The meteoric growth in telehealth adoption during the COVID-19 pandemic is a case study in how a crisis can trigger overcoming barriers to the adoption of technology and process improvements. The issues and solutions are applicable to most information technology implementation projects.
Telehealth is the use of information and communications technology to deliver health care services when distance separates the participants. It often includes the use of video-based communication. Telehealth offers the potential for efficient, effective, and affordable delivery of health care services. At its best, telehealth is a collaborative environment where communication, interventions, and content are shared among the participants.
Dr. Rod Elford is a family physician at the Copeman Healthcare Centre in Calgary and a pioneer in the implementation of telehealth. In his experience “telehealth is an excellent tool to connect medical doctors with patients during the pandemic.” Telehealth, he says:
- Facilitates a clinical visit without the patient having to travel to see a medical doctor in person.
- Decreases the risk of exposure to the COVID-19 virus for the patient and clinic staff.
- Decreases the need for Personal Protective Equipment (PPE).
“I anticipate that, as both medical doctors and patients become more comfortable using telehealth during the pandemic, many will continue to use it afterwards because of its benefits.”
However, many barriers previously prevented widespread adoption. These barriers include:
- Insufficient software ease-of-use for both medical doctors and patients.
- Inadequate Internet infrastructure.
- Insufficient computing resources in use by medical doctors and patients.
- Medical doctor and patient comfort with the historic in-person health care delivery model.
- The effort required to learn how to use new computer software and hardware.
- How we have chosen politically to organize and pay for the delivery of health care services in Canada.
- The cautious, sometimes stifling, role of the Ministries of Health.
Establishing the necessary technical, administrative, and operational infrastructure required to achieve the promise of telehealth can be challenging. Here’s how the COVID-19 pandemic bursting onto the health care scene eliminated most of the telehealth adoption barriers.
The software package marketplace offers medical doctors a huge variety of telehealth solutions. Some are integrated into the various Electronic Medical Records (EMR) systems medical doctors use in their clinics. Most are standalone. Some are approved by Ministries of Health while others are not.
For most patients, the software for telehealth interactions with medical doctors depends on the agreed choice for the form of communication. The choices are:
- Health care specific video – Telus’s Virtual Visits, Akira, Babylon, EQ Virtual, Maple.
- General-purpose video – FaceTime, Skype, Teams, Zoom.
- Telephone – landline, cell network or internet.
- Text – Messages, WhatsApp, and many others.
- Email – preferred email client.
A few telehealth solutions also include a patient app with the following typical features:
- Videoconferencing for consultations.
- Scheduling appointments.
- Interactive symptom checking to suggest possible courses of action.
- Prescription management.
- Health care records review.
Software-related barriers to increasing the adoption of telehealth include:
- Being challenging to use for medical doctors and patients.
- Insufficient functionality compared to general-purpose smartphone apps.
The COVID-19 pandemic caused a sharp increase in demand for telehealth software packages and smartphone apps. That increase caused:
- EMR and telehealth software package vendors to improve the capability of their software.
- Medical doctors to license more telehealth software packages.
- Patients to download and install telehealth-related apps onto their smartphones.
By definition, telehealth is dependent on the existence of a robust, highly-available telecommunications infrastructure. In the populated parts of Canada that infrastructure functions well.
However, in sparsely-populated rural areas, where the telecommunications infrastructure is the weakest, telehealth offers even greater benefits.
Telecommunications barriers to adoption of telehealth include:
- Inadequacy of computers and Internet connections at clinics and at the homes of patients.
- Flaky Internet availability in rural areas.
- Significantly more expensive Internet bandwidth in rural areas.
- Higher computing resource requirements for end-to-end encryption.
The COVID-19 pandemic caused an increase in demand for telecommunications. That increase caused:
- Telecommunications companies to increase their capacity.
- Medical doctors to improve the computing infrastructure in their clinics.
- Patients to tune-up their computers and in-home network.
Dr. Darrell Palmer, a pediatrician at Kaleidoscope Pediatric Consultants in Calgary who sees mostly children with complex medical issues, finds that “virtual patient visits, though convenient and sufficient for some follow-up visits, are less than ideal or totally inadequate for other purposes.”
Service delivery change
Telehealth requires that medical doctors adapt their service delivery and patient interactions from the traditional in-person model to a virtual model.
Service delivery barriers to increasing the adoption of telehealth include:
- Resistance to change exhibited by medical doctors and patients.
- The reality that some types of diagnostic investigations require medical doctors to physically examine the patient.
The COVID-19 pandemic forced telehealth on medical doctors and patients in an effort to stay safe or out of desperation. That imposition caused:
- Medical doctors to adapt their service delivery.
- Patients to accept some of the limitations of virtual interaction.
Ms. Robyn Woods, the CEO of The Uncomplicated Family, says that her company’s virtual care software, Teleroo World, “facilitates collaboration among patients and caregivers to achieve continuity of care and quality, personalized care.”
Ministries of Health
Even though the staff of Ministries of Health do not directly deliver health care services, their health care frame of reference largely assumes the in-person service delivery model.
Government barriers to increasing the adoption of telehealth include:
- Billing codes that restrict payment to only in-person service delivery.
- Telehealth billing codes that do not adequately compensate medical doctors for their time.
- Proposed Alternative Relationship Plans (ARP) that do not adequately compensate medical doctors compared to the current fee-for-service model.
The COVID-19 pandemic caused Ministries of Health to quickly implement new telehealth billing codes that mirror the codes used for in-person service delivery. That change caused:
- Medical doctors to dramatically increase their service delivery using telehealth.
- Improved access to medical doctors for patients.
The successful implementation of telehealth, just like most information technology implementation projects, relies on the combination of technology improvement and careful attention to people change management issues.
Dr. Rod Elford observes that “the rapid adoption of many telehealth apps, including many that are not authorized for medical consultations, combined with minimal training and standards for how the consultations are conducted, has resulted in a bit of a wild west state. Over time these consultations will begin to conform to medical college standards and result in quality telehealth consultations on par with in-person clinical visits.”
What strategies would you recommend that will increase the adoption of telehealth to improve health care delivery? Let us know in the comments below.