March 17, 2021    8 min read

Telehealth explained

When it comes to healthcare, doctors are no stranger to technology — it has become an integral part of medicine. Telehealth simply uses information and communication technologies to deliver health and care services when patients and care providers are not in the same physical location.

Telehealth services primarily occur between patient and physician or patient and healthcare provider, including the transmission of diagnoses, exchanging health education, monitoring medical conditions, and providing health advice. Telecommunication methods include using electrical devices, such as phones, web cameras, video conferencing systems, and the internet.

Telehealth encompasses telemonitoring, telemedicine, smart sensors, remote patient monitoring, teletherapy, remote diagnostics and virtual consultations. In New Zealand, health professionals practising telehealth are subject to the same standards and requirements as any traditional doctor.

By definition, care delivered in this virtual manner relies upon technology to provide full enablement of care models. Telehealth relies on fast broadband internet services and secure modes of delivery of that information to be effective. In many cases, these models must change to maximise the delivery of care in this way as well as cater to added regulations such as data and privacy laws.

Technology to support these care models has been commercially available since the eighties. Today, many people readily carry smartphones that can fulfil a telehealth device’s function, further paving telehealth adoption.

Now you understand what telehealth is and how it works, let’s take a look at eight trends for 2021.

1. Increasing telehealth adoption

Telehealth is forecasted to be an essential part of the health landscape. In a recent study by Deloitte, they anticipate the virtual health market in the United States to grow more than 23% annually over the next five years, reaching close to US$100 billion by 2025.

Research shows that the future of health will likely include growth in virtual healthcare and telehealth. In many cases, it has already started to emerge that telehealth will better enable clinical care for people in remote or rural locations and people with limited mobility or a lack of transport.

The Covid-19 pandemic has been a significant catalyst for telehealth adoption. For New Zealand, the pandemic generated a considerable shift towards telehealth being part of the solution for breaking community transmission.

The success with telehealth has led to an active conversation of health professionals towards continuing telehealth consultations for many clients after the first major lockdown.

What used to be viewed as a last resort alternative to in-person consultation is now a cost-effective first line of treatment for non-urgent illnesses and follow-up appointments. We can expect to see healthcare insurance companies work with their healthcare providers to broaden access to telehealth.

2. Robust electronic system required for controlling drugs

While forms of telehealth have been available for years in many countries, it isn’t fully legalised in all countries. However, the pandemic has put telehealth in the spotlight. For example, in Brazil, where hospitals had been building up capabilities for some time, telehealth was finally legalised in April 2020. South Africa also rushed through its guidance in 2020.

But even with the broader adoption of telehealth, some countries have restrictions regarding the services that are legally allowed to be delivered via telehealth. Some restrictions include GP services, prescription medicines, specialist consultations and mental health services.

Prescribing medicine is the most commonly restricted service. Some countries won’t permit any virtual prescriptions, while others limit the prescribing of certain controlled drugs.

Electronic prescriptions for controlled drugs has been particularly problematic in New Zealand. Given that some of these drugs are potentially addictive and can, without strict control measures in place, become powerful street drugs, any electronic prescription system must involve robust and secure systems. Such electronic systems exist, for example, where the prescription generates a barcode, which maintains both the integrity of the prescription and the clinician’s identity.

However, doctors in New Zealand report that some District Health Boards (DHBs) are not quite there yet. For example, during lockdown, a doctor has still needed to leave her house to go to the office and fax a prescription for a controlled drug through to the pharmacy. She also had to hand an envelope with the hard copy to her DHB postal service. Through this whole process, she increases the risk of community transmission. Understandably, the Medical Council needs to balance the needs of the time against the security required around these drugs.

The learnings of the health care system from the lockdown period lead further towards leveraging more of what telehealth can offer.

3. Moving away from one-off treatment

Studies have demonstrated that telehealth used for remote monitoring and care at home can reduce patients’ time in the hospital for chronic illness management.

We anticipate providers will be savvier about using telehealth to reach at-risk populations in 2021. Telehealth can extend access to those not only living in rural areas but seniors and low-income and high-risk individuals – groups that are more likely to have chronic health conditions and be in the top spending tiers for health care expenditures.

A US telehealth provider, CallOnDoc, sees many patients with chronic disease who need ongoing care.
Wearable health devices that track things like heart rate, blood pressure and more helps make virtual ongoing care effective.

4. A strategic approach to offering telehealth

While in-person services will gradually increase as the pandemic wanes, it’s unlikely that physical encounters will return to pre-pandemic levels if sophisticated systems available to cater for telehealth are adopted. However, given the momentum, the question for 2021 is less about whether telehealth will grow and more about how competing players in the telehealth system plays out.

If health systems want to adopt telehealth successfully, they must be more strategic in developing their virtual offerings and how telehealth fits in with the health care providers planning. There is also a need to participate in alternative payment models, being forward-looking to create next-generation clinical models and target specific patient needs and preferences. Merely slapping a virtual component on the traditional model won’t be sufficient.

face masks As the pandemic continues, telehealth will be the first line of defense for many people.

5. Need for a digital-ready workforce

As telehealth awareness increases along with adoption rates, the focus on workforce development should emerge to allow healthcare professionals and caregivers to more readily use telehealth solutions. Healthcare professionals who can’t use the technology can cause low confidence in the healthcare provider in general.

6. Invest in technology

Investment in technology across the health care sector will continue. We already see this in New Zealand on a rapid and large scale. For example, the use of digital health tools, from the Covid-19 Tracing App, wellness trackers to telehealth and virtual health — most are accessible from the comfort of home.

For telehealth, investment in clinical knowledge and technology will enable more effective telehealth initiatives. Using technology to support the provision of telehealthcare does not mean that health workers will lose their jobs. There are not enough health professionals, and there has been a labour shortage in this area for some time. Telehealth encompasses a shift to a greater degree of person-centredness, both in terms of providing patients with a more targeted and responsive level of care – how and where they choose, as well as addressing the pressures on the health workforce.

Additionally, watch for the growth in the crossover between medical care, drug monitoring, and health and wellness. In fact, Apple Watch has already previewed this potential with heart rate and blood oxygen monitoring. Data output from devices like this will enable support to become more personalised and triggered by user behaviour. So, for 2021 we see that this year is for patient-controlled health, where health decisions are not dictated by, but instead, in consultation with – a healthcare provider, leveraging insights and data pulled from various health technology tools at people’s fingertips.

7. Interoperability

Interoperability means the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged. Interoperability isn’t integration. Interoperability is a real-time data exchange between systems without middleware. When systems are interoperable, they don’t just share information but can interpret incoming data and present it as received, preserving its original context.

With this in mind, the components of telehealth solutions need to be:

  • Standards-driven
  • Abide by laws and regulations such as privacy
  • Forward-looking
  • Interconnected

As more telehealth services are available to patients outside of clinical locations, there will be more opportunity to collect data and a higher degree of dependence on interoperability. Providers will have to up their game from just providing and recording facts to passing on critical insight back into these interactions to maximise the benefits to the patient.

8. Security, patient privacy and consent

The use of telehealth requires patient and provider trust and ongoing consent to be at the forefront of managing experiences and expectations. Transparent data governance frameworks — including cloud risk assessment, audits, and the role of data protection as users in Privacy Impact Assessments — is key to supporting the adoption of telehealth and virtual health solutions.

The legislation and regulations governing telehealth are very much in flux right now. For New Zealand, the new Privacy Act 2020 is a modern adaptation of the previous law and bring about stricter data protection rules that organisations carrying on business in New Zealand must follow, even if they do not have a physical presence in the country.

For telehealth, non-compliance with laws and regulations can become costly and result in enormous penalties as the cybersecurity environment is complex and rapidly changing. Therefore, the management of cybersecurity threats will need to be routinely reverified against current best practice standards.

The pandemic has helped to accelerate the adoption of telehealth and, with this, revealed its largely positive capabilities. During the pandemic and particularly high Covid-19 alert levels, telehealth enabled many patients to access a range of services without travelling to a health care facility. Additionally, telehealth is being used as a navigation or triage tool to expedite access to adequate care, close gaps in access to care, and improve ease of access to medical care, therefore reducing wait time and risk for some patients.

Innovative practices that have embraced this omnichannel approach to delivering care are also establishing this as a new normal by selectively using telehealth visits for certain types of encounters, such as post-op visits or triaging patients. Even when we return to a “new normal”, the opportunities for telehealth innovation will continue. Although the telehealth landscape needs to resolve some weighty issues, we believe that telehealth is here to stay.

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