Post coronavirus pandemic, telehealth will become the new normal for clinicians and patients alike – this was the takeaway message from an expert panel of Australian and New Zealand health clinicians who met virtually for a live webinar discussion this week on the future of telehealth.
The discussion, which was facilitated by not-for-profit organisation, Health Informatics New Zealand (HiNZ), and sponsored by Visionflex, a leading Australian manufacturer of high-quality telehealth equipment, explored how Covid-19 has caused a seismic cultural shift in the acceptance of telehealth engagement between clinicians and patients.
The panel examined a variety of telehealth applications, including: general practice; rural and remote locations (including the world’s most-isolated destination, Antarctica); and also the health of some of society’s most disadvantaged – the homeless, and those serving time in correctional facilities.
Telehealth – helping vulnerable and remote communities
For Dr Meg McKeown, telehealth has always been a vital tool in her diverse roles of providing medical treatment to homeless people in Tasmania, and as a polar-medicine doctor for the Australian Antarctic Division.
The arrival of Covid-19, she says, has only accentuated the importance of telehealth.
“I’ve got these two roles at the moment,” explained Dr McKeown who is Medical Director for Moreton Group Medical Services. “One where I’m working for the Antarctic Division and we are very much used to using telehealth in that arena… But also, now that I’m back in the ‘real world’, I’m still working in a situation where telehealth has been a saviour during Covid; it has actually built me a position that didn’t exist before Covid.
Dr McKeown makes initial contact with her homeless patients via telephone, and when out on the road, her team uses the ProEX-Mobile Telehealth Solution by Visionflex which incorporates a comprehensive medical examination toolkit, patient data storage and live-streaming over 4G, to connect remotely with patients so she can deliver optimum health outcomes.
“So, homeless medicine telehealth in Covid times – we’re advocating to continue as things progress. And [when] Covid is maybe under control, goes away, or a vaccine comes, whatever, we would still love to see homeless medicine with telehealth,” said Dr McKeown.
“And I guess that speaks … about equity,” she added later. “We’ve used telehealth to reach a group of people who haven’t really had much in the way of healthcare … I have access to seven different databases that I get all my [health] information from to find out the background for a patient and it’s been great because I can consolidate all of that in one place and actually address those needs for them.”
Likewise, in Antarctica where Dr McKeown used the ProEX-Mobile to connect with medical and dental specialists back in Australia for guidance on every patient interaction “that was more than ‘I just need a Band-Aid’”, telehealth is a “very, very natural fit”, and is here to stay.
Telehealth – an effective and efficient tool for inmates in corrective facilities
“I think telehealth is going to move forward,” said Dr Jacqueline Canessa, Senior Clinical Medical Lead at St Vincent’s Correctional Health at Parklea Correctional Centre in western Sydney.
“And I agree that video conferencing is far better than telephone in terms of connecting and being able to understand what is happening [with a patient].
“In all those areas, I see that [telehealth] is sustainable; it’s easy; it’s not too expensive … I think it’s going to hold its place and … the younger generation coming through are very familiar with phones and face timing [and] I don’t think it will take much time for all of us oldies to catch up.”
She tempers this by adding that there is still a need to find a balance between the use of telehealth and face-to-face consultations, particularly in the delivery of psychiatric medicine where it is important to focus on “building a rapport”.
Parklea Correctional Centre has around 1,600 inmates and the prison’s medical clinic is supported by St Vincent’s Hospital, which is located 45km away in central Sydney. When required, prison inmates connect with hospital medical specialists via sophisticated telehealth technology. In this regard, says Dr Canessa, telehealth as emerged as not only an important tool for delivering positive health outcomes for inmates, but it is also helping to address issues of high staff turnover at Parklea.
“If we can’t get the expertise, we do have to transfer [inmates] to the local hospital,” explained Dr Canessa. “What we’ve been able to do with telehealth, at least in terms of addiction medicine, is to have an addiction specialist based at St Vincent’s Hospital and they’ve been able to do videoconferencing to assess patients … That’s been a really important area for us.”
Consequently, telehealth has had a flow-on effect on keeping transport costs down, and reducing staff costs due to the requirement that all inmate medical transfers are accompanied by two security officers.
Dr Canessa adds that beyond the prison application, St Vincent’s Hospital is also exploring the use of telehealth to connect with their rural hospital colleagues; and for follow-up visits for patients of the hospital’s well-respected heart-transplant team. Telehealth has also been invaluable for maintaining continuing medical education during Covid, and peer-to-peer review.
Additionally, she says there is “great scope” for the future use of telehealth to provide equitable access to healthcare for rural patients, and for homeless health. These applications both align with St Vincent’s mission and values to provide high-quality and compassionate care.
Other salient points raised by the telehealth experts on the webinar panel include:
Dr Samantha Murton, President, The Royal New Zealand College of General Practitioners: “We did these sudden changes [during Covid-19] and you want to go, ‘oh lets go back to normal’, but actually, what you need to say is, ‘okay, we’ve done a sudden change, there are some difficulties with [telehealth] but we need to move forward and continue the momentum and I think part of our whole battle over these next few months is continuing the momentum so that we can keep things changing and move into a new era where the norm of phones and videos and electronic health activities becomes our everyday practice and not something that’s novel.”
Lisa Livingstone, Registered Nurse, Nelson Marlborough District Health Board, New Zealand: “Covid [has been] a blessing and curse. It certainly brought everyone’s attention to Telehealth. We’ve certainly been working on [telehealth] for quite some time before that, doing pilots and projects with other people and other groups. But what Covid did was it sharpened everyone’s focus. We went from something like 128 Zoom users to about 1,300 in about four days, so it was quite a challenging time and environment to be in.”
Dr Ruth Large, Emergency Physician, Rural Hospitalist, Clinical Director Information Services and Virtual Healthcare, Waikato District Health Board, and Chair of the New Zealand Telehealth Leadership Group: Dr Ruth believes that clinicians are very keen to embrace telehealth now and into the future, and for the technology to remain sustainable, medical practices and organisations should continue to look at telehealth as an opportunity to drive “cultural change” and to foster a culture that is both open and focused on learning. Just as important is sharing knowledge and business case studies. “Sharing the learning is so important,” she said.
Did you miss the webinar? It is now available to watch on demand, click on the link below.