The winds of change in healthcare

Chris Bain cautions against the rapid roll-out of telehealth

Chris Bain, the inaugural professor of practice in digital health in the Faculty of Information Technology at Monash University, cautions against the rapid roll-out of telehealth

Over the past six months, we have seen the global pandemic caused by Covid-19 transform our world, disrupting almost every aspect of our lives, be it personally or professionally. While businesses have been forced to evolve rapidly healthcare providers have also come under increased scrutiny and intense pressure to create systems and processes that work under this new normal. Among new demands lies an increasing necessity for alternative, digitised diagnostic and treatment methods to replace face-to-face contact between healthcare professional and patient.

The necessity for such telehealth technology has seen a rapid, widespread development and rollout of services that ensure the safety of both patients and healthcare professionals.

Recent data from Global Market Insights indicates that despite being valued at US$45bn in 2019, by 2026 the telemedicine market is likely to be worth more than US$175bn. In Australia alone, between March and May 2020, more than 10 million health and medical services have been delivered through the telehealth items introduced by the government alone.

For those of us who work within the realm of digital health, the changes that we see coming to fruition are processes for which we have advocated, for many years. While these technological advances will see healthcare transformed, however, it is vital that users understand these services aren’t without risk.

The speed at which these services are being developed will require ongoing evaluation to ensure they continue to provide effective, safe and secure services.

Misdiagnosis and reduced use of services

Many of the instruments used to perform the most basic diagnostics during face-to-face consultations, from stethoscopes to blood pressure monitors, are not present during telehealth sessions. Often services offer voice only, or voice and video channels, along with some asynchronous document-sharing, which limits the sometimes life-saving interaction between practitioner and patient. As a result, a key risk is that of misdiagnosis.

THE TELEHEALTH
PARADIGM HAS
THE POTENTIAL TO
SUPPLY A MEDICAL
PRACTITIONER
WITH ALMOST AS
MANY INSIGHTS
INTO A PATIENT’S
CONDITION AS
THEY COULD
GATHER IN A
FACE-TO-FACE
ENVIRONMENT

While digitised diagnostic tools are being developed, with commercial mobile apps already providing access to pocket ECGs or stethoscopes, the development of technology will inevitably make these infrastructures more perceptive, accurate and reliable.

As such, the telehealth paradigm has the potential to supply a medical practitioner with almost as many insights into a patient’s condition as they could gather in a face-to-face environment.

Data restrictions enforced by regulatory and governmental bodies, however, have the potential to heighten the risk of misdiagnosis. It is essential that these limitations are reviewed and adjusted to ensure patients are provided with a safe and reliable medical service.

On a more basic level, national lockdowns have meant many GPs, hospitals and other healthcare services have relied upon virtual consultations to ensure that patients can still access the necessary support and medical advice without venturing beyond their doorsteps.

In March alone, however, data from the Australian Medicare Benefits Schedule revealed that 89% of consultations, almost 1.1 million, occurred over audio-only calls. As an issue also highlighted by medical practitioners, while these digital platforms are an integral tool they are a far cry from fully replacing the face-to-face interactions that are key to diagnosis and treatment.

In addition to the risk of misdiagnosis, there are those who have been put off seeking medical advice altogether, with reports of a relative drop off in interactions between people and their healthcare system.

Australian healthcare experts in cancer and heart disease have asserted that as we continue to navigate the coronavirus pandemic, many hospitals and health services have become less busy, with similar reports coming from the US, UK and Japan, among others.

In the future, further investigations into the factors that influence this drop off trend will be key to improving key aspects of telehealth services. We must ask ourselves to what extent is this reduced interaction because most current telehealth services don’t offer vital measurement tools that have become essential features of face-to-face consultations. This includes the remote measurement of blood pressure, blood sugar, or other vital parameters.

Of course, while many are concerned about Covid-19 and overwhelming their health service, practitioners have warned that, despite the pandemic, other health conditions do not simply disappear.

Lack of support in navigating new telehealth services, the limitations of such services and increasing public reluctance to visit healthcare facilities when necessary could have a detrimental impact on public health as national lockdowns are eased across the world.

Security problems

In addition to the practicalities of using this relatively new technology, safety and security risks are an unfortunate reality when introducing a host of new technology offerings into the telehealth industry in such a short space of time. From compliance risks and increases in non-regulated AI devices to security risks associated with medical-grade video conferencing, the sector has not properly been assessed.

The sheer quantity of new telehealth offerings combined with a lack of regulation, as governments tackle the current pandemic, provides a perfect environment for some more dubious companies to take advantage through misuse and false advertisement.

In recent weeks a leading figure in the Australian medical technology landscape, an ex senior Victorian healthcare executive shared his personal experience of interacting with an IT platform masquerading as a digital GP service. This platform functioned as a prohibited chatbot exchange service and shared his personal data with market research companies, unbeknown to the user. His experience is far from unique but is integral to drawing attention to the necessity for regulatory measures to be put in place as soon as possible.

Future of telehealth

The growth of the telehealth industry over the past few months alone is undeniable, however as the pandemic begins to ease it will be interesting to see to what extent this transition to digital will become a permanent feature of our healthcare systems.

It’s well-recognised that one of the historic barriers to the wider use of telehealth services is financial. Increased use of telehealth services could spell a loss in revenue for GPs and hospitals in countries that rely on private healthcare systems. In the past, governments have discussed whether adequate remuneration for healthcare providers should be provided so that the digital health providers could be used interchangeably with better funded physical care where it is safe and appropriate.

While the barrier of remuneration has been taken down in the setting of Covid-19, this will not continue after the pandemic is over. The coming years could see us return completely to our pre-Covid state, given the fundamental role of money in this equation, or we will see society adjust to a new equilibrium with a greater level of telehealth service provision than existed previously?

If we assume that our future holds more telehealth services being provided as a matter of routine than existed previously, new challenges will have to be tackled. With issues already arising with misdiagnosis and security concerns, we are only beginning our journey in establishing a stable platform from which safe and sustainable telehealth services can be delivered.

Questions regarding the adequacy of workflow, the long-term viability of technology-based solutions and improvements in the current systems will have to be addressed. This will not be an easy or quick process but will require a dedicated period of evaluation, facilitated and, preferentially, funded by national governments. Establishing this system and process is vital, not only during the current pandemic but for providing broader access to healthcare services to those who may have previously been underserved.