“Just as Penicillin was the wonder drug to emerge from WWII, perhaps we’ll look back on the COVID-19 Pandemic as the inflection point for teleHealth.”
Dr Mark Lewis, MD @marklewismd
Introduction
eHealth is a broad term which refers to the use of information and communication technologies in healthcare. In late 2018, digital leaders, representing the HSCP group and the National HSCP Office, came together to lead eHealth developments for the health and social care professions.
In the context of the COVID-19 pandemic, health systems are looking to rapidly expand the use of digital solutions across a number of different care areas and settings.
In this, the first in a series of eHealth-related blogs, we will set out the starting point for those of you currently grappling with deploying this complex service change at speed and, in particular, we will explore teleHealth considerations.
These unprecedented times require disruptive thinking and innovation.
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Digital Solutions – the Starting Point
Digitally enabled services offer huge opportunities to continue to provide high quality care, reaching patients in the community. In addition, for those HSCPs in isolation, digital tools can enable them to continue to work effectively.
Digital solutions always begin as well thought-through quality improvements, underpinned by sound Quality Improvement (QI) principles including a) being clear on the intended change and b) establishing how it will be determined that a change is indeed an improvement.
Technology serves as an Enabler, not the disruptor. It is important, too, to consider measures which will demonstrate improvement.
From our experience, keeping the service users at the centre of the plans is vital to ensure any change ultimately improves experience and outcomes for them.
HSCP are well versed in QI methodology with large numbers now trained and routinely leading QI projects in their work environments.
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Our Top Five Considerations for teleHealth Solutions
Prior to COVID-19, the need for teleHealth was outlined in Sláintecare action 10.3.3. ‘To provide teleHealth solutions to support delivery of care in the community closer to patients and their families’.
Aligning with this action, the HSE Service Plan 2020 has prioritised the adoption of a telehealth strategy.
Many HSCPs have already begun to design and implement teleHealth solutions and there has been a definite acceleration in the past fortnight.
So, what are the top five considerations for teleHealth solutions?
- Telephone vs Video consultation. Consider what is actually needed. Not all clinical interactions will need or can be delivered via video consultation, while a combination of both might be needed in some areas.
What use-cases are appropriate for Video consultations?
- Routine chronic disease check-ups
- Counselling and psychological support
- Any condition where trade-off between attending in person and staying at home favours the latter
When should Video generally not be used?
- Potentially serious, high-risk conditions needing extensive physical examination
- If internal examination (e.g. gynae) cannot be deferred
- Co-morbidities affecting ability to use the technology (e.g. confusion)
- Serious anxieties about the technology (unless relatives are on hand to help)
- Some hard-of-hearing patients may find audio difficult but, if they can lip-read or use chat, video may be better
Credit to Professor Trisha Greenhalgh on behalf of the IRIHS research team, University of Oxford https://q.health.org.uk/event/video-consultations-how-to-set-them-up-well-fast/
- Choose a solution that meets privacy and security requirements, and ensure that you have a secure network/wifi connection. The quality of the connection is also important – better connections mean better consultations!
- Liaise with your ICT department about requirements for set up – do you have a laptop or PC with speakers, microphone and webcam? Will you need a headset to keep hands free for writing or interacting with patient resources?
- Ensure that you design and plan the QI process for your teleHealth clinics before you start. Don’t jump in to making calls. Consider:
- Where will clinics take place? Is the environment set up appropriately?
- How will teleHealth clinics be scheduled?
- What information will the patient need in advance to prepare them for the appointment?
- How will consent be obtained and recorded? Measures taken in response to Coronavirus involving the use of personal data, including health data, should be necessary and proportionate. Decisions in this regard should be informed by the guidance and/or directions of public health authorities or other relevant authorities. See https://www.dataprotection.ie/en/news-media/blogs/data-protection-and-covid-19 for further information.
- How will you document the consultation?
- How will follow up be arranged?
- Consider what the patient will have to do to take part, you should aim to minimise the set up requirements on their part as much as possible as digital literacy can vary.
- Ensure that HSCPs delivering clinics have appropriate training on use of any new technologies.
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The National HSCP Office is compiling an online repository to collate and share eHealth and clinical HSCP resources to reduce duplication of effort at this time. Watch out for updates, it will be live on 3rd April, 2020.
This post was written by the eHealth HSCP Advisory Group.* Stay tuned – our next blog will address eLearning opportunities.
(*Members include Marie Byrne, Heather Cronin, Meabh Smith, Deirdre Gilchriest, Claire Browne, Joanne Dowds, Julie O’Connell, Fiona Maye, Orla Maguire, Ruth Reidy, Kate Murphy, Sarah Moore, Eileen Heffernan, Paul Ryan, Éadaoin O’Hanlon, Siobhan Keohane, Alison Enright).
“Move fast - Speed trumps perfection”
Michael Ryan, WHO
Do you need information and advice on COVID-19? Go to www.hse.ie/coronavirus
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