- Telehealth has been shown to improve patient outcomes and reduce healthcare costs.
- Remote healthcare delivery can also help slow the spread of COVID-19 and reduce pressure on medical staff.
- But its use must be tempered with a focus on data privacy and cybersecurity.
Crises are opportunities for innovation. Faced with insufficient hospital beds, medical equipment and personnel, normally slow-moving healthcare systems have improvised and innovated in response to the COVID-19 pandemic. Some have characterized recent developments as collapsing 10 years of healthcare innovation into two months - and nowhere has the rate of change been as dramatic as the area of telehealth.
For most people, telehealth means the substitution of in-person clinics with teleconsults - that is, the use of video conferencing to “see” a doctor - and it is one of the fastest-growing healthcare sectors. In developed countries like the US and Germany, hospitals and clinics now offer virtual clinic sessions to patients. In Asia, providers like China’s Ping-An Good Doctor and Indonesia’s AloDokter and Halodoc have reported huge increases in usage.
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Teleconsults are merely the tip of the telehealth iceberg. Other elements include the use of AI chatbots to screen for diseases, predictive analytics to stratify the risk of a population so that proactive care can be targeted at the right groups, remote monitoring in ICUs, general wards and homes so that patients can be continuously and remotely monitored, and the delivery of alerts, reminders and educational materials to patients.
Recognizing the urgent needs that telehealth can meet during this pandemic, governments have put aside their previous concerns about telehealth and temporarily loosened certain regulations. The US - which was among the first adopters of telehealth - received an early boost under President Barack Obama, when Obamacare imposed penalties on hospitals if patients were readmitted within 30 days of discharge. This incentivized hospitals to adopt remote monitoring in order to lower readmissions. In March, the US Government allowed patients to tap Medicare funding when they receive care via telehealth during the pandemic, leading to its widespread use. The US has also been a mature user of tele-ICU services, with an estimated 11% of American ICU beds under telemonitoring. The adoption of telehealth in the US may be one of the reasons why, despite the volume of infections and deaths, American hospitals have not been overwhelmed during this crisis.
In the Asia-Pacific region, Australia has been the most advanced user of telehealth, having used it for several years to manage chronic disease patients. During this pandemic, Australia expanded subsidies to cover the remote treatment of patients remote by video or telephone. It has even allowed clinical staff who have been exposed to the virus, and those under quarantine, to continue working by telehealth. The Singaporean, Indonesian and Philippine governments have followed suit. Singapore has used government funding to pay for teleconsults during this period. The Indonesian government is actively encouraging Indonesians to use telehealth platforms by publishing a list of providers on its COVID-19 website. In early April, in the face of COVID-19, the Philippines announced a framework for telemedicine.
The benefits of telehealth
The rapid expansion of telehealth is not surprising, given that there is already a large and established body of research into its benefits.
First, telehealth makes clinical staff more productive and effective. In the general wards, nurses have to regularly check patients’ vital signs. - and so by automating these checks, nurses are freed for other important tasks. In the home management of chronic diseases, patients take their vital sign measurements, such as blood pressure, at home, and the vital signs are automatically transmitted to a telehealth nurse. Nurses may be able to manage up to 200-300 patients at one time, because clinical alerts are pre-built into the software. By providing remote support, a seasoned clinician working in a central ICU-monitoring centre can provide critical bedside support to ICU staff in other locations, in order to augment their capabilities.
Second, telehealth improves clinical outcomes. However well-trained, medical staff may still miss significant trends in patient conditions because changes are too minute, or because staff are overburdened. Telehealth solutions embed care protocols so that deteriorations are detected earlier and clinicians can be alerted to intervene. Studies in the US prior to COVID-19 have shown that ICU patients under telemonitoring showed 26% reduction in death rate, 30% reduction in length of stay in the ICU, and were discharged home 15% faster.
Third, telehealth lowers the cost of healthcare by increasing accessibility, improving productivity and delivering better clinical outcomes, all of which benefit governments, insurers and individuals. A recent report by West Moreton Health System in Queensland Australia showed that since the start of their chronic disease programme in 2016, there has been a 28% decrease in preventable hospitalizations from chronic conditions, and a 53% reduction in emergency room visits by patients on the programme. Singapore’s Changi General Hospital piloted Asia’s first long-term Heart Failure Telehealth Programme, which showed a 42% lower cost of care compared with traditional follow-ups over the phone.
During this pandemic, the use of telehealth can slow transmission of the disease by keeping at-risk people out of waiting rooms and reducing their contact with healthcare facilities. It also enables patients who are not suffering from COVID-19 to continue to receive care. This is particularly important for elderly people, who are at the greatest risk during this pandemic. By improving staff productivity, it stretches the capacity of hospital staff so that more people can be treated. Telehealth protects clinicians by reducing physical contact with infected patients. Suspected cases and milder COVID-19 cases that do not need hospitalization can be remotely monitored, freeing up beds for serious cases.
As the pandemic rolls through vast and resource-poor regions where travel is difficult, telehealth can be a game-changer for care delivery. Indonesia and some countries in Africa have already benefited from such models. In Africa, companies like Philips have worked with UN agencies to use telehealth to deliver healthcare to less accessible communities.
After the pandemic: reassessing telehealth
Beyond the pandemic, governments, insurers and healthcare providers need to work together to ensure that the innovation sparked by this crisis endures and accelerates. Post-crisis, telehealth can still help alleviate the pressures posed by healthcare resource shortages, the growing elderly population and issues with healthcare accessibility. However, we need to take steps to ensure that the drawbacks and risks of telehealth can be mitigated. For example, we need to review government regulations to protect patient data privacy and ensure IT network security. Clinical protocols and workflows should be revisited to ensure that remote care is used only for suitable conditions, and that the doctor-patient relationship is not compromised. Proper training needs to be provided for clinical staff as they change their way of working. Very importantly, we need to ensure that our medical insurance systems offer the right incentives to use telehealth. Let us not squander the opportunity offered by this pandemic to do things better.