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Virtual Healthcare – it’s real healthcare delivered differently

Tuesday, 8 May 2018   (0 Comments)
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NZHIT guest column by John Ashley, Selwyn Foundation’s chief operating officer – community


NZHIT Virtual Health industry group chair John Ashley explores the barriers to telehealth nirvana – where using virtual healthcare is so common it seems mundane.


Being able to access health information and advice from anywhere at any time – and providing health professionals with the ability to see and talk to their patient across distance to save the hassle and disruption that traditional clinic appointments bring – sounds like a no-brainer. So why is this the exception rather than the norm?


Virtual healthcare (encompassing terms like telehealthcare, telemonitoring, telemedicine, smart sensors, remote patient monitoring and virtual consultations) is nothing new. The technology to support these models of care has been commercially available since the eighties, and now most people carry a mobile phone that can fulfil the function of a telehealth device around with them all day, every day.


“Delivering health care at a distance is a practical and moral imperative in a world where underserved populations are the rule rather than the exception” (Rada, 2015).


However, there seem to be real barriers to adoption of these technologies to save clinicians, patients and their families, health systems and funders time and money. So, what’s holding us all back? Inertia. It takes more energy to get a large object moving than to keep it moving. The health system appears to be locked into a kind of stasis that supports doing nothing. At best, we seem able to kick off small (and sometimes not-so-small) pilots to trial remote health technology in one region or another. These efforts bear fruit, but then wither and die.


What’s in the way?

Is this due to a lack of funding? A lack of imagination? A lack of effort on the part of the participants? Maybe a lack of a guidebook and way-finding signposts to help us on the telehealth journey? Is it apathy? How can an overwrought health system take time to look away from the tasks immediately in front of it and learn new skills and techniques, or embed new procedures into common practice?


Are we funding the providers of care in the right way that recognises working smarter? If a GP or specialist is penalised for working quickly through their patient lists – dealing with the straightforward cases that don’t require an in-person face-to-face meeting over a phone call, video link or some other electronic communication – will they ever be keen to adopt new ways of working? Funding approaches need to “enable and incentivise cost-effective innovations”.


Are patients and their whānau equipped with the prerequisites to enable a two-way conversation over a video link with their care team? If not, what’s holding them back? Can we fix that by providing an affordable communication device and internet connection? Telehealth provides real hope for reducing inequities in access to healthcare by allowing people from remote areas to beam straight into a doctor’s office.


Is the problem at the other end of the link? Do doctors, nurses and allied health teams have access to devices that enable a call to be placed or received? Health seems to be lagging behind other industries in this area, and often the lack of use of technology in communicating with users of healthcare is put down to fears around patient privacy and consent, or data security.


There appears to be a tendency within health to lock systems and information down to the point at which they become so impenetrable as to be useless. I’d be happy to bet that if you asked the average person on the street if they’d be willing to trade the (relatively small) risk of someone getting hold of their health information in exchange for not having to give up half a day to attend a clinic, they’d leap at the offer (of course the importance of security should never be down-played).


Interoperability an issue

Are we being constrained by a lack of agreement on which standards and platforms to adopt? Are providers locked in to one or other proprietary platform that doesn’t ‘talk’ to the solution that another user uses? How can we stop that happening in future? Work is underway on the adoption of interoperability standards in health, and this needs to continue and expand to virtual health technologies.


There are a host of reasons why we are not much further along the telehealth journey than we were a decade ago. However, there are some encouraging telehealth programmes emerging, like Southern DHB and WellSouth’s use of telehealth as part of an integrated Health Care Home approach, and the iMOKO app being used to deliver better access to health services for children (especially in impoverished regions). iMOKO allows trained health deputies – such as helpers based within schools – to carry out throat swabs and capture images of skin infections to share with a remote GP.


Researchers have recently suggested that “while the technology can provide benefits, it is the context in which the technology is implemented and skill with which the implementation is conducted that realises the benefits” (Freed et al., 2018). A group of health industry partners, represented by NZHIT, are very keen to work with other organisations and individuals to break down these barriers to virtual healthcare, and to speed up the journey toward telehealth nirvana – a place where the use of technology to aid a meaningful discussion about our individual health and wellbeing seems mundane and trivial. When we get this sorted, virtual healthcare will just be healthcare.


If you’d like to join with us in this journey, please get in touch.


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