Why telehealth technology is the key to advancing Australian health care
We must learn from the pandemic and use it as a guide for new healthcare models — one that includes greater implementation of technology for remote consultations with a fully functioning reimbursement system.
Right now, we differentiate healthcare services based on primary, secondary and tertiary care. The future will see more integrated models and a differentiation of service delivery means through hybrid digital and in-person models.
This hybrid or blended service model that includes digital as well as in-person consultations has seen a lot of uptake during the COVID-19 crisis. The immediate goal was to reduce the risk of transmitting the virus to staff and patients, particularly where busy hospitals were already understaffed. Online consultations enabled patients who were attending in-person appointments, rehabilitation programs or requiring isolation to receive care through outpatient programs. Clinically appropriate doctors could monitor their recovery without contact, thereby reducing transmission risks. Additionally, telehealth allowed clinicians who were isolating to continue providing care to their patients.
We are starting to address the backlog of elective surgeries that were put on hold during the first wave of the pandemic, and in Victoria. The waiting list for elective surgeries is up between 20 and 60% over last year. Compared to the previous year, many hospitals are operating at 115%. But it’s only possible to push the frequency of surgeries until all the hospital beds are filled.
And this is where the next opportunity for telehealth opens up.
Many patients having elective surgeries are kept in hospital for several days, sometimes weeks. It has been shown that Australian patients tend to stay in hospitals longer than in other countries. For example, the current length of stay for elective hip replacements in Australia is about four to five days while in Europe and the United States, hip replacements have been completed on a same-day basis for selected patients for a decade, with comparable outcomes.
Moving patients from in-patient care to out-patient care in a shorter time is a huge opportunity for increased throughput in our hospitals. In addition, COVID has shown us that we can deliver out-patient care safely via video telehealth with comparable outcomes. This is an opportunity for private and public hospitals to catch up with waiting lists and enable safer care for patients, away from infectious hospital wards.
Hospitals in the future will look very different in the way they provide and support care — fewer beds, but with more services supporting hospital-in-the-home care — more of a hub-type model.
Why not extend the excellent care that a patient is receiving during their hospital stay into the home? Nurses can continue to check in frequently to ascertain vital signs. Physiotherapists can check in to provide patients with supervised exercises. Dietitians can check in to do meal planning with patients and their family. Hospitals are particularly well set up for team care — there is immense power in extending this into the patient’s home.
And while we’re at it, we can do this in a preventative manner as well. Many studies have shown that patients who prepare for surgery with ‘prehabilitation’ are less likely to encounter complications during surgery and are more likely to achieve better outcomes and faster recovery. Prehabilitation is a strategy that uses exercise and dietetics to improve patients’ functional capacity before surgery. Patients in better health will stay in hospital for a shorter time.
Prehabilitation needs a team care approach as well. Hospitals are particularly well set up to provide that team care approach. With technology, prehabilitation can also be provided via telehealth.
The mass rollout of quality telehealth resources is readily available to any consumer and professional with a standard internet connection. We are at a turning point where internet technology, consumer devices, reimbursements and human behaviour are all coming together to allow a fundamental change to take place in health care. COVID has demonstrated that it is possible.
So where to from here?
It is essential that Australia’s healthcare system moves to support and utilise higher fidelity remote consultations and that clinicians have access to the best possible technology to manage this. Here I’m talking about technology that supports more advanced telehealth consults, ie, combining audio and video, not just a simple phone call.
Phone calls are of limited use when delivering rehabilitation services such as physiotherapy, occupational therapy, dietetics, speech pathology, wound care or midwife consultations. In all these consultations, the practitioner has to see the patient and their behaviour. Patients need to be able to show the clinician their progress and ask questions about their body parts. As a picture is worth 1000 words — a video is worth 100,000 words!
Video telehealth is still in its infancy in Australia, with less than 5% of all telehealth consultations delivered by video. Its potential is, however, enormous in freeing up beds in hospitals, getting patients home earlier to their loved ones where they recover faster, and all this without reducing the high-quality care that they receive in hospitals.
There is an opportunity for hospitals to expand the quality of their service from hospital-only services to the patient’s home. This extends to pre-admission prehabilitation and post-discharge rehabilitation services. Hospitals can allow for more surgeries and thus shorter waiting lists.
It’s a win for everyone: the hospital helps more patients over a longer period; the providers witness the whole patient story and retain continuity of care; the patient spends less time in hospital and learns to become independent faster; and the insurance pays for more cost-effective healthcare services rather than for beds and hospital food. Research has proven that such continuity of care reduces the risk of readmission, thus overall helping our healthcare system.
Example model of care:
- Prehabilitation for two weeks.
- Hospital admission, surgery, post-surgery treatment, hospital discharge for two days.
- Home care by providers for 1–2 days.
- Telehealth for 10 weeks.
It is crucial that we adopt and maintain a system that makes full use of leading technology in order to be safer and more efficient. Our approach to telehealth must extend beyond simple phone calls — and sometimes even video calls alone will not be sufficient. Sometimes a physiotherapist just needs to measure the range of motion of a patient, or a speech therapist needs to make a language assessment. Australian company Coviu has been effective in taking video telehealth to the next level by offering providers with digital functionality that replaces the tools available for in-person consultations.
Since its inception, Coviu has been built to host clinical tools that mimic the in-person experience. Coviu has already built and integrated a number of these tools, including WISC-V (for clinical assessments), PhysioROM (measures the range of motion in a physiotherapy scenario) and ResApp (for respiratory diagnostic testing). A key priority for the Coviu business is to continue working with the industry to digitalise clinical tools.
Critically, our healthcare system needs to implement better training programs for practitioners to identify how to convert their clinical practice for the digital age, and how to best make use of the tools required to form the future of healthcare. We need a set of processes and workflows for clinicians that involve a telehealth consultation as a first point of call, rather than an in-person appointment. These can be used for clinically appropriate non-emergency cases. We need training for providers to help upskill our nation’s healthcare workforce in this area and we need a better-informed public to understand that these services are available and lead to comparable health outcomes.
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