Switch to telehealth unsustained

eHealthNews.nz: Digital Patient

Tuesday, 27 April 2021

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NEWS - eHealthNews.nz editor Rebecca McBeth

The mass shift to telehealth during Covid-19 has not been sustained and leadership needs to be bold in tackling the digital divide to improve healthcare in New Zealand, a new report says.

The Ministry of Health is funding several streams of digital enablement work to increase the use of telehealth and teleworking and improve digital inclusion, overseen by the Digital Enablement Oversight Group (DEOG).

It has published a gap analysis of its Digital Enablement programme, to discover why the switch to digital during the pandemic has not been sustained and where to target funding to make the biggest difference in the future.

It says primary, community and rural health providers have struggled to sustain digital delivery in part because of “the difficulty in sustaining any significant change in an inherently unsustainable business model”.

Most providers only switched to delivering digital care during the pandemic because it was mandatory and have now switched back, with some claiming that “patients hate digital delivery”.

“Many clinical leaders and managers suspect that the real reasons behind switching back are the difficulties of sustaining a mixed model of in-person and digital, selecting each appropriately with minimal financial, managerial or administrative support and no supportive or technological framework,” it says.

DHBs have also struggled to sustain the shift, likely because the initial change was not done in a way that embedded it into routine practice.

Clinicians and mangers reported that funding models do not incentivise or reward telehealth and delivering it incurs costs for things like hardware and licencing. Financially, it can make sense to deliver care digitally, but it is more complex to bill people.

However, the largest primary care providers have enhanced their digital offerings, providing a “digital front door” for patients anywhere in the country to access their digital services.

Some respondents worry that this model will serve only those patients who have the money and digital literacy to interact, therefore widening the digital divide and fragmenting care.

The report recommends that the programme’s oversight group, which brings together key MoH directorates, healthcare providers, influential agencies and patient representation, should “lead, champion and support much more consistent progress across New Zealand”.

The oversight group should focus on digitally enabling vulnerable, disabled and rural populations, to ensure people have the data, devices and literacy to engage with digitally enabled health services.

It should also ensure that successful local projects are taken up across New Zealand.

The report says the DEOG needs to publish a roadmap showing which improvements it will progress and why, as well as a framework which covers enablers and clinical systems. It should then track and report progress.

It says that small amounts of innovation funding are unlikely to deliver system wide change unless those changes are both potentially scalable and coordinated carefully to actually scale up and more organisational support is needed.

“If co-ordinated well, through a framework-based roadmap, digital enablement can make significant improvements to efficiency, patient experience, access and ultimately to equity and patient empowerment,” the report says.