The current coronavirus pandemic (COVID-19) has resulted in tremendous growth in telehealth services around the world. The rapid uptake of telehealth has mainly been due to necessity – following social distancing requirements and the need to reduce the risk of transmission. Although telehealth has been available for many decades, the COVID-19 experience has resulted in heightened awareness of telehealth amongst health service providers, patients and society overall. With increased telehealth uptake in many jurisdictions during the pandemic, it is timely and important to consider what role telehealth will have post-pandemic.
Many healthcare workers have used telehealth for the first time, and consumers have had the opportunity to receive care directly into their homes. This experience has highlighted both the benefits and the challenges of delivering care via telehealth. At large, the expectations on how care can be provided are shifting and an opportunity now exists to redesign our healthcare system. Consequently, it is timely and important to consider the role that telehealth will play in the future delivery of healthcare.
In order to sustain the use of telehealth during and beyond the COVID-19 pandemic, we outline five key requirements. These requirements are based on the most common barriers and enablers reported in the telehealth literature; a selection of which include:
- Developing a skilled workforce
- Empowering consumers
- Reforming funding
- Improving the digital health ecosystems
- Integrating telehealth into routine care
Develop a workforce skilled and competent in using telehealth
Providing care via telehealth requires additional skills and appropriate support. COVID-19 has highlighted that a large proportion of the workforce has not been trained in how to deliver care via telehealth. The rapid rollout of telehealth demanded creative models of training and support to ensure staff develop the necessary skills to deliver telehealth services
Empower consumers to advocate for telehealth
Public awareness of telehealth has increased since the beginning of the pandemic. For many, this has been a positive experience. For others, however, the rushed nature of the transition and technology issues may have resulted in a less than ideal introduction to telehealth. The consumer needs are central to reforms in the health sector.
Reform funding to focus on high-value care
To reduce COVID-19 transmission and enable care to be provided at a distance, many payers either introduced telehealth reimbursement or eased restrictions on existing remuneration arrangements. The Center for Medicare and Medicaid Services temporarily relaxed a range of regulations to enable maximum flexibility in telehealth-delivered care such as allowing beneficiaries from any geographic area, delivery of teleconference via smart phones and some services to deliver care by telephones. These sweeping but temporary financial reimbursements paved the way for the tremendous growth in telehealth use. To maintain telehealth activity, sustainable funding models are needed beyond the initial temporary measures.
Improve the digital health ecosystem
With the sudden transition to telehealth, the variation in technology infrastructure across countries and within countries has become apparent. Populations with greater access to broadband and hardware such as mobile computers and/or tablets, software licenses that support videoconferencing and peripheral devices such as cameras and microphones, were able to adapt to video consultations better. The lack of suitable infrastructure and/or familiarity with using videoconferencing platforms (on both patient and provider-end) are likely reasons for limited uptake of video consultations. To combat these issues, we need to develop national information technology infrastructure to support telehealth so we can move into the digital future seamlessly and successfully.
Integrate telehealth into routine care
The long-term sustainability of telehealth relies on implementation planning to ensure effective integration of telehealth within complex health systems. We need not to think of telehealth as installing a technology but think of it as improving a service, and address the organizational, logistical, cultural changes and workflow issues. Organizations wishing to maintain and enhance the delivery of telehealth services beyond COVID-19 should embed an implementation strategy into their operation plans and ensure that these requirements are adequately funded. Telehealth should be considered as just another channel to access healthcare.
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