I met other telehealth practitioners for the first time at the ‘Success and Failures in Telehealth 2019‘ (SFT19) Conference at Surfers Paradise last week (October 2019). Health practitioners from every health modality are applying telehealth as a communication and care delivery channel for easier access and better communication in healthcare. Awesome to see first hand the versatility of applications and connect with industry pioneers who’ve been doing teleheath far longer than me!

Themes from telehealth projects across Australia

Unanimously, all presentations I saw demonstrated clear and strong evidence of benefits to both practitioners and patients in terms of care delivery. Plus importantly, reduced opportunity and financial costs of accessing care not only for users, but for payers - be it hospitals, insurers, taxpayers.

Significant funding has been granted across many different telehealth projects in Australia, but frustratingly not sustained. Or is it local area health networks are not picking up and absorbing telehealth costs into existing budgets once grant funding finishes?

Regardless, what we’ve got is strong proof of concept, but poor proof of sustainability of telehealth. This short-term mindset towards a long-term care delivery goal is surprising. Albeit as a private sector practitioner, I appreciate I may be naive to how funding ecosystems operate in public health, where most pilots are occurring.

A consistent theme that echos my own experience in teledentistry to date is a very real struggle with engagement on both sides of the video screen:

1. General lack of awareness of telehealth as a healthcare delivery channel, particularly for those that experience the greatest hardship to accessing care in traditional face-to-face ways: best demonstrated by Medicare stats that report only ~250 thousand consults claimed nationally in the 2017-2018 financial year and a 10 year budget running at less than 20% of planned expenditure.

2. Resistance of healthcare operators outside the hospital system to set up for telehealth, despite good financial incentives to do so in the case of Medicare funded doctors, unlike the private sector practitioners who are currently predominantly bootstrapping.

The burden of legacy tech in healthcare

Integration between new technologies and existing piecemeal tech systems is a huge issue. This was strongly reinforced throughout the telehealth conference. Personally I believe a different approach is required or tech in healthcare will continue to lag behind other industries to the detriment of care and the sanity of industry workers!

Rather than a goal of “integration” between tech systems which is laborious, expensive, probably financially unrealistic, and likely unachievable with the multitude of different systems in play throughout the health sector, health would be better served by effective “communication” between - or regardless of - platforms.

I’m no tech expert, let’s be clear, I’m a health practitioner first and foremost, but I’ve built my own platform with the intention that the service can be used and data can be transferred and accessed anywhere, by anyone authorised to do so. Data can then be downloaded at the point of use and transferred as needed to other internal or point of care services.

As tech is evolving so rapidly, investing in any tech heavily at the moment that can’t easily be upgraded is a risky and poor venture due to becoming obsolete or legacy very very quickly. It’s akin to throwing the baby out with the bath water.

In my opinion, in healthcare especially, we’d be better to invest in workflows and new and improved care delivery models: involve all staff with regular training to normalise this; place an emphasis on tech system agnostics that support these new and improved workflows with an expectation the tech will regularly iterate, just like software updates on a mobile phone.

Let’s buy into a telehealth tech movement over a current tech solution. Just like mobile technology is a continually evolving movement, whereas the phone or tablet you have today will not be the one you have in a year or two.

Some will argue the case for data privacy and security. Healthcare compliant data security is now widespread and it’s now cheaper and easier to access than ever. Even mainstream platforms like Gsuite by Google and Amazon Web Services provide this level of data control accessible for use by any individual, business or enterprise. It’s time to let go of this pervading fear of data breaches.

That’s not to say the risk is gone, it’s not. It never will be entirely. But the risk is less than it’s ever been and will continue to improve, rapidly. Denying healthcare technology advances that can save lives and quality of lives for many more people in many more locations because of data breach risks is no longer acceptable. For the simple fact that people won’t die from a data breach, but they will from lack of access to care.

Mindset shift needed to embrace iteration over perfection in clinical care communications

Healthcare workers are trained to be perfectionists, highly discerning evaluators of risk/benefit ratios, and are generally risk adverse requiring strong evidence for adoption. In short we’re generally not natural experimenters or innovators. We’re rule and protocol followers. And rightly so!

The stakes of failure are high in health - permanent disability or death is to be avoided at all costs. So we have a high discomfort and pain tolerance. We’ll persevere with suboptimal environments well beyond what many others would in most other industries. Until there’s absolute trust the risk of death - or lawsuit - is less with the new technology than the existing.

I’ve played in the startup world, with a ‘lean design thinking mindset’ mantra of “fail early, fail fast”. Healthcare could not be more diametrically opposed to this currently widely accepted approach to innovation and entrepreneurship globally. However perfection will always only ever be a moment in time, until it can be done better…

So there’s a huge opportunity for a flexible, innovative, yet rewarding middle ground in telehealth and virtual care: being predominantly communication channels, the fall back is and always will be a face-to-face consult. This is a great failsafe for practitioners and tech platforms themselves, mitigating medico-legal and harm risks that are always back of mind.

This face-to-face failsafe gives us practitioners the space and the safety to experiment with telehealth technologies. In fact, why should people be denied access to healthcare altogether just because it’s not practical for them to get to face-to-face care at the whim of a practitioner? If the virtual picture isn’t as clear, how much does it actually matter as long as next steps can be formulated?

The evidence to date across many health modalities - like those presented at the SFT19 conference -consistently and repeatedly show that healthcare access and health outcomes dramatically improve for patients using telehealth technologies. It’s time to embrace telehealth because not doing so is no longer best practice healthcare.

Breaking down health modality and care setting silos

Telehealth funding issues have clearly demonstrated that each modality independently building and running their own telehealth project is not sustainable. Legacy tech issues has clearly demonstrated the frustrations and limitations of continuing to silo health data and access in this day and age.

One of the plenary sessions invited conference delegates to reimagine healthcare. Based on the evidence and experiences presented at the SFT19 conference, it’s very apparent that crowdfunding and sharing cost burdens for universally applicable health tech, like telehealth is the way to go: a universal communication system across the whole country enabling access by all stakeholders at any touchpoint, on demand.

Telehealth is the opportunity and the conduit to overcome silo obstacles to effective, integrative quality healthcare: facilitating cross-modality, cross-facility and cross-funding access to care and health data, anywhere.

The tech already exists to do this. Clinivid already has traction in hospital and enterprise settings. Developed by a former health communicator, it’s smartly modality and interface agnostic. Coviu is offering similar in the private sector. My own platform ViDe is developing a marketplace approach for the whole dental industry.

Now to get the various stakeholders to embrace collaborative care for win-win outcomes!

Alert the media! Telehealth is here, it’s easy and it works!

Resoundingly, the biggest hurdle remaining for widespread engagement to telehealth is that Australians just aren’t yet aware telehealth as a service is available now.

I was exasperated to learn that Medicare has taken the stance of leaving it to consumers to ask for telehealth from providers. We’ve got a ‘chicken and egg’ ‘catch-22’ scenario that’s just not acceptable in my opinion. Such an important healthcare development requires a coordinated top down approach to practitioner and consumer education and engagement.

Practitioners will respond to market demand for services and upskill or modify their practice accordingly if they can see the operational value in it.

While I’m aware good explanatory resources have been developed for telehealth by various state based health networks, unless you know to search for them, you won’t come across them buried under “T” in the alphabetical listing of services on their respective websites.

Fortunately there’s a simple solution: a nationwide community service announcement and promotion of telehealth as a service. Funded collectively by all stakeholders - ideally Medicare included given their large budgetary surplus for telehealth at present. The return on investment would be fairly immediate in terms of savings in transport, earlier health interventions, reduction in claims for more expensive services, better recoveries and more.

Let’s do this!

Dr Christine May is the Principal Dentist and Founder of ViDe Virtual Dental. She attended SFT-19 at her own expense. Views expressed in this article are her own. See Australasian Telehealth Society for more details.