My View - Telehealth is not the point

VIEW - Ruth Large, Fellow of HiNZ and chair of the NZ Telehealth Forum

New Zealand’s next leap in digital health is about models of care, not technology  

For more than two decades, New Zealand has been experimenting with telehealth - Plunketline, Healthline, telepaediatrics, regional stroke services - none of this is new.

We did not begin the Covid19 pandemic as a digitally naive system, even if at times it felt that way. 

And yet, despite this long history, we are still prone to having the same conversation - does telehealth work? 

That question is now largely the wrong one. The more useful, and more uncomfortable question is this: what happens when we try to use telehealth without changing how care is organised?  

Telehealth does not clone people 

One of the most persistent myths in digital health is that technology, by itself, creates capacity. That a video consultation somehow bends the laws of workforce physics when it does not. 

Traditional hospital care is constrained by two things, clinician time and physical infrastructure. Telehealth as straight substitution - a clinician on a screen instead of in a room - changes the location of care, but not the constraint. One clinician still delivers care to one patient at a time. 

This is why many clinicians emerged from Covid feeling bruised rather than liberated. Telehealth was layered onto already stretched workflows, often without administrative support, redesigned triage, or clear escalation pathways. The benefits accrued largely to patients - less travel, less waiting - while the cognitive and operational burden landed squarely on staff. 

Technology enabled continuity, but did not transform the system. 

When capacity does appear 

Capacity gains begin to appear only when telehealth is paired with new models of care; deliberate triage, delegation and role redesign, team based escalation,  protocolised pathways and clarity about who is responsible for what, and when. 

In other words, telehealth becomes a force multiplier only when it is coupled with service redesign. 

This distinction matters, because it shifts the conversation away from platforms and towards clinical governance, workforce design, and flow. It also helps explain why some virtual services scale safely and others simply create more work. 

Enter the virtual hospital 

Internationally, there is increasing clarity about what a Virtual Hospital actually means and it is not a collection of video clinics. 

The literature describes virtual hospitals as centralised, multidisciplinary hubs delivering continuous, hospital level care remotely. They are designed for defined populations - particularly people with chronic disease, frailty, or high risk of admission - and they operate proactively, not episodically. 

Telehealth is part of the toolkit, but it is not the organising principle. This framing aligns closely with the consensus reached at New Zealand’s Virtual Hospital Symposium in early 2026, where clinicians, system leaders, and digital health experts converged on a pragmatic view: 

“A virtual hospital is not a building, not an app, and not a bolt on service, it is a hybrid model of care, intentionally integrating virtual and in person services under clear clinical governance.” 

Notably, the symposium placed equity, workforce sustainability, and interoperability at the centre of design, rather than assuming these would emerge later as ‘benefits’. 

Hospital in the Home and the discipline of definition 

Hospital in the Home (HiTH) is often cited as evidence that virtual models “work”. The evidence does support this, but only when HiTH genuinely substitutes for a hospital bed. 

When HiTH is tightly defined, clinically governed by hospital services, and resourced appropriately, outcomes are comparable or better for selected patients, with reduced bed days and pressure on acute services. 

When definitions loosen, and HiTH becomes a relabelled community service or a monitoring overlay, both evidence and credibility erode. 

This definitional discipline is not pedantry, it is what protects clinicians from being asked to deliver hospital-level responsibility without hospital-level support. 

Remote Patient Monitoring

Remote Patient Monitoring (RPM) does not treat patients: it does not replace clinical judgement and on its own, it does not reliably reduce admissions or costs. 

The literature, and lived experience, suggest a blunt truth: RPM amplifies the quality of the system it sits in. In a well-designed pathway, it supports early intervention and confidence. In a fragmented one, it generates alerts, workload, and frustration. 

RPM works best when treated as infrastructure, embedded in Virtual Hospital or HiTH pathways with defined thresholds, escalation authority, and workforce capacity to respond. Otherwise, it risks becoming very expensive reassurance. 

Is virtual care the panacea? 

No, and it never was, but governed well, virtual care enables something genuinely important: care without walls. This is care that is not constrained by geography, buildings, or historical service silos. 

Achieving this is not primarily a technological challenge. It is definitional, organisational, cultural and clinical. 

Which is why this conversation belongs not just in IT forums, but in Clinical Senates, governance rooms, and workforce planning discussions. 

If telehealth were a pill, we would not prescribe it indiscriminately. We would ask about indication, dose, combination, and monitoring. Digital health deserves the same clinical discipline. 

The next leap for New Zealand will not come from better platforms alone. It will come from clarity about models of care, and the courage to redesign them.  

Author note: 
This piece draws directly on insights presented to the New Zealand Clinical Senate and discussions from the Virtual Hospital Symposium, reflecting both international evidence and New Zealand clinical consensus. 

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