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Finding the path to telehealth adoption at scale

Stanton Newman
Jul 19, 2019 - reading time 7 mins

By Professor Stanton Newman

Vice-President International, Professor of Health Psychology

 

Professor Stanton Newman, Dean of the School of Health Sciences until 2017, joined City University London in September 2010. He is Professor of Health Psychology and completed his B.Soc. Sci. (Hons) degree and doctorate at the University of Natal, South Africa. 

 

Professor Newman became a lecturer at LSE and Guys and Middlesex Hospital Medical Schools before joining University of College London.  Professor Newman was Head of the Department of Psychiatry and Behavioural Science from 1993 - 2004.  In 2003 he set up the Centre for Behavioural and Social Science in Medicine, a unique project to encourage interdisciplinary working in physical illnesses at UCL. He attended the London Business School and ran UCL Consultants Ltd.

 

In 2009 Professor Newman was appointed the Principal Investigator on the Whole Systems Demonstrator Project funded by the Department of Health to evaluate the role of assistive technologies in health and social care.

 

Professor Newman is an Honorary Member of the Royal College of Physicians and a Fellow of the British Psychological Society.  He is a Chartered Clinical and Health Psychologist and engaged directly in clinical work seeing patients at his weekly clinics.

By Professor Stanton NewmanRead less
Telehealth technologies, such as remote consultation and patient-monitoring systems, have real potential to help solve some of healthcare’s most intractable problems, from aging populations and the rise of chronic conditions to allocating healthcare resources more efficiently. But despite these benefits, telehealth largely remains an untapped tool for healthcare professionals. According to the Future Health Index 2019 report, telehealth has yet to become a common part of many healthcare professionals’ day-to-day work, with 39% reporting that they have never used the technology in their practice or hospital.
Finding the path to telehealth adoption at scale

Much of the discussion around telehealth focuses on concerns about losing the ‘human touch’ in care, or debates about the true quality of care when delivered from ‘behind a screen’. While those questions are important, they risk overlooking how telehealth helps patients and delivers value across healthcare. The Future Health Index team spoke to Professor Stanton Newman, Vice-President International, Professor of Health Psychology at City, University of London, to discuss how telehealth can deliver value in healthcare organizations, and where the conversation needs to shift to promote wider adoption.

 

FHI: What are the key healthcare challenges that telehealth can help solve?

SN: Management of chronic disease is a critical application. Aging populations and increasing instances of conditions like diabetes, heart failure and a range of other conditions require new early warning systems that will enable healthcare professionals to better prioritize patients needing care. 

Telehealth can also make primary care visits much more useful. These visits are often uninformed: the healthcare professional frequently does not know why the patient is coming and the very first question asked is “what brings you to my surgery today?”. If physicians had some pre-warning, over, for example, a patient’s blood glucose levels over time, that would lead to a more informed and effective use of healthcare professional and patient time. 

There’s also a great deal of value in driving patient behavior change, and telehealth has a role to play in this. Targeted information that is ideally personalized from telehealth technologies along with increased communication between healthcare professionals and patients can help provide patients with the ongoing support they need to maintain the behavior change that is needed for managing conditions such as heart disease, obesity or kidney failure.

 

FHI: There’s a common perception that adoption of telehealth technologies may alter the clinician-patient relationship. How can healthcare professionals mitigate against this?

SN: It’s important to establish a model where the first interaction between the patient and the physician is face to face. Whether that’s visiting a local healthcare professional or seeing a specialist in a hospital, that first consultation is vital in establishing a human relationship.

Once that has been done, the evidence is that you can shift the relationship to take advantage of telehealth technologies without jeopardizing it. Research suggests that patients like interacting with healthcare professionals via telephone, email or video consultations, as long as the relationship has been properly established at the outset. It makes sense if you think about it: telehealth enables patients to feel more in control of the situation by giving them more channels through which to access healthcare professionals easily.

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FHI: According to the 2019 Future Health Index, 71% of the general population have been discouraged from visiting a healthcare professional when they had a medical reason to go. Could telehealth improve this?

SN: That’s interesting. A key role for primary care services is to screen potential problems in patients. The patients that use primary care services are often described as the tip of the clinical iceberg: you only see a small part of the picture, and there are many more people who may need care but are not going to in-person primary care check-ups.

With wider adoption of technologies that enable patients to monitor, report and self-manage their healthcare needs remotely, healthcare professionals will start to have a clearer picture of the number of patients requiring intervention. This will then help move away from scheduling check-ups on a three- or six-month basis and towards scheduling appointments on the basis of clinical need. 

 

FHI: This would have an impact on how healthcare is financed in many countries: do you think this is a factor in low uptake of telehealth?

SN: There is this fundamental contradiction in many healthcare systems around finances. In a value-based care model, an outcome is potential reduction in the flow of patients to hospitals, as telehealth technologies would enable earlier interventions and prevent complications that would drive up cost. There is clear value in this arrangement, but in fee-for-service models, hospitals are rewarded for the number of procedures they carry out, so reducing patient flows in this way is completely against the fiscal drivers for any healthcare organization. 

A longer-term impact of telehealth technology will be earlier interventions driving increased survival with chronic conditions. This could result in increased costs for healthcare in the short term, but at the same time this fulfills our ethos of saving lives and improving outcomes and care.

 

FHI: According to the 2019 Future Health Index, 39% of healthcare professionals globally say that they have never used telehealth in their practice or hospital. Do we need more education around the benefits of telehealth in order to reduce this figure?

SN: This isn’t surprising. Many clinicians in hospitals are doing what I call the standard traditional model of care. They’ve had years and years of training in this model, and technologies like telehealth have significant implications for that model. This kind of change requires managerial support, training, and wider organizational changes. Telehealth adoption is not going to be driven by individual clinics or healthcare professionals – it requires a high-level decision from the wider healthcare organization, which would then roll out the relevant procurement, training and patient consent initiatives. 

Implementing telehealth takes bravery and bold decision-making: it’s not just about implementing new technology, there is a deep culture change required to change the years of training and financial relationships that have built up. The goal is to improve patient empowerment, patient quality of life and patient survival rates, but to do this at scale takes some time.