Friday, September 22, 2023

Telehealth is coming – are you ready?

The digital revolution is coming to healthcare – whether we are ready or not writes Sheilagh Foley but are we ready to accept tele-health and more importantly, will it work?

About a month ago I had two doctor’s appointments in two different hospitals on the same day. My plan was to cycle between the hospitals. I had a two-hour leeway and thought I would be OK, but the first clinic overran by hours. I was trapped in a crowded waiting room and completely missed my second appointment. It was the first time in my life I did not show up for an appointment. Everybody involved made their best effort, including me, and we failed. I was left wondering – surely, there has to be a better way?

If one or both of those appointments had been online I would not have missed anything. Is Ireland ready for a new approach to health care? The ‘New Ireland’ is home to the brash, outrageous and free. It’s also home to the traditionalists and the tea-drinkers. Not to mention the TikTokers and the tech giants. We are a melting pot of old and new, sweltering in the Age of Technology – change is inevitable for us all.

Per the 2022 Irish Census the population now stands at 5.15 million people. It is the first time in 171 years that Ireland’s population has exceeded five million. The average age in Ireland is 38 years old, and 80 per cent of households in the Census had a broadband internet connection. Eurostat estimated that in the third quarter of 2022 Ireland had the largest budget surplus of the 27 EU member states.

It’s rare for a nation to be so full of potential, if we can do whatever we want – what do we do? Buy all the world’s gold supply and bury it under the Spire in O’Connell Street? Start logging NFTs? Create a national TikTok dance? Maybe, but first, let’s address our health. It is, after all, the one thing we all have in common.

Our health system was built and based on a smaller population with tethered resources. It is unwise to expect an old system to cope with new demands – the timing seems right to overhaul the system, to do something different. We are at an inflection point in healthcare; we need to consider if we want to go in the direction of say America (the ‘haves’ and ‘have nots’) or say Denmark (the early adopter of telehealth, known for short waiting lists).

Since the Covid pandemic nearly every industry has used technology to reimagine their operations, from pubs moving to dial-a-pint, or in-person education switching to online classes. Most people are now familiar with contactless banking, virtual fitness and online shopping. The virtual gauntlet has been thrown down for the health space to join the accelerated trend towards the digital provision of services.

What can we do?
Ireland’s Health Service Executive (HSE) has been drawing up plans. A new future is being built and it will start with telephone and video-enabled care, remote health monitoring, and online supports and therapies.

I am the first person to cringe at the mention of a video; I don’t even particularly like phone calls in any shape or form. But, I have been that patient, sitting for hours in a hospital waiting room, trying to send texts to ensure my child is picked up from school (because even if I am seen by the doctor within the next five minutes, I am still an hour away from my actual life).

Video enabled care
I am mortified at the thoughts of talking about my body parts, or personal matters, to a disembodied head on a screen, or a throaty caller. But I will get over it, I will get used to it. I might even look forward to it (maybe not the ‘throaty’ calls). It will give me hours of my life back. I can take the calls on my terms in my locations. I can have my notepad and pen (or digital device) by my side for notes, or making sure I ask certain questions.

I understand it’s awkward, it’s weird, the doctor won’t be able to physically examine me, that is a genuine concern. However, I wouldn’t want a video call for a serious illness, nor do I believe I would be offered one in such circumstances. But for a check-up, for a manageable complaint, it would be my preferred option, because in my life, time matters, especially when it’s my time. I applaud the idea of realigning the care from the service location to the patient’s situation.

Most people I know are packing a pedometer, even the self professed Luddites and technophobes usually have at least one wearable dangling off their limbs. It seems like a natural step for hospitals to start sticking a strap on our wrist, adding a patch to our arms, bluetoothing our scales to their app, and so on. Virtual wards and remote monitoring are already under way in the NHS (and certain pilot schemes in Ireland).

It will require a mental leap and a strong trust in each other, and the system, and the products. It’s quite remarkable to think you could leave a hospital with all the equipment required to continue monitoring you as you recover in your own home. It will free up beds for those in severe need of physical care. Your vitals will still be checked, the rounds will continue but across a video instead of in-person. It might seem very strange and detached, but it has the potential to feel more patient-centric than a congested busy ward might feel.

I am a fan of hospitals; they generally serve to keep us all here a little longer. Patients, at times, have to push with all their might to get into a hospital. Once in, we have been known to push with all our might to get back out! I have had many hospital visits that culminated in medical interventions that has saved my life, and I am extremely grateful to those doctors and nurses.

However, my conclusion is always the same – the real recovery starts when you get home. Hospital stays are often necessary but they generally do not prepare you for getting back to your routine and the invisible (and very visible) pulls on your existence. I am often drained after a hospital stay, even just visiting someone in hospital is exhausting. It might be the subliminal messaging given off by all the beds and people in dressing gowns roaming around – it’s like a visual sleeping pill. When my daughter was four years old, I walked her to school and waved her goodbye. I felt unwell and went straight into ER where I was admitted and kept for 30 days. My daughter was too young to be allowed into the ward. It was a very distressing time for us both. As far as she was concerned, she went to school one day, and I left her for a month!

As time went on and I started to improve a little, I was allowed to walk a short distance outside my ward with a telemetry box (a form of remote heart monitoring). I was able to meet my daughter at the elevator and give her a hug. That hug probably meant as much to my recovery as the mountain of medication I had been consuming.

I understand getting to grips with remote monitoring could be challenging, especially for the older generation. I had a private care hospital-in-the-home experience that was ineffective. I became progressively unwell and was under-treated. I was too complex a patient for the service they were delivering. However, I would feel more comfortable in a HSE version of remote care as they are more used to complex patients, chronic disease, care pathways, escalation protocols and a team approach.

There are certain criteria to fit the profile for remote monitoring, if you are considerably unwell, or extremely complex, or uncomfortable, a traditional hospital setting might be more suitable for you.

Online support and therapies
The advent of Covid, and the young generation, have made great strides in tearing down the taboo of talking about or addressing mental health issues. Nowadays, people might be more open to working on their minds, but I still think a lot of people don’t know where to start. Thanks to innovations in telehealth, the solution may already be in your hand.

The HSE is stepping into the virtual fray with Silvercloud, It’s an online mental health platform offering free internet-based Cognitive Behavioural Therapy (CBT). You must be referred into the program (which includes pathways such as your GP, Primary Care Psychology, Jigsaw, Counselling in Primary Care CIPC or Community Mental Health Services).

Then you can access the app or website to explore your thoughts and feelings and help to manage your mental health across a variety of topics. You are assigned an online coach for 8 weeks after which you transition to a year of self-guided use.

It’s my understanding that it’s not suitable for people with significant issues (or those under 18) but more suited to support adults with mild to moderate experiences of anxiety, depression, worry, etc.

The convenience of an app on our phone to coach us through some pressure point moments is ideal, not just for young people, who seem to be the target market, but perhaps for people who may find it hard to ask for formal help (particularly men). Also, not everyone is cut out for talk therapy or able to devote an hour to it a week. Please note, talk therapy is very useful and can be used alongside online therapies, and can be a more concentrated form of care. Also talk therapy can provide real-time feedback, whereas online therapies can seem more self-exploratory.

Personally, and I might be looking into my own head when I say this, what about perimenopausal women dealing with errant emotions? Many of us don’t have two seconds to ourselves because we’re too busy auditioning for the local circus (spinning plates, juggling balls, dealing with clowns, don’t even talk to me about cleaning up after the elephants or putting tigers back in their cages).

Having CBT tools, a mood monitor, a thought journal, an affirmation or meditation at our fingertips might just save the day. I was originally quite sceptical about ‘Telehealth’. I wondered if it would pale in comparison to the real thing? Would the patient be the last consideration?

Would we be able to do it physically and psychologically? I wasn’t sure how it would work, the ‘ask’ seemed too big, cooperation and collaboration from all parties would be essential, would anyone willingly be on board? I decided I needed more information, so I read about different countries’ telehealth strategies and considered implementation (New Zealand, Australia, and Canada are making great progress, Denmark is already 15 years into it!).

I watched videos about NHS virtual wards and HSE pilot tests. I attended meetings, I spoke to people, I aired my concerns, I listened to responses. I had lived abroad for years, I had experienced many versions of telehealth, I knew it could work – but could Ireland make it work?

I learned firsthand that the HSE is stepping up and doing their part through building roadmaps, hosting information consultation days, and creating a vision and strategy for Telehealth in Ireland with input from the key stakeholders.

I have been to the HSE table, it’s a welcoming one, and everyone there is invested in making this work. Telehealth isn’t a ‘Them Vs Us’ situation, it’s a collaboration. The public, patients, and clinicians need to be listened to and their concerns addressed through awareness, education, adaptability, and making them all part of the process.

We are living in exciting times, Ireland’s potential is almost palpable. Can we onboard a new innovative approach to health care? Yes, we can.

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