COVID-19 an opportunity for collaborative approaches to digital technology

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eHealthNews.nz editor Rebecca McBeth

COVID-19 was first encountered in Wuhan, China, in December 2019 and has since swept around the world, with cases reported in more than 100 countries. Experts say data and digital solutions will be key to New Zealand’s response in the case of a widespread outbreak here.

Health systems globally are planning for a pandemic as cases of COVID-19 continue to rise.

According to one of a number of online tracking sites, as of March 11 there were more than 118,000 confirmed cases and 4,262 recorded deaths.

In New Zealand, the number of confirmed cases remains at five, but more than 2,000 people or households are currently registered as in self-isolation.

Clinicians spoken to by eHealthNews.nz say the rapid deployment of data and digital solutions will be key to the health system’s response if there is a wider outbreak in New Zealand.

Systems can be developed to remotely track and monitor patients, and video conferencing technologies can enable health professionals to provide care and advice without having to see patients face to face.

Shayne Hunter, Ministry of Health deputy director-general, data and digital says that while data and digital services have a place in delivering good healthcare, the Ministry is mindful  that technology solutions need to have a tangible benefit to the health system, the population and the patient.

"There are risks and benefits with making rushed decisions to introduce new technology, especially when the situation continues to evolve," he says.

"We are continuing to work with DHBs, primary care and other jurisdictions to understand their needs and learn from their experiences."

International response

Virtual approaches to care are being adopted worldwide to reduce the risk of someone infected with COVID-19 turning up at a health provider and to ensure healthcare workers have time to deal with the extra workload created by the virus.

The NHS advises anyone who thinks they have symptoms or who might have been exposed to the virus while travelling to use an online symptom checker to help determine what they should do next.

NHS England has also advised its 7,000 general practices to start conducting as many remote consultations as soon as possible, replacing patient visits with phone, video, online or text contact.

In the United States, agencies like the Centers for Disease Control and Prevention are encouraging people who feel sick to first talk to doctors remotely, by video or phone, to avoid filling waiting rooms.

And a new funding bill gives the Health and Human Services Secretary the power to suspend rules that restrict access to telehealth for people on Medicare.

Virtual care

Chair of New Zealand’s National Telehealth Leadership Group Ruth Large says telehealth is an obvious choice for a health system coping with a widespread outbreak of the novel coronavirus.

She says those at high risk – the elderly with pre-existing conditions – are great candidates for video consultations as they are already well known to the health system, either in primary care or in a hospital setting, and therefore do not necessarily need physical examinations.

However, she is not confident that New Zealand’s district health boards have the technology and systems in place to allow rapid uptake of telehealth if necessary.

“This is a really good opportunity to think about more collaborative approaches,” she says.

“We have some great telehealth pilots and a few examples where services have become business as usual, but there’s still quite a lot of isolated or sporadic use of telehealth.

“The impression I have is that we are on the cusp and this is a good opportunity to think about how we can ramp up that service.”

Large says health staff who are thinking about these issues should first consider how they could support colleagues to self-isolate if necessary.

“Do you have the technology and the tools to work offsite and is there a part of your practice that you could do easily remotely?” she asks.

“What systems have you got in place that you can leverage on and is there a time you can set aside to provide video consultations for patients who want to avoid coming in?”

Primary care

Island Bay Medical Centre GP Richard Medlicott believes the COVID-19 outbreak could be an opportunity to take a step forward in virtual care delivery, if it means patients and clinicians become accustomed to using and paying for telehealth consultations in the same way they do other consultations.

His practice has offered video appointments via patient portal ManageMyHealth for some time without very high uptake from patients, but he expects demand to increase if COVID-19 spreads widely in New Zealand.

Medlicott charges the same for a telehealth consultation as he does for a face-to-face appointment and patients can select either option when they book online.

“I don’t think funding is an issue so there are no major barriers to rapid uptake of telehealth and virtual care,” he tells eHealthNews.nz.

Patients having the ability to do other things online such as book appointments and request repeat prescriptions can also help to avoid face-to-face contact.

Two-thirds of practices in New Zealand now offer a patient portal.

Royal NZ College of GPs president Samantha Murton says many portals include the technology to offer telehealth consultations, so the majority of general practices could start offering them reasonably quickly, if required.

However the latest Ministry of Health data shows only 29 practices are using video conference for consultations.

“It’s the payment methodology around virtual care which all of us, doctors and patients, need to get our heads around,” Murton says.

ManageMyHealth chief architect Sanjeewa Samaraweera says there has been increased interest in video consultations and many health centres have started to enable the MMH capability. 

He says this not only allows patients to have a consultation without visiting a health centre, but can enable staff who are self-isolated, but fit to work, continue to see patients.

Industry response

MMH is also introducing a pre-screening tool on the patient portal where everyone is asked four questions before being alloted to book online or via mobile apps.

Samaraweera says that depending on their answers, some patients are allowed to book an appointment, while others are given health advice or directed to the coronavirus Healthline number.

Other Kiwi health IT companies are also responding the evolving situation.

Orion Health has developed a ‘comprehensive pandemic outbreak monitoring platform’,

which "includes the ability to remotely monitor and engage patients in their homes, facilitating communication between quarantined people and the healthcare service, as well as maintaining visibility of those recently discharged,” an Orion statement says. 

“Over time the solution will increasingly use artificial intelligence to allow providers to identify patients at risk of deterioration and optimise their care. This will allow resources to be allocated to those most in need.”

Secure messaging app Celo has developed a new tool called Celo Broadcast, which allows organisations to send targeted, and closed loop communication to their staff for critical updates. 

NZ Health IT chief executive Scott Arrol says, "NZHIT's members have a number of digital solutions already in use, such as HealthPoint for access to web-based information and Vensa has solutions for mass text messaging that are already in use and have ramped up capacity to assist with the current situation".

He says there are many other companies that provide video-conferencing, telemonitoring and other services with the ability to step in to assist the health sector now and in the future.

Consistent messaging

In February, the Ministry of Health set up a dedicated freephone Healthline 0800 358 5453 for people concerned about COVID-19.

Healthline is now dealing with around 5000 calls a day.

The National Telehealth Service, which runs Healthline, has already trained more than 80 additional non-clinical staff and has a further 60 recruited/credentialed and ready to start training next week. It has brought in additional nurses and is boosting its clinical capacity further in the next few days.

The Health Navigator website is also working to collate online COVID-9 information to provide a single, reliable source for whānau and community members.

There are other websites providing COVID-19 information, but not all use plain language to convey their messages and many are from overseas, according to Health Navigator communications director Susie Hill.

“Health Navigator focuses on best practice information, which is reviewed by local subject matter experts. It collaborates closely with others in the health sector who also want to the public to be able to access consistent reliable health messages and to reduce the cost of duplicating efforts.

“For example, Health Navigator is currently working with Healthline’s public health experts to explore a series of COVID-19 videos covering topics such as what is self-isolation, how to reduce your risk of contracting and spreading COVID-19 and reminders to call ahead of any GP visit if you think you may be infected.”

The idea is for videos to be shared via social media and with health organisations that wish to use them, Hill says.

If you would like to provide feedback on the above feature article, please contact the editor Rebecca McBeth.

Read more features:

CiLN: A passion for using technology to transform healthcare

Partnership approach makes Hawkes Bay DHB Clinical Portal a success

For more information and resources about COVID-19 go to https://www.hinz.org.nz/page/covid19

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