While many industries struggled to hold their ground in the midst of the COVID-19 pandemic, the healthcare industry thrived. In fact, the pandemic fuelled the transition towards telemedicine. With social distancing measures in place for months on end, strict stay-at-home orders, alongside higher demands and reduced capacity in healthcare systems, there was a dramatic swing towards telehealth following the start of the pandemic.
Following on from our previous blog "The Telehealth [R]evolution" we now assess the current status of telehealth as the dust begins to settle nearly two years after the onset of the pandemic through the personal lens of a clinician.
How big was the swing to telehealth once COVID arrived?
Prior to the start of the pandemic, between 2009 and 2017, the percentage of hospitals fully or partially implementing computerized telehealth systems grew from 35% in 2010, to 76% in 2017. It can be said that rather than causing this increase in telehealth, the pandemic has catalysed this growth.
During my time as a clinician, I would have used telehealth on a small number of patients in the past before the pandemic. As recent research on the transition to telehealth has indicated, the switch at some healthcare centres was dramatic and often happened rapidly. In one example at a primary care centre the use of telehealth drastically increased. On the Friday, all primary care encounters were in-office visits. Contrastingly, on the following Monday, nearly 90% of consultations were taking place via telehealth..
Research using the data from The National Disease and Therapeutic Index comparing 2019 to Q2 2020 reported that use of telemedicine, which accounted for fewer than one in fifty of primary care visits during 2019, accounted for nearly two out of five visits during Q2 of 2020.
Personal experience of telehealth as a clinician
Personally, having worked as a physiotherapist, I have used telehealth in the past to provide care for patients with musculoskeletal complaints and neurological conditions. Consistently, patients have reported back to me at their surprise at how effective it has been. They enter the telehealth appointment with low expectations of its efficacy, but finish with an increased appreciation of what can be achieved via telehealth. Using digital telehealth platforms like Salaso and Physitrack were really valuable for both clinician and patient in telehealth appointments. They were also helpful in subsequent treatment adherence with patients really engaging with these digital solutions.
Interestingly, as a physiotherapist, an ever increasing evidence base in the management of certain conditions such as lower back pain appears to be pointing towards more active interventions such as exercise and education rather than hands on therapy and so telehealth is well suited to this space. From my personal experience on the ground in telehealth, I do feel that a blended approach with a mixture of face to face visits and telehealth works best. In particular, as it would enable you to undertake more in-depth assessments in face-to-face appointments such as neurological testing if required for some patients, minimising further the risk of diagnostic error.
Where is telehealth now and how is it positioned against challenges?
According to the Facts and Factors market report, the global telehealth market is expected to grow at 26.5% CAGR annually during 2021-2026. The global telemedicine market generated $40.20 billion in 2020, and is projected to reach a whopping $431.82 billion by 2030.
Growth in telehealth usage peaked in spring 2020 but has stabilised since. Telehealth has recently shown reduced insurance claims throughout the USA with the month of July versus June 2021 down 6%. Interestingly, mental health consistently appears to be the top diagnosis within all telehealth claims.
It was thought that the complex FDA regulatory framework and technology adoption amongst elderly would be two key potential barriers to telehealth adoption and growth. However, by issuing a number of temporary policies, the FDA has looked to support digital health innovation during the pandemic, further favouring the use of telehealth services. They have also issued guidance documents to expand the use of digital therapeutics for psychiatric disorders and medical devices for remote patient monitoring during the pandemic.
Similarly, the technology adoption that may have been perceived to be a barrier in older patients has actually been shown to be one in which they adapt quite well. According to the national poll on health aging, that focused on Telehealth Use Among Older Adults Before and During COVID-19, the vast majority (91%) found it easy to use the technology necessary to complete their telehealth visit, and 64% reported that they feel comfortable with video conferencing technologies (which is up from 53% in 2019.)
The digital divide continues to remain a barrier to telehealth adoption as not everyone has access to personal laptops or broadband even today. Interestingly, telehealth companies are starting to take initiatives to address this. For example, Babylon’s collaboration with Rwanda's National ID Agency (NIDA) to make digital consultation available to non-phone users or users using shared-devices is really noteworthy. As telehealth becomes all-pervasive there are calls for telecommunication devices to be covered as a medical necessity, especially given the correlation between poverty and telemedicine unreadiness
A hybrid future
Patients engaged very well with telehealth during COVID, with many reporting it to be comparably effective. However, with face-to-face medical visits returning, many patients feel the need for this more personal form of face-to-face care. Literature shows that virtual consultations have provided positive outcomes with good levels of patient satisfaction. Telehealth can also provide increased access to care and empower patients with chronic conditions to manage their conditions. There is a benefit too for healthcare organisations, as telehealth can improve adherence to medication, reduce missed appointment times and lessen wait times.
However, the fundamental challenge will be for policymakers to help the legislation catch up with the growth in technology through additional means of reimbursement for telehealth. Interestingly, pressure in this area is growing, as outlined in the recent CB insights report on the state of telehealth Q2 2021, showing a large increase in the number of lobbying reports particularly in the last twelve months as pressure continues to mount for long-term telehealth regulatory reform.
Telehealth improves outcomes, and in so doing improves public health. It is however not a panacea – with some areas of healthcare like mental health, more suited to it than others. There is also a hesitation around technology security that remains to be addressed. Due to these existing perceptions of telehealth, models are likely to evolve to optimize hybrid virtual and in-person care delivery, going forward.
Are you interested in learning more about TELEMEDICINE & VIRTUAL CARE DELIVERY? Join your peers at our upcoming digital health meeting on Commercialisation models for Virtual Care in Respiratory Diseases
03 Nov 2021