COVID-19: the case for telehealth provided on a silver platter.

Why this is the accelerant virtual care really needed.

There has been no shortage of COVID-19 headlines in the last couple of weeks. The pandemic is shutting down our world’s immune system by crippling entire continents and collapsing whole economies, all while stripping people from the social freedom they’re so used to.

Our current challenge is not to eliminate the coronavirus, nor is it to stop all contagions. It’s to pospone coronavirus contagions long enough so that our healthcare system is able to handle all cases, ultimately driving down fatality rates. Flatten The Curve, as they say. Remember how supermarkets were flooded with people buying enough toilet paper to last a decade? Well, imagine the same amount of people flooding our hospitals, only to find out there were no more beds and ventilators. If we don’t take up our responsibility, it’s fair to say that hospitals — together with their healthcare staff — will crumble under the massive pressure we’d be putting on the system.

Many argue that, once we get control over this virus, life as usual might mean a very different thing. But it’s times like these that enable new advancements to see the light of day. COVID-19 will invigorate new innovations and accelerate existing ones. And among those, telehealth rapidly moves up the priority list.

Telehealth around the world

Many cities and countries across the globe are turning to teleconsultation services to cope with the growing demand for care. The UK is shifting its efforts towards a digital-first triage model by introducing free training programs to support healthcare professionals in carrying out remote consultations. The U.S. announced an emergency declaration by expanding telehealth benefits for Medicare beneficiaries, and its Boston Children’s Hospital is doing more virtual visits in a given day than they did the entire proceeding year. The American scale-up Solv even saw their consumer telemedicine usage up nearly 3400% in one month, and the number of daily active telemedicine providers on the platform has increased by 2425% in that same period of time. In Germany, healthcare professionals are allowed to actively promote their telehealth services to patients, and the German health ministry is currently promoting free telehealth services during the coronavirus crisis. And last year, Stockholm even made it mandatory for healthcare providers to offer digital services in an effort to really provide on-demand healthcare to their patients.

Telehealth’s ability to increase access to care, reduce healthcare costs, decrease risks that come with hospitalisation and improve quality of care delivery has already been shown by studies resulting in 38% fewer hospital admissions and 31% fewer hospital re-admissions. And France learned that 7 out of 10 patients got the answers they needed during online consultations, whereas only 2 out of 10 were instructed to physically see their doctor for a more thorough examination.

There’s even a growing number of digital healthcare organisations, of which the best known example is Mercy Virtual: the first virtual hospital — one without beds — in the U.S., which is operating solely through the use of telemedicine by using highly sensitive two-way cameras, online-enabled instruments and real-time vital signs. And closer to home we have Ksyos, a Dutch digital healthcare organisation that has enabled accessible and affordable healthcare to more than 350.000 new patients last year alone, provided by its 12.000 doctors and medical specialists.

Just like technology is never the solution but only the enabler, telehealth will never be the intervention but will simply enable interventions that might otherwise be unaccessible, unaffordable or inefficient.

And in Belgium?

Even though 64% of our population shows to be willing to communicate online with their care provider — which was shown before the current crisis — there aren’t many signs of telehealth in our tiny country yet. Only AXA Belgium — a private health insurance provider — took matters into their own hands by launching teleconsultation reimbursements for their client base a few months ago.

But the COVID-19 crisis forces nations to solve problems quickly and efficiently, so the following headline caught the eye of the belgian healthcare community: “Doctors temporarily receive renumeration for medical consultation via telephone.” The Belgian minister of social affairs and public health announced the approval to enable a way to triage patients who are possibly infected with the new virus, and to guarantee the continuity of care for other patients. Oh, and the push for this approval seemingly came from the doctors syndicate and healthcare professional associations themselves. It makes sense though, because it’s the healthcare professionals — especially doctors, nurses and pharmacists —who are especially vulnerable, since they’re serving at the front line of the current crisis. And the looming shortage of protective gear isn’t helping either. Sick healthcare professionals would result in less people to take care of the growing number of COVID-19 cases, but also all other patients who might still need urgent care.

But it’s rare to see such a move initiated by exactly those who fear that these technologies will profoundly alter the way they practice their profession. I guess COVID-19 could be the tipping point for the nay-sayers to realize the benefits might greatly outweigh the reasons not to use these technologies. And while, in the meantime, the same approval has taken place for psychology and speech therapy, it’s only a matter of time before the remainder of our health domains follow suit.

However, it’s important not to mistake approval for propper implementation and execution, otherwise we’re missing the point. Unfortunately, many patients are unaware of this new approval, and doctors are confused about how to communicate this new way of working with their patient population. So, many people who feel sick — especially in COVID-19 times — head down to their doctors’ office where they find themselves in front of closed doors, which ultimately leads them directly to pharmacies or hospital emergency departments. And that’s exactly the result this measure wanted to prevent. Besides, it’s 4,5x more expensive if patients are admitted through the hospital’s emergency departments, even for the ones that aren’t in need of an emergency intervention. Given the continuous increase of these numbers each year, telehealth might turn out to be a game changer. Especially since none of the previous measures taken by the government and the hospitals seemed to have a positive effect on the amount of people coming through those emergency departments’ doors.

Now, in Belgium, there aren’t too many teleconsultation software providers yet, which might be why this approval specifically talks about consultations over telephone instead of through video chat. ViViDoctor was once a promising Belgian start-up, but unfortunately start-ups go bankrupt when an alleged approval keeps pending for multiple years. I’m sure the current crisis will give rise to a few new Belgian players, so I’m getting my hopes up for this temporary measure to stay in effect after the pandemic.

Redefining telehealth’s meaning

For more than 4 decades, medical professionals have been sending medical imaging from facility to facility for analysis, making it the first domain in healthcare to fully embrace this telecommunications trend. Radiology used, and still uses, telehealth in it’s most infant form. And even though more extensive telehealth capabilities have been around for a while, utilization has been very low. Broader acceptance requires important regulatory changes, firm interoperability infrastructure and new reimbursement models. With the continuous growth of mobile communications technology, the benefits of telehealth have moved straight into our pockets. Not to mention the possibilities to deliver healthcare across national borders, once cultural biases, international regulations and technology standards have been ironed out.

Where businesses have already embraced tools like Zoom, Skype and Teams for remote work, now individual healthcare providers and patients are discovering the benefits of using them in their home setting. Patients tune in with their physical therapists to continue their exercises through an extensive video library, sporty individuals participate in online workouts and social media does its job to make sure everyone is aware.

But telehealth isn’t just about teleconsultations. The emergence of sophisticated technologies such as artificial intelligence allow for chatbots to become a very viable tool for human conversation and engagement. The role of the growing ability for technology to understand voice, recognize images and figure out speech patterns, will be built into the dialogue to enable analytics that expand the simple conversations to a diagnostic tool in of itself. And after the algoritms do what they do best, we’ll likely see the integration with consumer-facing healthcare service providers to enable automated shipping of personalized testing kits, nutritional items and individual advice.

Just like technology is never the solution but only the enabler, telehealth will never be the intervention but will simply enable interventions that might otherwise be unaccessible, unaffordable or inefficient. I’m curious whether it’ll be the traditional providers that will adopt virtual care modalities, or whether it’ll be start-ups who are building digital practices from the ground up. In any way, 2019 proved to be a record year with a whopping $1.8 billion in global VC funding, so it’s safe to say that telehealth start-ups will be watched from up close after the corona pandemic.

Although the coronavirus continues to have a devastating impact on many facets of our society, at the same time it’s an opportunity to take a step back and rethink our model of care. An opportunity to rethink how we see patients, how we interact with them, and how we set ourselves up for a future in which we are able to contain a new virus before it becomes a pandemic. But it’s above all a crisis that grounds us, and enables a willingness to collaborate and experiment at a speed never seen before.

For telehealth, COVID-19 is the accelerant it needed.

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As a disclaimer, the views or opinions expressed in my blog articles are personal and do not reflect upon those of the people or organisations I’m associated with.