The terms ‘telehealth’ and ‘virtual care’ are often used interchangeably to describe the provision of remote medical care through technology.
In reality, however, they are different.
Telehealth refers to the connection between clinicians and patients, or other clinicians, via a type of teleconference system. Virtual care, on the other hand, refers to the entire spectrum of digital healthcare services offered to patients.
According to Mr Kerry Stratton, Global Director of Healthcare Solutions at InterSystems, one key distinction between the two terms is the word “care”.
“We’ve seen the need, during this COVID-19 period, to take telehealth to the next level. And that’s where patients have been unable to attend their Primary Care physician, local healthcare specialist facilities and hospitals,” said Stratton.
“But patients have still needed to receive care. Going forward, for telehealth to continue in a meaningful way, we need to focus on how to provide the best quality care and patient experience.”
Benefits of virtual care
The pandemic has unsurprisingly led to a surge in demand for telehealth services, with patients preferring to stay home rather than visit a medical institution. Most hospitals, too, have opted to restrict in-person appointments to minimise the risk of cross infections.
However, there are other benefits to virtual care that go beyond what has been necessitated due to COVID-19.
Stratton highlighted how chronic illness patients are now able to cut down the number of times they have to physically visit their specialist or doctor for routine appointments.
He believes the growth of virtual care will continue well after the pandemic. “The risk of infection is not the only reason to treat patients remotely. Patients with chronic conditions, for example, should not have to spend large parts of their lives traveling to appointments and sitting in waiting rooms.”
Nor is videoconferencing the only technology enabling virtual care. There is also enormous potential for consumer technologies to improve the experience.
“In China, we’ve seen private hospitals redesign their approach to care around an online-to-offline integrated experience. They have leveraging the InterSystems TrakCare healthcare information system and WeChat social media platform for online scheduling, bill paying and communications for medical encounters.”
The next step, he said, is to leverage remote monitoring, telemetry and smart devices, and seamlessly connect them to patients’ electronic medical records. This is something InterSystems is currently piloting with a private hospital in Thailand.
“Virtual care enables much more than regular appointments,” said Stratton. “It’s also about clinicians being able to reliably gather data via connected devices when patients are in a remote location.
“So it’s not only convenient for the patient and for the doctor. It provides a clinical benefit, because the clinician can collect data and rely on that data to make decisions about their patient.”
Getting buy-in and building trust
Virtual care has really only shot to prominence during the pandemic and will need some time before it is widely accepted by both patients and clinicians.
To get buy-in from patients, Stratton believes that healthcare providers need to build more trust in the reliability of virtual care.
“Patients need to feel like they’ve had a proper consultation,” explained Stratton. “That means the experience the patient is getting must feel like something they would have got from an in person consultation with a doctor.”
Buy-in from clinicians is just as important. There are two aspects to this, he said: technology must enable doctors to treat their patients effectively, and it must alleviate the drudgery of tasks such as searching for information and minimising data entry.
“Clinicians need to feel that they are using their skills in a better way, that they are in control of the situation and are able to focus on the patient interaction and make the best decisions,” said Stratton.
“During the virtual care episode, the clinician needs to be able to seamlessly look at the patient’s history and other relevant information without being distracted from communicating with them,” he said.
“So they need an EMR (electronic medical record) system that is very intuitive and easy to use and presents itself in a seamless way.”
To provide high quality care, clinicians should be presented with the relevant information for the current episode, said Stratton, without requiring them to sift through irrelevant data. It also needs to be accessible on any device, in any setting.
For clinicians, trust in the information is also essential. The EMR must ensure that healthcare data from different kinds of sources, including remote devices, is usable by clinicians.
“We need to segregate information so the doctor knows what data has been collected remotely, and what’s been collected through clinical labs, for example, with proper governance. That needs to be clearly understood.”
Interoperability and governance
While admitting that there will never be a 100% perfect virtual care solution due to ever-evolving technological advances, Stratton is confident that InterSystems is “pretty advanced”, having been able to quickly accommodate the immediate concerns of clinicians over the last two years.
“Our investment in innovation helped prepare us for the pandemic,” said Stratton. “We immediately understood what the problems were and what we had to focus on.”
COVID has only served to accelerate demand and adoption of advanced healthcare technologies.
“The ability to connect third party apps into an EMR system is really important. Our data platform, IRIS for Health, incorporates FHIR (Fast Healthcare Interoperability Resources), and that’s key to integrating both wearable devices like Fitbits or Apple Watches, and biomedical equipment in the home like oximeters.
“So interoperability is key – the ability to connect and push information or pull it into the EMR.”
Sending data from remote devices directly into the EMR system will also allow clinicians to perform analysis and identify trends which can assist the clinician in making the decision of what the next treatment for a patient should be.
Another key area was clinical governance, to ensure the integrity of the data collected. Stratton noted that healthcare systems require stricter levels of governance than others, given that the lives and well-being of patients are at stake.
“We are very much focused on the principle of ‘do no harm’. Clinical governance is prioritised in the development of our technology and the systems we implement are tested by clinicians working in our clinical safety group,” said Stratton.
“We make sure, for example, that healthcare data is checked thoroughly by the EMR System on the way in. If it is not identifiable, understandable, or pertinent to the questions being asked, we prevent it from being used.”
The future of virtual care
With healthcare providers focused on the fight against COVID-19, many patients with chronic illnesses – bar those in critical condition – have had to wait longer to receive treatment.
In England, for example, almost five million people – a record high – are still waiting for hospital treatment as of May this year.
Stratton predicts more healthcare providers will turn to virtual care to provide effective treatment, as it saves patients time traveling and waiting for care compared with in-house consultations, and saves money by diverting patients from emergency departments.
“If we can overcome some of the issues with telehealth, and turn it into more of a care paradigm, more people could get access to specialist care and have consultations virtually,” said Stratton.
“Then it would be a natural progression for virtual care to become something that’s real and wanted, and it could be used to help cut down waiting lists to a more acceptable level. This would take the pressure off clinicians, and obviously be of benefit to patients.
“As a technology provider, if we can provide systems that enable the provision of care to patients in a more convenient and effective way, and is also sympathetic and empathetic to their situation, then I think it’s really meaningful and worthwhile doing.”