Virtual Care and Telehealth

Telehealth, telemedicine, and virtual care are partially overlapping terms.

In this section, we will cover:

The GDHP Evidence and Evaluation Work Stream reviewed studies evaluating telehealth and mentioned the WHO guideline of “using surveys, interviews, and literature reviews to evaluate mHealth and telehealth (digital health intervention) systems measured by improved communication to clients for behavioural change, and better monitoring of health status.” (6) Within individual engagement, “WHO recommends the use of client-to-provider telemedicine to complement, rather than replace, the delivery of health services and in settings where patient safety, privacy, traceability, accountability and security can be monitored.” (95) This will help ensure individual consent, data protection and storage, and verify provider licensing and credentials.

How does Telehealth Impact Individual Engagement?

GDHP members have observed telehealth has increased individual engagement. Overall, GDHP members have seen a significant increase in telehealth usage during the COVID-19 pandemic when individuals responded favorably to having a virtual care option for safety and convenience.

Ireland reports successes motivated initially by their COVID-19 response and continuing after the pandemic. Ireland emphasized telehealth is beneficial for solutions beyond virtual care, such as engagement, research, and evaluation.

Ireland | From Around the Globe

Telehealth in Response to COVID-19

The National Virtual Health Team (96) provides telehealth solutions. In response to the COVID-19 pandemic, telehealth solutions were deployed to great success. There is a national telehealth program focused upon four core workstreams:
1. Video Enabled Care
2. Remote Health Monitoring
3. Online Supports & Therapies
4. Engagement, Research and Evaluation

During the pandemic, several solutions were quickly deployed to support video-enabled consultations. Since 2020, there have been over 400,000 video-enabled consultations with individuals.

Individuals may be more engaged than they were before telehealth became available because telehealth enables some to receive healthcare who otherwise may not have been able to receive it. Before any new service like telehealth can gain widespread acceptance, people need to know what it is and how it can help them. New Zealand is working to help people understand telehealth.

New Zealand | From Around the Globe

Make Telehealth Understandable to Individuals

New Zealand has a NZ Telehealth Forum and Resource Centre (97) which provides guidance for individuals and health providers. Its Healthify He Puna Waiora website (98) gives information about telehealth with resources to support individuals and providers in the implementation of video and phone consultations. It also has a directory listing features and reviews of hundreds of health apps.

What are the Challenges to Telehealth and Telemedicine?

GDHP members state the barriers to telehealth reaching its full potential in their countries are technological, social, and financial barriers, such as:

• Limited technology infrastructure (broadband), especially in rural and underserved areas;
• Lack of digital health literacy;
• Concerns about security, privacy, and health equity;
• Insufficient reimbursement to providers of telehealth; and
• Lack of access to health records which is a disadvantage compared to in-person care.

Despite these barriers, telehealth and telemedicine are growing rapidly as the barriers are addressed, particularly technology infrastructure and digital health literacy. In a large-scale example, the Kingdom of Saudi Arabia has implemented telemedicine at a national level through a virtual hospital.

Kingdom of Saudi Arabia | From Around the Globe

A National Virtual Hospital

In the Kingdom of Saudi Arabia, about 30% of care is supplied virtually using a national telemedicine platform. Virtual care benefits Saudi residents in rural and remote areas where access to healthcare facilities may be limited since the residents do not have to travel far to receive care. The Seha Virtual Hospital is a national resource staffed by over 150 doctors with a capacity of over 480,000 patients annually. As the world’s largest virtual hospital, Seha is connected to a network of 170 hospitals around the Kingdom and offers over 50 subspecialties. (99) To pave the way for the success of the Seha Virtual Hospital, the Kingdom of Saudi Arabia recognized broadband infrastructure as the main condition for digital inclusion. The Kingdom of Saudi Arabia addressed technological barriers and, by 2019, 100% of the population was covered by a mobile cellular network, 97.5% owned a mobile phone, 96% was using the Internet, and 99% of households had Internet access. The Kingdom of Saudi Arabia also has programs to increase health literacy, digital literacy, and digital health literacy.

How is Telehealth Reaching Underserved Populations?

Many GDHP members with telehealth experience mention telehealth has been a major benefit in efforts to reach underserved populations. Several countries have identified that health equity improves as underserved populations gain more opportunities to receive healthcare. Brazil, Poland, Portugal, and Sri Lanka identify different types of disparities (geography, socio-economic status, health conditions) among populations where telehealth is improving health equity.

Brazil, Poland, Portugal, and Sri Lanka | From Around the Globe

How Telehealth Improves Health Equity

• Brazil promotes telehealth integrated with other national healthcare services, especially to reach underserved populations. It recognizes “telehealth and telemedicine services as essential tools to promote care for patients in vulnerable situations and in unfavorable conditions, located in remote areas, with greater social and geographic dispersion, with the same effectiveness of care in large urban centers.” (55)
• Poland highlighted remote provisions of healthcare have been significant to ensuring continuity of care and has allowed various groups of individuals to receive consultation which would not have been otherwise provided.
• Portugal bridges the financial gap by making telehealth services free to all its citizens.
• Sri Lanka reports good healthcare services coverage throughout the country. Their telehealth services will further enable healthcare providers and the public in rural primary care centers to receive consultations from specialized care centers. Sri Lanka notes telehealth is used frequently by people with diseases leading to social stigma.

These member stories demonstrate the importance of health equity being designed into telehealth efforts. While telehealth can improve health equity, equality is not guaranteed. A study in the United States of America notes “telemedicine use was highest among those living in the Northeast and West regions, and use increased with age, education level, and with family incomes at or above 200% of federal poverty line (FPL). Telemedicine use was highest in large metropolitan areas and decreased with decreasing urbanization level.” (79) Data from studies such as this can help countries identify and reach the populations most underserved by telehealth.

What Difference has Telehealth Made?

As noted by GDHP members, telehealth makes a difference in healthcare. Often, telehealth is narrowly focused on certain populations or disease conditions, but the scope is broadening over time. GDHP members recognize they can use telehealth in ways they did not anticipate initially.

Canada | From Around the Globe

Virtual Care and Remote Individual Monitoring

Canada has a long history with virtual care, especially for people living in rural and remote areas. The nation’s telehealth efforts originally focused on cancer care, mental health, teleradiology, and other specialized services which are scarce in remote areas.

During the height of COVID-19, virtual care represented about 60% of all visits with strong individual satisfaction. Virtual care rates have now declined to 20-30%, with important discussion ongoing about appropriate uses going forward and whether reimbursement for clinicians should be updated to incorporate virtual modalities for the long-term.
 
Remote individual monitoring is also common for some conditions. Several provinces support remote monitoring for congestive health failure and chronic obstructive pulmonary disease. It demonstrates a strong value proposition to keep individuals healthy at home and free up emergency and acute care capacity.

Australia, like Canada, has a large geographic area. Australia has used telehealth to increase continuity of care for many individuals who might not be able to travel for in-person visits.

Australia | From Around the Globe

Telehealth’s Critical Role Ensuring Continuity of Care

Telehealth has been transformational to Australia’s universal healthcare program called Medicare. It has played a critical role in ensuring the continuity of care for hundreds of thousands of Australian individuals. Australians can consult a medical specialist, allied health professional, nurse, midwife, or nurse practitioner via telehealth instead of face-to-face, if appropriate.

“Between 13 March 2020 and 31 July 2022, 118.2 million telehealth services have been delivered to 18 million individuals, and more than 95,000 practitioners have now used telehealth services – August 2022.” (100) Like Canada, Australia found the COVID-19 pandemic to be the driving force for telehealth initially, but now is realizing that telehealth’s sustainable benefits can continue into the future.

Telehealth Recap

Telehealth actions you may want to consider:

• Use telehealth to achieve high individual satisfaction and individual engagement;
• Address the main barriers to telehealth, including lack of technology infrastructure (such as broadband), lack of awareness, and lack of reimbursement in some countries; and
• Use telehealth to improve health equity and deliver care to underserved populations who otherwise cannot receive adequate care (such as rural populations).