What can we learn from the Telehealth move?

I am writing this in the midst of the COVID19 Pandemic that has shocked the world and is one of the biggest tests for our health systems in recent times (1). This moment in time has forced many sectors to rapidly innovate to maintain cash flow and the musculoskeletal pain management community is one of them. A vast ‘re-tooling’ must take place during COVID19; all unnecessary health and medical professionals are forced to move to telehealth. This will be uncomfortable for some but, as I explain through this blog, it may ultimately force innovation in important and necessary areas entirely unrelated to an increased use of technology. There may be some significant silver linings to all of this.

A New Hope

Telehealth was once seen as the great new hope amongst rapidly changing times, it just never really panned out that way. Telehealth is defined as, ‘use of telecommunication techniques for the purpose of providing telemedicine, medical education, and health education over a distance’. This catch all term encompasses not just all innovations for delivering healthcare but also what is delivered. Although telehealth is not new, health systems and policy makers became focused on this as the world around us changed. Australia’s National eHealth Strategy was completed in 2008, in the midst of a paradigm shift in technology. Google, Facebook, YouTube and of course, smartphones had all exploded onto the scene from the late 90s to early 2000s and the world was alight with excitement about the future. Health systems were swept up in this excitement and a telehealth revolution was born. It just hasn’t revolutionised healthcare.

It works, just the same

The problems with slow uptake of telehealth isn’t due to a lack of effectiveness. There is ample evidence that telehealth is effective for multiple chronic health conditions (2, 3, 4, 5). For musculoskeletal conditions, it is clear telehealth is as effective as standard care (6). Telehealth does seem to improve access to healthcare, especially in rural and remote areas (7). And although there are still some concerns from patients about confidentiality in specific situations, patients enjoy telehealth and feel well supported (8, 9). Assessments online are just as good as assessments in-person (10). And telehealth is certainly cost-effective for health systems (11). While some brave souls are indeed changing with the evidence, there is still an ongoing issue with actually getting health professionals to do it en masse (12, 13).

The demand is there

Life is increasingly online for our patients and where people go for health advice is changing. An interesting narrative review – here – looking at health delivery across low and middle income countries reported, “the majority of multiway and social media projects identified in this review were patient/user driven, such as Facebook or Twitter, with little or no involvement of treating physicians or nurses.” The context of care is changing and we not only have to accept it, we have to move with it.

The tension

Many problems with the implementation of telehealth seem to be problems experienced by clinicians and systems.

• Systemic support: Health systems are complex and telehealth interventions have to penetrate multiple levels of complexity before becoming ‘standard care’. There has been no support from government or private health insurers in providing specific billing codes for telehealth consultations (14, 15). That is, however, until COVID19 happened (16, 17).
• Clinicians have to unlearn behaviours: Even though many studies report clinician’s experience of telehealth is positive, a top cited reason for the lack of adoption of telehealth is technologically challenged staff (18, 19).

Clinicians also have to learn new ways of doing business, which can mean a wholesale change of business models; but pivoting is nothing new and now, it seems, it’s necessary (20).

Technological innovation outstrips anything the health system can achieve and of course we can forgive a few treatment providers feeling slightly behind the curve. But the inertia in telehealth adoption may point to a more serious underlying problem.

Learning from the technology sector

We can’t copy what the technology sector does, but we can learn from them. Technology giants like Google and Facebook know a little bit about innovation and they don’t get there by copying what everyone else does. They also ask their customers about what they want – a lot. Remaining conservative in healthcare is important to avoid losing oneself with each and every passing trend. Has healthcare tried to keep up with the technology sector, rather than learn from it; has healthcare been innovating in the wrong ways?

Diamonds are made under pressure

Clinicians are being forced to move to telehealth during COVID19, but there are some different innovations to be made during this trying time. And like the technology sector, we can start by improving what we do best and innovating in the important areas. Here are three key tips to real innovation in healthcare:

1. Listen to our customer’s (patient’s) needs: In healthcare, we have a fundamental aversion to a simple philosophy that makes other sectors good at what they do – asking and responding. With telehealth, we don’t need to reinvent the wheel, we simply need to ask how big, how wide and where our patient’s want the wheel to go.
2. Focusing on the drivers and barriers that our patients tell us about: Many barriers for our patients surround attitudes, decision making and behaviour towards health. These issues are actually not technology focused. But conversely, they don’t need clinics to solve either. They simply need us. If we start here, we are solving problems for our patients, and that’s ultimately the biggest challenge for us and for telehealth.
3. Respond and learn: The technology sector has changed the world not because they are better at innovation, but because they are better at responding and learning. The health system is reactive and proactivity may be needed now more than ever. If we get better at proactively responding to our patient’s needs, they may just become proactive themselves.

“Brave (men) rejoice in adversity.” Seneca