Wednesday, April 5, 2017

Why Telehealth Won't Make Healthcare Sustainable - Semantic Consulting


Underlying our largely broken health system lie a number of faulty assumptions.  Chief amongst these is the idea that healthcare only occurs when a patient meets face-to-face with a health provider.  The appointment is currently the fundamental unit of healthcare delivery across the globe.  Behind this assumption lies the view that healthcare is so complex and knowledge-intensive, and health providers so deeply skilled, that anything outside of the face-to-face appointment is not legitimate healthcare.
In my view, this flawed assumption contributes to an incorrect understanding of what healthcare actually is.  I’ve started to refer to this as “the flawed architecture of healthcare“.  In response I’d like to propose a new architecture for healthcare, drawing heavily upon many of the concepts contained within the transcript of Don Berwick’s Escape Fire address.
Rather than healthcare only occurring through the transactional unit of the appointment, I’d like to propose that “healthcare occurs every time a patient interacts with information that relates to their own health.”  In some (perhaps many) situations this interaction between patient and information can and should be mediated by a health provider, but not always.
There are many legitimate cases where a patient can and should interact with health information that will support their decision making and modify their behaviour.  In a previous blog post I gave the example of how my wife and I used Digital Health Communities to support us through a very difficult time when my wife suffered from Hyperemesis Gravidarum during two pregnancies.  In that post I explained that we used helpher.org, not for diagnosis, but for emotional and psychological support, and for the sharing of stories.  I argued that this was every bit as much “healthcare” as the many appointments that we attended.  This distinction is critically important, because it continues to hold back the sustainability of our health systems, even in the face of much so-called innovation.
Let me take the example of telehealth…  Firstly, let me be clear that when I say telehealth I mean health appointments via video conferencing.
Now don’t mishear me, I believe that telehealth does great things for the accessibility of healthcare.  It lessens the tyranny of distance, giving greater access to primary and specialist healthcare for patients living in rural and remote areas.
But here’s the thing.  Telehealth (i.e. video conferencing) does nothing to change the fundamentally flawed current architecture of healthcare.  In fact, it serves to reinforce the view that healthcare is about face-to-face appointments, albeit via video conferencing.  Telehealth does nothing to improve sustainability by allowing patients to interact with health information, but merely digitises the existing construct of the face-to-face appointment.
If we’re looking for a major step forward in health system sustainability, telehealth is not it.  Rather, we need to look towards the ways in which digital health will allow us to connect patients to providers through mobile devices, creating genuinely new models of care in which clinicians can engage with their patient cohorts in ways that don’t always involve face-to-face appointments.

Telehealth does offer an increase in accessibility. Studies have already shown that it actually increases the number of office or clinic visits.  Reports on ROI are also in question.












Why Telehealth Won't Make Healthcare Sustainable - Semantic Consulting

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