They say adversity is often the catalyst for change and for the Australian healthcare sector, COVID-19 has been no exception. Faced with the awkward objective of treating more patients with fewer resources, the sector has embraced innovation quickly; upholding – even surpassing – usual rates of service provision.
Telehealth has been pivotal in this response, far exceeding the scope, reach, and end-user value authorities had fathomed. Patients across all age groups have welcomed the tech, as readily as it was welcomed onto the MBS Rebate Schedule.
In April 2020, as the COVID-19 outbreak took hold, more than 4.3 million services had been delivered to upwards of three million patients via telehealth. This has since grown to around 50 million consultations, nationwide.
As authorities debate the role and ubiquity of telehealth as a permanent fixture of the healthcare landscape, we spoke with Dr. Rahul Gupta, Clinical Lead at the NMHEC-RAP Telepsychiatry Service and Conjoint Lecturer at the University of Newcastle.
Ahead of the National Telehealth Conference, he shared his expert perspective on the challenges and opportunities a longer term rollout of the technology might bring.
Accelerating virtual care
For many patients and clinicians, telehealth has served as the prototypical virtual care technology. Post-COVID, it may open the gateway to the broader paradigm of virtual care – comprised of apps, RPM (remote patient monitoring) technologies, EHR (electronic health record) and virtual hospitals, amongst others. Dr. Gupta believes the health and technology sectors are now primed for this shift.
“The uptake of Telehealth has set a precedent. We have learned that change we expected to play out over five to ten years can in fact happen almost overnight,” he said.
“[Previously], much of the hesitation towards virtual care was grounded in concerns about privacy and efficacy, along with general technophobia. Telehealth has accelerated people’s acceptance of health-tech in general and, as a sector, we should build on that.
“As public attitudes, policy, and funding models sway in the right direction, now is the time to act and lay the foundations for a consumer-centric future of health,” he added.
Bridging this divide, vendors will need to channel efforts on integrating telehealth with the EHR, along with other virtual care enablers, Dr. Gupta highlights.
“Interoperability will be paramount to the success of a virtual care system,” he said. “Some standards already exist, but ideally we need telehealth systems to communicate with all RPM technologies, and for this to feed back to the EHR.
“When we have a fully conversant network of apps and tools that speak to one another, fully-fledged virtual hospitals will begin to feel like a more mainstream option.”
With this shift, though, an increased focus on privacy and security will be essential throughout the virtual care continuum – from patients, clinicians and any user that handles clinical information, Dr. Gupta added.
“These technologies – many of which are used in the home by non-tech-savvy users – will be capturing the most intimate of data. As we up our digital presence, we will need to protect patients in the best way we can.”
Likewise, misconceptions about data breaches may also need to be addressed, he said.
Advent of Telepsychiatry
Another vertical that lends itself to the telehealth medium is psychiatry, Dr. Gupta highlights, and policy makers should consider how to capitalise on this match.
“The promise of psychiatric services in remote areas, through the use of telepsychiatry, has made it one of the important components of telemedicine services. Some early psychiatric services in NSW for rural and remote outreach were commenced as early as 2005,” he said.
“Thankfully, mental health is quite suited for telehealth. You don’t need to physically examine the patient, for example.
“That said, to make this a sustainable feature of the healthcare system, the technology has to be fit for purpose.”
For this, health leaders will need to consider what is appropriate and what is not.
“Like any therapeutic modality, the suitability and appropriateness of telehealth needs to be determined according to the clinical context and preferences of the patient and clinician,” he said.
“For example, it may not be suitable to carry out an initial assessment via video link, where the client is not cooperative or the audio/video is sub-optimal (particularly if there is a lag, echo or poor lighting), as practitioners could miss out on vital cues and micro-expressions that reveal important aspects of a person’s condition. On the other hand, a follow-up review of a known patient may be quite suitable by telehealth.
“Going forward, I would like to see the health care system refined – including virtual care as a routine component of business as usual – in consultation with the end users, clinicians and patients, who are best-placed to make recommendations on how the tech should look and work. Patient safety, governance and data on monitoring and evaluation should be built in any virtual care initiative.
“Just as we talk about COVID-19 as once in a lifetime pandemic, this is a once in a lifetime opportunity to drive major changes and reform in delivery of health care,” he concluded.
Dr. Rahul Gupta is Clinical Lead at the NMHEC-RAP Telepsychiatry Service, Hunter New England Local Health District and a Conjoint Lecturer at the University of Newcastle. He also has certification in Health Informatics.
Join him for an insightful discussion at the National Telehealth Conference, due to take place 20-21 April 2021. This year’s event will be held virtually and at the Swissotel Sydney.