Humanising Telehealth

By Rudrani Ghosh

How can telemedicine account for the loss of human touch?

An unprecedented amount of attention has been drawn towards telehealth during the COVID year. From payers to providers to drug developers - all the healthcare stakeholders are increasingly joining their hands with telemedicine and telehealth forces to enlarge the access and availability of socially-distant care. In other words, COVID-19 has forced the healthcare system to do a 180 degree on telehealth and what awaits this technology in the coming future.

Before the coronavirus hit us, the use of digital technology was building up but very slowly, however, as the pandemic swept the country, the healthcare world had to gear up the rapid adoption of those technologies to predict disease spread, analyze data, diagnose and treat patients remotely. In some ways, the pandemic seemed to be a wake-up call to shift the healthcare system from analog to digital remote care solutions.

And then came the knight: Telemedicine

Thanks to the pandemic and the ensuing social distancing norms that the healthcare model increasingly shifted to online solutions among which telemedicine solutions deserve special mention. By strengthening and reinforcing a clinical alliance between doctors and patients, telemedicine plays a crucial role in the uninterrupted ride to humanize health care.

According to Dr. Vikram Venkateswaran, Founder and Editor, Healthcare India, "Although telemedicine has been around the corner for almost 20 years, its legality came into being on the 25th March 2020. The important point is" he continues "telemedicine is at a nascent stage today, but gradually, within 10-15 years telemedicine will switch over to telehealth and the difference between the two is that telemedicine is for patients while telehealth is for the consumer (preventive care)."

The dilemma

We all know at baseline, in a doctor-patient alliance the most crucial elements are trust and empathy and as the Corona pandemic has forced us to transcend towards the digitalization of health — it has indelibly changed the interaction between the clinicians and the patients. So the key question is: How can the same level of trust be established with the patients if the doctors cannot meet them face to face? In this context, Dr. Venkateswaran added, "Telemedicine or telehealth should have the ability to integrate with the normal clinical processes of the organization, in a sense that, the entire consultation process should be a compilation of automated comprehensive solutions."

Balancing between Virtual and in-Person Care Delivery

It has been reported that there is an increase of over 11000% virtual visits in the Centers of Medicare and Medicaid Services. Even, Brigham Health in Boston, Massachusetts, witnessed an increase of virtual visits from pre-COVID 19 to its peak in May. As the entire world was witnessing this massive shift to virtual care, it was understood that at least half, and in many cases nearly all of the care can be provided virtually. But during the virtual care offering, one should follow a cleaner approach of dedicated sessions of all telemedicine care with properly assigned equipment, space, and focus to efficiently deliver virtually in a block of time.

According to Dr. Harish Pillai, CEO, Aster India, Aster DM Healthcare, "the major stumbling block in the implementation of telemedicine undoubtedly would be connectivity and infrastructural challenges. Despite the advances in technology, telemedicine is still faced with challenges such as connectivity issues, low bandwidth, and poor video and image quality. The clinical constraint is also obstructing implementation, as telemedicine is preferred by clinicians for minor health issues and for reviewing reports."

Adding to this, he says, "Awareness among the public is another major area of the block. When patients do not understand how to use telemedicine, it can reduce utilization and hamper accessibility. Leveraging social media and content marketing will help spread awareness among patients on the launch of the telemedicine service, educating the audience is an important factor."

By making Amazon as a benchmark and drawing parallels to it, Dr. Vikram conveys that telemedicine is purely a technology-oriented care delivery model and "and thus, organizations would have to work in collaboration with function experts, doctors, nurses, technologists, and others in order to improve their platform credibility (just the way Amazon worked in close collaboration with both retailers and technologists) so that they can bridge the gap between clinicians and consumers. Hence, if properly managed, the consumer confidence on telemedicine trend is here to grow."

First impressions matter

Tele-health consultation has its limitations. While in face-to-face consultations, appropriate levels of light touch can be incredibly reassuring and have a valid therapeutic impact, doing this in a virtual patient visit can be more challenging given that physical contact is impossible. It becomes especially difficult to convey empathy during a telephone visit — Let us envision a scenario.

Suppose, you were on a webinar and, when you asked a question, you were met with silence. You'd probably assume that you asked an invalid question or may not construct it properly and everyone stopped listening. For patients, this negativity bias means that if they ask a question and you pause to think before speaking, they've had a few moments to assume the worst. And depending on the context of the consultation, the worst could be very bad indeed.

In this context, Dr. Venkateswaran says, "the telehealth platform should have the ability to deliver dedicated quality internet connection (which will help in the smooth seamless flow of audio and video consultation) along with easily used function and features. Integration with other stakeholders like pharmacy or lab is very important as the flow has to be confluential." "Telemedicine platforms have to think of an end-to-end story. The telemedicine platform should also develop a system where there is a way to port one's data which can be made available to various care providers based on one's requirement," he adds, "another crucial aspect in this context is that — the doctors have to be trained in how to speak on these platforms."

Hence, tools that are aimed at convenience and are clinically relevant will have faster adoption cycles. Digital platforms can take away the time factor and make the entire journey very convenient. By reducing the time of the customers at the hospital by the use of the virtual care model, the hospitals can instead leverage the large waiting lounges to commission other clinical services.

Telemedicine is here to stay

Dr. Pillai thinks that "Virtual care can not entirely replace face-to-face consultations, but it will help patients with limited mobility access medical care. Healthcare facilities need to find telehealth technologies, that would help their patients achieve specific outcomes based on their needs. Traditional ambulatory and hospital-based practices, which are mostly provider-centric, can be supplemented by telehealth delivery systems that are more patient-centered and use technology to improve access and quality, lower costs, and assist providers in managing an ever-increasing amount of data and relationships."

He further elaborates, "Patients want to save as much money as possible when being provided with care while maintaining the highest possible standard. Reducing the cost of care by removing certain consumer expenses should be included in a successful telehealth program." " A patient's experience from the first interaction to the completion of care should improve in a quality telehealth program. Meeting or surpassing consumer expectations is the result of the implementation of a successful telehealth program" he adds.

Hence, the implication of telemedicine is very big in a country like India, but a proper framework has to be put together to make it work efficiently. As we enter this new era of digital switch over spurred by COVID, these models won't be judged by their initial growth but rather by the ultimate clinical quality, patient satisfaction, technical accuracy, financial feasibility, and health equity.