It's not every day that you get a phone call from space, but that's exactly what happened to Dr Stephan Moll when his wife told him that NASA was on the line. An astronaut on a six-month space journey was experiencing the first known blood clot in space and needed medical help. With limited medication available and dealing with the challenging conditions a human body faces in space, Dr Moll, a team of physicians on Earth and the astronauts on board had to rely on two main requirements for the remote delivery of medical services to succeed: communication and trust in a totally new and untested environment.
A 90-day treatment regime involving daily emails and phone calls between the patient and Dr Moll, together with the patient performing personal ultrasounds with guidance from an Earth-side team, resulted in a successful mission all round.
While few of us will ever require medical treatment beyond Planet Earth, the events of 2020 produced a global health crisis that forced us to rethink how to deliver healthcare services.
COVID-19 disrupted everything. It's also given us a once-in-a generation opportunity to advance health and well-being through technology, decentralised service delivery, the harvesting of data well beyond what is typically seen as 'health related', and a paradigm shift in patient centricity.
The pandemic kick-started many advancements with digital technologies enabling everything from Zoom meetings to contact tracing, to rapid scaling of manufacturing, and construction to build equipment and facilities in record time. Although some technologies, such as telehealth and electronic tracking of patient data are here to stay, we have barely scratched the surface. Digital healthcare is lagging most other sectors in progress and adoption.
Why has digital healthcare not reached its full potential?
Virtual health to digital healthcare
Virtual health is only one part of digital healthcare, yet it is the area most visible to the community. In 2020, McKinsey defined virtual health as a combination of telehealth, digital therapeutics, and care navigation. The uptake of virtual health during COVID-19 has been remarkable, which is encouraging for the future of digital healthcare.
Being a 'virtual customer' is an easy concept. Our most sensitive information – bank balances, managed funds, personal mail, and wills – have shifted to digital services. Apart from the odd fraudulent slip-up here and there, and emails that prompt "… did I really just reply to all company employees, including the CEO…", it works pretty well.
The same goes for retail. People buy everything from international flights, hotel rooms, million-dollar real estate and artworks online. Elon Musk revealed that 78 per cent of Tesla Model 3 orders were made online.
Perhaps that is why the transition to virtual health in 2020 had been relatively seamless… however, look back in time.
Virtual health had been heralded as a necessity for years, largely because of anticipated cost-efficiencies, improvements for access to high quality patient-centred care, and potential to drive disease prevention and well-being. Many countries struggled with the conversion from paper to digital, and from face-to-face to virtual.
One reason may have been the literal life and death stakes that healthcare operates in. It's one thing to buy the wrong size shirt online, for an airline to double book your seat or for a scammer to skim money from your account. These can all be fixed. It's quite another thing for a clinician to make a mistake around diagnosis that could severely impact or end someone's life.
In spite of this challenge, there are pockets of disruption and success in virtual health, for example, the UK's Babylon Health service (virtual GP consultations over video link), Chile's remote-monitoring for chronic disease management, and India's mHealth which gives individuals access to doctors on their smartphones.
As stated by McKinsey: "For the past 10 to 15 years, virtual health has been heralded as the next disrupter in the delivery of care, but there has been minimal uptick in adoption."
And then COVID-19 came along and changed everything with telehealth appointments, digital patient forms and text messages feeding back results becoming even more commonplace.
Does this mean the next leap in digital healthcare, encompassing a whole new way of delivering services through more efficient and cost-effective health facility design and construction; improved patient triage and care options; as well as expanded delivery to remote, regional, or disadvantaged communities, is just around the corner? Will more efficient communications and governance across the nation, together with increased flexibility and resilience to future pandemics, simply become the norm?
What needs to change?
The challenge with digital healthcare is not technology. This has been evolving over 50 years. Since 2014, surgeons have been performing 'telesurgery' without any noticeable resistance from patients.
Many root obstacles to digital healthcare are human based: a health service as opposed to system-wide focus; lack of expertise to lead the transformation; rigid organisations; policy setting misalignment top to bottom in Government; and inflexible healthcare funding models.
Another challenge is to reconcile the divergent views of the clinician and the consumer. The former sees digital healthcare as more technology within the existing system, but the informed consumer can see new care options anywhere they need them. Some clinicians might not like such disruption, but they will embrace it when consumers are clamouring for it. The consumer-centric view must be nourished.
What difference would digitising healthcare make?
Digital healthcare is predicated on data in the cloud, readily accessed, processed and used by health professionals. We have all happily increased our data use during COVID-19, but there is still pushback from people who are concerned about privacy and security. You only have to look at the outcry Western countries have faced when trying to embed coronavirus tracing apps on people's personal devices.
Most studies and stakeholders agree that a digitally-enabled healthcare system will cost less, create less wastage, be able to deploy resources to where they are needed, provide healthier facilities for patients, staff and the environment and create a safety net for future potential pandemics. Pilots conducted around the world show consumer demand itself is altered when alternatives are offered.
Many people are prioritising their health and well-being. In Todd Cope and Chris Crook's paper What is important to Australians right now?, 7 in 10 Australians name their family's health and well-being in their top 3 most important things in life. Furthermore, they are looking to live and work beyond cities in regional and remote areas; however, equity of access to quality healthcare remains a blocker.
Reducing pressure on existing healthcare infrastructure and its workforce through digital enablement is a compelling economic case, given the system-wide reduction in capital and recurrent cost. Easing demand on oversubscribed acute care assets allows their repurposing to meet other needs, such as mental health, youth and indigenous services.
What now?
COVID-19 has given the healthcare sector a burning platform to roll-out further broad-based changes in digital healthcare, but it is far from certain whether healthcare will rise to the challenge.
Virtual care technology is available and works. Consumers are not always averse to medical technology or sharing their data in the cloud – just look at Fitbits. Whether we are talking patients, clinicians, the community, administrators or operators, trust has been a cornerstone of the transition until now and will continue to be in the future.
The advantage of being able to pivot easily to virtual health should mean that further transformation in digital healthcare enhancing the development and delivery of healthcare services, isn't far behind.
With healthcare costs rising, infrastructure and populations ageing, health needs increasing, gaps in the inequality of service delivery not closing quickly enough and future pandemics looming, it is no longer a question of if, but when?
