Saturday, Jan 28

COVID-19 Accelerates Digitized Health System

The world on December 31, 2019 began a war not against humans, ideologies or aliens but against a minute virus that can never be seen with the eye. A war not fought by soldiers, words or machines but by frontline health professionals.

In a war where saliva is deadlier than a bullet, and all participating are armed with facemasks, reinforced with sanitizers and secured with constant handwashing. This type of war, the biological warfare, is unlike the warfare usually experienced where blood, smoke and shattered buildings characterize the battlefields.

Though this warfare has seen some blood spill, the common trait found when comparing World War II to COVID-19 is the aftermath; change from the normal to a new normal.

According to McKinsey, after World War II “there was no postwar miracle; the actions that forged recovery were all human made. Good policies, political commitment, and hard work made it happen. The same will have to be the case in recovering from the coronavirus crisis. Not the same policies, of course—the conditions are too different.”

However, with the coronavirus war, the dictate of recovery would be digital which has already started taking form. At the initial stages of the outbreak, most countries placed restrictions on movement where people stayed indoors all day and businesses stopped operating except those that engaged in delivery of essential products and services.

While the virus was declared a pandemic, activities and interactions were boosted online as it was revealed that the virus spreads through physical proximity. Almost all transactions were moved to electronic platforms for fear of getting too close with another whom you may not know may be infected and also to prevent touching cash as notes and coins were likewise said to be carriers of droplets that could possibly carry the virus.

Shopping for the littlest thing including groceries moved to online platforms which increased delivery services. Education was moved online as it is nearly impossible to prevent students from touching, hugging or speaking to one other.

In the world of health, the fear of having to go to the hospital without the virus and getting infected at the hospital deterred people from visiting in person. The stigma of being looked at from the corner of the eye at the hospital for reporting symptoms like headache, cough and running nose led to the preference of online consultations with doctors.

The thought of getting infected by carriers of the virus caused health professionals to equip themselves with digital knowledge to reduce the number of people who visited the hospital except it was a dire situation.

Since the pandemic era, suggestions are the health system will never revert to its position of the pre-COVID, literally and figuratively, neither will it remain where it is now as the system is rapidly evolving. Prior to COVID-19, telehealth and home care were niche areas that had not yet reached its potential but were gradually taking shape. However, the advent of the novel coronavirus came along with a new dawn for the face of telehealth. Now, telehealth is undoubtedly the initial point-of-care for many non-emergent issues.

The rising need for Telehealth/ Telemedicine

The use of telehealth has been growing in the past few years, though more slowly than expected but they say, out of every crisis arises a new opportunity. Telehealth is said to be the distribution of health-related services and information via electronic information and telecommunication technologies. This allows long-distant patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. These platforms also enable families of patients to speak with their loved ones in acute care. 

For Telehealth, this may be an opportunity whose time has finally come. The volumes of telehealth consults have gone up in several multiples since the pandemic struck.  John Kravitz of Geisinger Health has seen a 500% increase in telehealth visits within the first couple of weeks since the outbreak. In anticipation, Geisinger has trained over 1000 providers (and counting) on conducting telehealth visits with patients.

According to reports, Geisinger before Covid-19, had an average of about 40 telehealth visits per day but following the crisis, has an average of 4,000 to 5,000 telehealth visits daily.

Factors inhibiting slower adoption

On a global scale, two factors inhibit the wide adoption of telehealth. They include: reimbursement constraints and patient and provider reluctance.

Telehealth is hardly an explored category due to the significant risks of reimbursement. According to the American College of Physician (ACP) Telehealth Survey 2020, about 24 percent of ACP members are utilizing e-consults on a regular basis. This is because medical communities as well as technologies are beginning to think of telehealth as one of the cost-efficient alternatives over conventional health care.

However, health practitioners are slow to adopt because of the following reimbursement risks: documentation risk; where the details of the consultation are not recorded, misdiagnosis; where an illness is mistaken for another and wrong treatment as well as prescription is given, training and infrastructure development; where this is likely to cost a fortune and lastly, payment and compliance regulation; where there is no constructive equipment to enforce payment by patients.

With patient and provider reluctance; patients’ perception of telehealth had been ‘this provider must not think my problem is not important since they are seeing me via telehealth’ but following the pandemic, the perception is gradually moving to ‘this provider cares about me and therefore is seeing me via telehealth’. Whereas service providers’ perception used to be ‘this person would have gone to the hospital if ill’ but now it’s ‘this person needs immediate response’. 

Difficulties in the use of Telehealth

For telehealth or telemedicine, there are three striking challenges that affects its usage. These include: discontinuity in patient relationships, cybersecurity risks and slow service delivery due to logjam online.

A recent report by McKinsey says, “when patients resume care, they may be more likely to seek it at health systems that have demonstrated safe operations in their ability to treat patients while COVID-19 remains present”. This is based on a recent “Consumer Healthcare Insights survey” which showed that, active communications and evidence of implementation of infection control measures (for example, mask requirements, physical distancing, sanitization) were the most commonly cited reasons which prompted patients to schedule care. It concluded that “the rapid adoption of virtual channels has created a crack in patient relationships and most likely to break it when telemedicine is fully accepted.”

Following the outbreak, most businesses, health inclusive, moved most of their operations online. This heightened the advantage of cybercriminals to swoop the vulnerabilities of online platforms. The World Health Organization, The Dept. of Health and Human Services of the United States and several state and local agencies have become targets. Meanwhile, health systems that have seen a doubling of their remote workforce have had to enable staff with Virtual desktop interfaces (VDI) and connectivity devices to connect to enterprise IT systems seamlessly with minimal data flow between devices in and outside firewalls. 

However, despite strong endpoint security, this large-scale shift to a virtual workforce also exposes new vulnerabilities waiting to be exploited.

In previous conversation, it has been established that people hopped on the wagon as health systems transitioned online. This led to an increase in visitors on health websites or in chat boxes. While most health systems such as Geisinger seem to have successfully scaled up their telehealth operations to meet up the demand, some have seen a rise in wait times that have negated the premise of “on-demand” care through virtual health tools. On the platforms of the health systems that are slow to adapt to the new normal, their service delivery is at a slower pace since their platforms are thronged.

Comprehensive growth plan for health systems

In a recent report sighted by The Vaultz from McKinsey, it indicated that should health systems apply the strategies used by businesses to recover from the 2008/09 financial crisis, it could be a comprehensive growth plan for health systems to adapt to the changing local market conditions post-COVID-19, while still aligning to future growth aspirations.

In the report, three steps were suggested: creating a growth transformation team, defining the approach, and building execution discipline and muscle memory to deliver the growth program effectively. 

Focusing exclusively on executing the transformation means establishing a dedicated, central team that articulates aspirations, defines the direction of the organization, coordinates activities, and measures success. Health systems may wish to consider establishing a team strictly focused on the strategic action plan around growth. This growth transformation team would likely require appropriate strategic, operational, and clinical representation to set organizational aspirations, make decisions on opportunities, and execute quickly. Stakeholders may seek a deeper understanding of the health system’s existing capabilities and sources of vulnerability.

With defining the approach, health systems should assess a comprehensive set of levers and choose the right multi-lever approach. Noting the levers as expanding scope of service, proactively shifting where care is delivered and expanding the continuum of care; investing in digital capabilities to ensure new patients can be seen and existing patients have appropriate continuity of care; and considering strategically aligned acquisitions.

The third recommendation is that health workforce should consider building the execution discipline plan among the core growth response team given the stress that they go through.

According to the report, health systems are assured of continued access to quality care across patient populations and growth if they consider a disciplined approach that is: grounded in a shared aspiration and a data-backed understanding of the starting point; characterized by a diverse set of initiatives that take into account market uncertainties and adapted to the local competitive environment; and implemented with rigorous performance management to ensure that timelines and metrics are met, and that tactics are modified as the ‘next normal’ comes into sharper focus.