare.

In Australia, the pandemic has precipitated the rapid rollout of widespread telehealth services to try to maximise the safety of both patients and healthcare professionals. More than 4.3 million health and medical services have been delivered to a total of more than three million patients through the telehealth items introduced by the Australian government.

For those who work in digital health, this kind of change is something we’ve been advocating for many years. Equally, however, we understand that these services aren’t without risk.

For example, a key report about telehealth, commissioned by the Victorian Department of Health and Human Services, in 2015 by DLA Piper stated: “The greatest risk for telehealth providers and host providers is misdiagnosis.” The report went on to outline other risks such as “potential liabilities arising from inferior equipment and technology, and the storage of images”.

Other risks definitely exist, including the security of the communication channels. The recently publicised phenomenon of “Zoombombing” – easy to do at a technical level – is a prime example of that.

Fewer people calling on GPs

Aside from the immediate risks regarding technology and its use in providing healthcare services, we’re also hearing reports from numerous jurisdictions about a relative “drop-off” in the interactions of people with the healthcare system. A survey of 175 GPs conducted by The Medical Republic found about half had lost more than 30 per cent of their revenue, while roughly one-third reported losses of less than 30 per cent.

For example, some Australian healthcare experts in cancer and heart disease have asserted that as we continue to navigate the coronavirus pandemic, many hospitals and health services are actually less busy than usual. There are similar reports from other countries, such as the United States, and certainly, the Australian government foreshadowed this kind of phenomenon in communications in early April.

At this point, the causes of this are not well-known. They could even extend to the fact that currently, most telehealth services in Australia are technically limited – or used in a limited way. Many of these services simply consist of voice, or voice and video channels, with some asynchronous document-sharing – although highly advanced exceptions such as Royal Prince Alfred Virtual Hospital do exist.

The question of reduced interaction

One question to be explored at a later stage, then, from a digital health perspective, is how much of this reduction in interaction is related to the fact that most of these telehealth services don’t allow things such as remote measurement of blood pressure, blood sugar, or other vital parameters that would typically be very easily measured in face-to-face consultations.

Does this deficiency in some way dissuade people from reaching out about healthcare needs or concerns in the same way they would have in the past?

Of course, there could be many factors at play here, including fear in the community about having any kind of physical interaction with other people due to the risk of COVID-19 infection, and hence a disinclination to attend clinics, emergency departments, and other places where care is still being provided.

What will be interesting to see is the extent to which some of these changes – for example, huge growth in the use of telehealth – are permanent, and even if they are, what life will look like after the resumption of relative normality in the healthcare system in Australia.

It’s well-recognised that one of the historic barriers to more broad usage of telehealth services was adequate remuneration for healthcare providers, so that the services could be used interchangeably with better-funded “physical” care where safe and appropriate.

That barrier of remuneration has been “taken down” in the setting of the COVID-19 pandemic – but this doesn’t mean that it will remain down when the pandemic is over. The question is, will we return completely to the previous state, given the fundamental role of money in this equation, or will we come to a new “equilibrium” with a greater level of telehealth service provision that existed previously, but not so much as we see currently in this phase of hyper-investment?

If we make the assumption that we’ll still end up in a more “advanced” position, with more telehealth services being provided as a matter of routine than existed previously, this still raises some interesting questions for those of us who work in the digital health field.

Questions of the adequacy of workflow, and of the security of technology solutions used, still remain. As do questions around the long-term usability of technology solutions being used by clinicians in this new state.

Too much, too soon?

It's an unfortunate reality that there are consequences of flooding the healthcare market with a range of technology solutions in support of telehealth in such a short space of time. From compliance risks, increases in non-regulated AI devices, and security risks associated with medical-grade video conferencing, have not properly been assessed. I’m not alone in expressing this concern.

So where will this all leave us post COVID-19?

None of these options are particularly palatable, but I would argue that neither is expecting or pretending that none of the above-mentioned risks, which are a small subset of all the possible risks regarding telehealth, could not come to pass.

What needs to happen in order to give us a stable platform from which to continue to deliver safe and sustainable telehealth services is a dedicated period of evaluation, facilitated by government – and preferably funded by the government, too.

Such an evaluation needs to consider some of the technical issues outlined above, fundamental issues of clinician workflow and productivity, as well as the clinical safety implications of these wholesale changes we’ve seen. It’s only in the light of such an evaluation period that we can make informed decisions at a national level about “where to next?” for telehealth in Australia

These are very interesting times in the digital health field.