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.