Emeritus Professor Anthony Maeder
Former Chair in Digital Health Systems, Flinders University
Telehealth is the provision of health care services remotely via electronic media such as phones or the internet. Telehealth offers the appeal of convenience and flexibility for all parties by enabling live ‘synchronous’ patient-carer interactions under less restrictive organisational constraints than needed for simultaneous collocated physical presence. Positive experiences with immediacy, personalisation and continuity of care provision lead both parties to find value in the approach. Numerous studies in a wide variety of care settings internationally have established the general acceptability of telehealth by both subjects of care and their health practitioners, who have been repeatedly reported as enthusiastic and engaged.
The last few years have seen a much broader adoption of telehealth across Australia than previously, partly in response to ever more stretched healthcare resources (especially workforce constraints), and partly due to the need for physical distancing and other infection control precautions during the COVID-19 pandemic. Health Minister Greg Hunt famously claimed ‘ten years progress in ten days’ from the rapid step-change increase achieved in telehealth services at that time. This phenomenon also swept aside lingering doubts about technological and human capabilities limiting the feasibility of scaling up telehealth.
But now questions are being raised in public and professional circles on the long-term effectiveness and sustainability of increased telehealth usage. These two issues have been made more prominent and immediate by the impending review of Medicare, along with discussions of broadening the base of health service delivery workforce members who can be properly engaged in telehealth. Both issues are highly relevant to considerations of how telehealth can assist in aged care, and so deserve consideration within that specific context.
Effectiveness or ‘doing good’ can be assessed through multiple perspectives. The associated clinical effectiveness of a unit- or program-of-care delivered by telehealth as compared with normal care provides a baseline view. Beyond this level, the efficiency of related service delivery and satisfaction of participants in the process add enhancement. At an even higher level, long-term service design and management decisions with attendant cost-benefit-risk analysis provide extended effectiveness criteria. We can imagine effectiveness as the clarity of the ‘window’ through which patient and practitioner experience care delivery, with a two-way process of personal interaction at its core.
Sustainability or ‘keeping going’ is partially dependent on effectiveness but is also highly dependent on the service ecosystem and its various administrative and economic constraints. On one hand, practical sustainability depends on the extent to which the components of telehealth-based service delivery can be integrated with existing workflow and infrastructure. Ideally, it becomes seamlessly embedded in numerous delivery processes and therefore subject to the same continuous improvement and cost containment expectations as the whole system. On the other hand, corporate sustainability is closely linked with how the overall health system evolves and new models for service delivery and payment emerge. The current approach of treating telehealth as ‘special’ and needing differentiated attention to support in areas such as training, management, and billing, is unlikely to lead to this form of sustainability. We can envisage sustainability as the ‘doorway’ through which many care delivery activities must pass, in a streamlined and unhindered manner.
Measuring and influencing these multiple factors affecting effectiveness and sustainability is more challenging in the aged care setting, due to the highly individual nature of care situations and subjects, with often imposed complex care settings. It is further confounded by the mix of workforce members and how their skillsets and qualifications might impact on their ability to deliver care properly using telehealth. Introducing or extending telehealth in the aged care arena requires a thorough analysis of associated delivery needs and pathways to allow appropriate and flexible service design. Thoroughly inclusive co-design approaches and large-scale survey- and interview-based implementation studies might offer more informative insights for effectiveness and sustainability in these circumstances than more conventional methods.
Both effectiveness and sustainability influences can also be identified upfront to some extent by gaining an understanding of the readiness or ‘maturity’ of the intended telehealth delivery environment. Frameworks for this type of analysis typically distinguish characteristics of all the different collaborating agents and channels involved, supporting ‘window’ and ‘doorway’ perspectives rather than a one-track outcome-driven appraisal. Undoubtedly experiences gained from ‘window’ and ‘doorway’ thinking in other examples of aged care service design and delivery will inform telehealth innovations and lend momentum to its incorporation.
*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.