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Bridging the digital divide

Monday, 13 April 2020  
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Return to home page editor Rebecca McBeth


The New Zealand health sector’s rapid adoption of virtual care in response to the Covid-19 pandemic risks exacerbating inequalities in the health system. Ensuring the vulnerable are not left behind has been identified as a key piece of work moving forward. 


The arrival of Covid-19 on New Zealand’s shores has seen an unprecedented shift in how healthcare is delivered.


Within just a few short weeks, the country’s general practices started conducting all initial contacts with patients virtually and hospitals are expanding their use of telehealth consultations for outpatient appointments.


Other services such as mental and sexual health have also moved almost entirely online and people are relying more than ever on access to the internet to keep up-to-date with the latest health information and advice.


The digital divide


This shift to digital ways of delivering care has the potential to create an even greater digital divide between those who have reliable access to information and communication technology and those who do not.


Royal NZ College of GPs president Samantha Murton says, “it’s critically important that we don’t leave anyone behind as far as healthcare goes, especially those who may not have steady mobile plans or a home phone.


“There are vulnerable populations in the normal health system and when there’s change, there is the potential that this vulnerability will be exacerbated.”


A Ministry of Health spokesperson says it is aware of the potential for digital solutions to impact New Zealand’s most vulnerable communities.


“Digital solutions typically supplement in person services rather than replace them, however at this time a digital approach is necessary for many health services,” the spokesperson says.


The Ministry is working with the National Telehealth Leadership Group to ensure that digital services are available to as many people as possible, especially Māori and vulnerable communities.


“While there will still be those who cannot access digital services, the use of digital services has the potential to increase the capacity available to provide in-person services for those who need them,” the spokesperson says.


Helping the vulnerable


The MoH says that during COVID-19, most consultations will happen over the phone, videoconference or using another digital solution to help prevent any risk of the disease spreading through person-to-person contact.


The government has pledged $20 million to support primary and community care providers to adopt telehealth during this time.


National Telehealth Leadership Group chair Ruth Large says this is really great, “but now we need to move our focus very clearly to the vulnerable.


“History tells us those are the people who are always left behind in a crisis and the only way to overcome that is to target them.”


Vulnerable patients will need to be kept away from hospitals and other health providers for an extended amount of time as “Covid-19 isn’t going to disappear”, so these issues need to be tackled with urgency, she explains.


The NTLG has recommended the Ministry introduce a ‘technology prescription’, which would allow health professionals to ‘prescribe’ a technology package to patients who do not have access to a device and data.


Large expects each prescription to cost around $400 and include a reliable android device with a data plan.


The MoH tells it is investigating how to provide internet access, devices and support for those who need it most.


Murton says most general practices are using telephone calls to contact people and are calling people themselves, so the cost does not rest with the patient.


Some are also using text messages to contact patients, “but getting that up to high volumes without costing enormous amounts of money is tricky,” she says.


Others are holding video conferences with their patients, but these use a lot of data and that is why it is crucial that in-person appointments remain available, she says.


Sponsored data


According to 2018 census data, 211,000 homes around New Zealand still did not have access to broadband.


An issue exacerbating this unequal access is that many places which previously provided free Wi-Fi, such as libraries and cafes, are now closed due to the Alert level 4 lockdown.


One way of tackling this problem is by making some health-related websites and platforms free for patients to visit and use. The official Covid-19 government website has already been made data-free.


Murton says the RNZCGPs has had a number of conversations with the Ministry’s Data and Digital team about this.


“We’re talking about making some portals free and Health Navigator and maybe some video consultation platforms,” she says.


“It’s about identifying the more widely spread and well used portals or information platforms or video platforms that would cover a large proportion of the population.”


The Ministry says it will be offering consumer digital services with sponsored data, where technically possible, so that the cost of data is not a barrier for people.


It is also looking at how to increase wireless connectivity in remote communities.


The idea of zero-rated data for health websites and patient portals is not new. reported last year that three telecommunications companies – Spark, Vodafone and 2degrees – were involved in the proof of concept to provide zero-rated data for three websites run by the Health Promotion Agency and two patient portals used in the southern region.


Since the Covid-19 outbreak began, the major broadband providers have removed data caps on all residential, small and medium business plans until the end of June.


Spark has also relaunched its subsidised and not-for-profit broadband product Skinny Jump – which aims to bridge the digital divide for New Zealanders who do not have access to broadband at home.


Turning the tables


Large says the health system has traditionally relied on patients investing a lot of their own time in order to attend in-person appointments.


In extreme cases this can involve travelling hours to a hospital, finding a park, navigating to a clinic then waiting for a 15 min appointment before heading home again.


She says the switch to virtual health turns this expectation on its head. It means more time has to be invested by the health provider to ensure both health professionals and patients have the necessary training and hardware to make the appointments successful.


Patients would also have to invest some time to make themselves familiar with the technology and ensure they have the basics, such as an email address.


“There are a lot of things some people have never had to think about before, but the rest of us take for granted,” explains Large.


There can be assumptions that the poor or elderly cannot use technology to access care, but Waikato’s experience with Smart Health revealed that was not the case.


Large says everyone can benefit from virtual care, but some people may need the tools to be provided or some extra support to use the tools they have.


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


Read more features:

PHO goes digital ‘on steroids’
COVID-19 an opportunity for collaborative approaches to digital technology


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