The future of telehealth in residential care: opinion

COVID-19 is seen as the catalyst for many changes to entrenched behaviours and practices across society. Of all sectors these changes have been no less in aged care.

The reality is that Covid accelerated existing slowly evolving trends by a factor or 10 or 100 in some cases. It also brought into the spotlight and into use, technology capabilities that had been available for years but without widespread adoption due to a variety of reasons: fear of change being the biggest.

So where have we come from and where are we going?

Telehealth is a phone call with a medical professional: which has been available since Alexander Graeme Bell invented the telephone over 140 years ago, however not widely adopted.

Telehealth 2.0 saw the addition of video call capability using platforms such as Zoom, Skype and Facetime. Interestingly, when Covid restricted the possibility and desirability for the community to visit medical professionals, much of the industry leapt on the idea of doing consultations by video.

However, people soon realised that in many cases video wasn’t much better than a phone. In fact in some cases, it was worse because of unreliable connection quality. So they moved towards relying on the phone more so.

And while many of us found a phone call to the doctor to be handy, there was no method for the doctor to gather reliable clinical data.

The gap between what telehealth is for most and what it could be for all is the ability for medical professionals to conduct a reliable clinical examination remotely. Enter Telehealth 3.0.

Telehealth 3.0 sees the augmentation of a video call with devices that are purpose-built to accurately capture and share that clinical data with the patient in one location and the medical professional in another. And with this evolution comes many other benefits to patients, carers and medical professionals.

What benefits does Telehealth 3.0 provide aged care residents?

"In many cases with phone or video-based telehealth the outcome of the appointment is the need for a face to face appointment anyway. Which frustrates everyone (patients and doctors) and doubles the number of appointments," says Ariel Linker, director of global business development at Tytocare, developer of Tyto.

Tyto is an all-in-one medical device that pairs the virtual visit with clinical examination. It addresses the telehealth gap, Ariel says.

“The only thing we care about is that at the end of a consultation the doctor can provide a diagnosis. Our statistics say they have achieved this in 94%+ of cases across 10,000 healthcare providers," she says.

Responsive Care

Where a medical issue requires a quick response, elderly residents are frequently rushed to hospital, which brings with it a myriad of issues for the resident and carers. Especially when a resident is frail, immunocompromised or highly transmissible illness is circulating in the wider community. In many cases this move to another facility could be avoided with responsive telehealth care.

Specialist care at the bedside

Across the globe medical specialists are in short supply. While this applies in metropolitan areas, regional areas are significantly more affected. Using Telehealth 3.0, specialists can provide care directly to a resident without the resident leaving their bed.

Visionflex is an Australian company providing telehealth solutions. Their telehealth devices include general exam cameras, which allow specialists to examine residents for issues in domains such as oral inspections, dermatology and especially wound care.

“Telemedicine for wound management is in demand and very effective using our devices," says Mike Harman, Visionflex’s CEO.

Collaboration in care

Another benefit of the technologies used to support telehealth is that the data is captured and recorded, enabling it to then be shared with others; perhaps family or specialists when a matter needs to be escalated or second opinion sought. All of this without the trauma and upheaval of further attendance at a hospital and examination by a doctor. Equally, this high quality of examination data can be uploaded to an electronic health record, providing a better medical history than physical artifacts stored in filing cabinets across multiple locations. 

What benefits does Telehealth 3.0 provide aged care staff and management?

Care staff empowerment

Whenever a resident leaves their aged care facility staff are immediately distanced from what then follows until the resident returns. And what often remains is an accurate knowledge gap of what transpired. This disempowers staff and negatively impacts their ability to provide the best level of care possible. Telehealth appointments enable and often require staff to play a greater role in the process which reduces the gap.

Build capability and clinical skills of care staff

Playing a greater role in the examination and assessment process will inevitability improve the capability of care staff. Which isn’t to replace doctors and specialists but can contribute to more accurate sharing of resident symptoms and response to care regimes. Equally, it can better equip staff to identify matters of concern that should be escalated.

Operational efficiency

When a resident is moved outside a facility for medical reasons this can not only be traumatic for them but lead to great disruption for staff. This disruption generates operational inefficiency for staff that are already stressed. Reducing resident movement improves operational efficiency.

What is required to make Telehealth 3.0 work?

Mindset shift

People involved in providing medical care are typically and justifiably risk adverse. For this reason, historically, health related industries are slow to adopt new technologies and lag behind all other industries in technology adoption.

So, although the case for telehealth is strong there is still a reticence to adopt. Covid forced a change in this mindset which progressive organisations need to harness and continue to push forward.

Dr Paresh Dawda is the director of Prestantia Health and Next Practice Deakin in Canberra. Both practices have a strong focus on providing services in to aged care and increasingly embedding telehealth.

Dawda agreed that there has been hesitation to adopt telehealth on both sides, among providers and care recipients.

However, "when done well, in the right circumstances", he says, “it can be at least as effective".

Dawda is seeing a growing number of aged care facilities who are successfully using telehealth with increasing frequency and says that staff are becoming more proactive in asking if they can engage with it.

This is a major hurdle overcome and would be further supported by all care providers being trained to identify when an in-person appointment would be more appropriate than a telehealth appointment.

Annica Blake, a US based managing director at ThinkLabs, says clinicians need to feel comfortable with their ability to provide an accurate diagnosis.

Blake and her colleagues have developed a range of digital stethoscopes which capture and record a patient's condition in real-time or via a remote recording.

She says that providing an accurate diagnosis can help to manage risks and ease a patient's uncertainty about adopting telehealth.

From a patient point of view, uncertainty regarding the adoption of telehealth comes equally from a fear of the unknown. However, again, Covid 19 saw many grandparents learn how to video chat with their loved ones. This alone has broken down perceived barriers to technology adoption.

Government support

It would be fair to say that pre Covid, Australian governments were largely unsupportive of telehealth initiatives. And Australia was not alone when compared with countries around the globe.

"In Australia the concept of telehealth was not widely available because of government funding models. This has now changed. Sadly, driven by covid, but now here to stay," says Ariel Linker.

While Australian Governments are now better funding telehealth appointments there are still many restrictions in place which could be reduced to improve telehealth adoption across the community.

Infrastructure

Any telehealth initiative adopted by an aged care facility must be underpinned by appropriate infrastructure. For example, video calls and examinations dropping out due to poor WiFi and internet will quickly kill off initial enthusiasm for telehealth.

Devices such as tablets and smartphones that support the gathering of clinical data must meet the minimum requirements determined by the suppliers. Cutting corners will only prove counterproductive.

A telehealth initiative and associated infrastructure requirements should be part of a broader technology strategy that supports the achievement of organisational goals.

The majority of aged care organisations do not have such a strategy. So, when funding becomes available, they invest in what seems like the most immediate need. However, without a holistic strategy there is very real danger that this investment, at this time, will miss the mark and generate other unforeseen longer-term issues; or simply prove to be a wasted purchase. Many organisations that rushed to improve their technology capability in response to Covid are already witnessing this.

With this is mind it is important for any organisation to understand the broader technology landscape of where they are now and where they want to go. Equally they must ask: what technology is widely available that would help us get there and what’s coming that will help us get there quicker and with more successful outcomes for all stakeholders?

What’s next?

No one is pushing for a 100% telehealth approach. However, many agree that a hybrid approach that combines in-person and telehealth care would deliver very positive outcomes for all involved.

Telehealth and technology in general offers aged care providers great opportunity to improve care, reduce stress on staff and deliver better outcomes with less budget.

One of the challenges is trying to predict what technologies are around the corner. If an organisation is cognisant of the direction technology is moving and underpinning infrastructure requirements they don’t have to try and read the tea leaves.

The lead time between technology being available and its widespread adoption is many years. So, organisations have the opportunity to develop 3-5+ year strategies for the adoption of technologies that will support the achievement of organisational goals. In doing so, variables such as budget, staff training and change management can all be incorporated. It all starts with a plan.

Mark Williams is managing director at Quigly Independent Consultants and researches technology in aged care.

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