Healthcare has traditionally been a slow-moving, cautious industry, but COVID has forced Australian healthcare to make changes within weeks that would otherwise have taken years.
Before 2020 and the COVID-19 pandemic, Australia healthcare wasn’t known for lightning-fast tech adoption. Probably for good reason. Healthcare has traditionally been a slow-moving, cautious industry, tied down in overlapping regulatory frameworks and the obvious need to prioritise patient safety. But COVID has forced Australian healthcare to make changes within weeks that would otherwise have taken years, perhaps decades.
The biggest, of course, being telehealth.
In April 2020, the Australian government expanded the Medicare-subsidized telehealth system, with 5.4 million remote consultations being conducted around the country. That number has now passed 40 million. A niche technology, once used by remote rural communities or bleeding-edge healthtech start-ups, had suddenly become the default care model for pretty much the entire country.
Is telehealth here to stay? Health Minister Greg Hunt seems to think so. On 27 November last year, he announced that universal, whole-of-population telehealth would now be a permanent fixture in Australia. “There’s not been much good that’s come from COVID,” he said. “One thing that has come from COVID is the fact that we have skipped a decade and jumped from 2030 to 2020 for the delivery of telehealth for all Australians.”
It’s hard to overstate just how big a change this has been. Professor Anna Peeters, director of the Institute of Health Transformation at Deakin University, says telehealth adoption in Australia, before COVID, was minimal at best. "It's been really low rates — we're talking hundreds of thousands of consultations per year, which as you can imagine is a tiny proportion of consultations that happen in Australia," she says. “But it’s a much more convenient way of accessing healthcare, it's a much more equitable way of accessing healthcare, and it can also give [the practitioner] more flexibility.”
This is the big question. There aren’t many healthcare professionals in Australia who wouldn’t want the industry to become “more convenient…and more equitable”, but is telehealth the best way to do that?
First things first: what is telehealth? Telehealth is the umbrella term for a collection of treatment options, including things like telemedicine and telephysio. It’s simply the use of digital technology to support long-distance clinical healthcare, in all its various forms. Essentially: doctors on Zoom.
The health sector was already beginning to embrace telehealth before COVID-19—particularly in rural Australia—but that steady growth has become a “tsunami” over the last year. Research firm Frost & Sullivan now predicts a sevenfold boom in telehealth by 2025, which is going to put a huge strain on providers, practitioners and worldwide digital infrastructure.
Not all practitioners or organisations are fans. Some things seem to simply work better in the flesh—like rehab. The Heart Foundation, for example, is urging hospitals to bring back face-to-face cardiac rehabilitation programs, after seeing engagement rates plummet towards the end of 2020. Only 14 per cent of heart attack survivors are actually doing their rehab via telehealth (compared to 73 per cent of face-to-face patients). This can obviously have pretty dire flow-on effects for recovery rates and further attacks.
“As restrictions have eased, face-to-face cardiac rehabilitation programs can be resumed, and telehealth should become just one of several options that can be tailored for the specific patient,” says the foundation's general manager of heart health, Bill Stavreski.
Most criticisms of telehealth follow similar lines: it’s a useful tool for doctors, sure, but perhaps not suitable as a universal method of care.
Tech companies, as you can imagine, see telehealth slightly differently. “It serves as a wake-up call for doctors to start ditching the traditional approach to medicine,” says Sajjad Kamal, co-founder and chief technology officer at healthtech start-up, AlemHealth. “They need to be more open to digital disruption. Taking a collaborative approach to tackle the crisis becomes necessary. It’s time for tackling healthcare problems through a collaborative approach where doctors can join forces with data scientists, entrepreneurs and other stakeholders.”
To give them their due, most Australian doctors seem to agree with Kamal. The Royal Australian College of General Practitioners sees telehealth as a “primary building block of healthcare reform”, and they’re pressing for telehealth to become permanent. “GPs and patients have benefited significantly from telehealth services and we have been actively lobbying the Government to see them become a permanent fixture,’ says RACGP Acting President Associate Professor Ayman Shenouda.
The benefits to telehealth are obvious. Patients can get from treatment and advice from the comfort of home. Telehealth is still backed by Medicare, so in many cases it’s entirely subsidised by the government. And patients no longer need to risk COVID-19 in order to receive medical treatment. It’s popular, too: according to a recent Cisco global survey, 74 per cent of patients prefer easy access to healthcare services over face-to-face visits.
Of course, the technology has its limits. There’s something unsettling about the quality of a person’s healthcare being dependant on the quality of their internet connection (a problem 5G will hopefully solve down the track). There are certain procedures and check-ups that can only be done in person—skin conditions, for example, seem to be increasingly misdiagnosed via telehealth. And some experts have also flagged continuity of care: telehealth patients can sometimes get bounced around between different practitioners, and it’s up to hospitals and clinics to implement data solutions and keep records up-to-date.
Some experts believe, by the time it has ‘passed’, the pandemic will have driven a decade’s worth of digital transformation. On balance, that’s a very good thing. Perhaps the only good thing to emerge from COVID-19. Rolling out telehealth for all Australians would have happened anyway, given enough time, but the pandemic forced us to innovate faster. And it’s hard to see anyone, doctors, regulators or government, squeezing the telehealth genie back into the bottle. Universal telehealth is probably here to stay, at least in some capacity.
Of course, Shenouda says it’s not really a question of one thing or the other. ‘Not everything can be done via telehealth and we will still … always offer face-to-face consultations,’ Shenouda says. ‘So if you need to see your GP face-to-face, you will be able to. That will not change.’
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