The COVID-19 pandemic has led to an unprecedented uptake in telehealth across Australia in both primary and specialist services and across urban as well as rural and remote settings. Many of the digital health targets I had predicted would take many years to achieve fell in a matter of weeks.
There has generally been wide-spread support and acceptance amongst consumers and clinicians for the rapid increase in telehealth during the pandemic and, on many levels, the rollout has been a remarkable success.
The question many of us are now asking is how do we harness this enthusiasm for telehealth to support the integration of digital health more fully into health and wellness?
There is clearly the potential to deliver new, consumer-centric virtual models of care that support the move from reactive to more proactive health management. While we have made many advances in how we treat diseases, we still largely deliver healthcare in the same way we have for decades. In many other industries, digital technologies have disrupted how services are delivered to make them more convenient, efficient and consumer centred. When was the last time you went to the bank or travel agent? For that matter, how often do you still use cash?
For someone like myself, with an underlying chronic cardiovascular disease, little has changed in terms of how my healthcare is delivered since being a child. I still see a cardiologist once a year and have an annual check-up. I wear a halter monitor for 24 hours prior to my appointment which captures a small snapshot of my heart rhythm. If I miss one or two appointments no one seems to notice or follow up. There is sporadic communication between my GP and specialist via letters and little or no sharing of any records between them. There is absolutely no monitoring of any of my vital signs or health metrics between visits. I also have no easy or simple way of sharing with my health professionals any health data I may capture myself on my phone or other personal devices.
… how can my experience and the experience of millions of others with chronic disease be improved by digital health?
I am not being critical of my care team, as they are excellent clinicians, but how can my experience and the experience of millions of others with chronic disease be improved by digital health?
There are multiple digital communication channels we use in other aspects of everyday in life and business including apps, text messages and automated calls to name a few. While these tools are starting to enter health, they are by no means universal. I predict we will see the growth in far more sophisticated consumer portals over the next five years that make use of existing digital tools to coordinate and manage communication in a consumer-centred way. Aligned with this is the increasing availability of digital tools and platforms to support behaviour change. There are hundreds of thousands of these available on App stores. Our challenge is understanding which of these are effective and how we integrate these into shared care models with our healthcare providers.
We now have multiple ways to monitor health and wellness at home. Over the last decade we have moved from access to a relatively limited range of expensive and clunky devices to a growing range of mobile, consumer-facing apps and devices that monitor a wide range of clinical and health metrics. This places in our hands the ability to continually monitor key vitals and be able to proactively assess when we need attention or follow-up. To enable continual monitoring we need the systems to link consumer facing apps and devices into routine health care delivery. We need the analytics to be able to accurately predict risk and the social licence to be able to access multiple personal and private data sets to be able to make these predictions. The challenges we faced in gaining broad acceptance of My Health Record in Australia underscore the challenges in gaining the confidence of our community surrounding the value of making our health data available to improve outcomes.
… virtual navigators can work with consumers to manage their chronic disease…
Finally, in my case, with a stable condition, one has to consider if the existing model of seeing a high cost cardiologist every year is an optimal high-value one. Models now exist where, with appropriate monitoring, virtual navigators can work with consumers to manage their chronic disease and only call in specialist care when needed.
How do we now move forward into this brave new world of digitally supported healthcare? Clearly, we need to sort out some of the fundamental problems we have in the system that are holding back innovation such as interoperability, sharing of data and so on. Many organisations are working on this and I would predict we will be well into fixing these issues in next 3 to 5 years.
… the greater challenges are non-technical. We need to understand the cultural changes required…
I think the greater challenges are non-technical. We need to understand the cultural changes required from a government, service, clinician and consumer viewpoint to routinely implement new models of care. We need to establish the evidence base that new models of care are effective and an improvement on current practice. We need to understand the cost implications of new models and that we can afford them. From a personal viewpoint we need to consider the importance of the therapeutic and personal relationship we form with our health professionals and how we maintain this.
From a social licence point of view, we need to ensure that we take these next steps as a society and have considered and sensible conversations around how to approach this. There is a great danger that we may move too fast and lose trust of our community or on the other hand get overly cautious and lock everything down and lose the enormous potential of digital health has to improve our outcomes.
Finally, a key consideration is to ensure that any new models of care are equitable and improve access and outcomes for all. It is paramount that we focus on making sure that any innovations meet the needs of the most vulnerable in our population, who are often the most in need of our health and wellness services.
