Telehealth: reality and challenges in patient care
The Covid-19 health crisis has forced the entire health system to radically change the way it helps patients.
Telehealth has proved to be more necessary than ever and forces us to think about where we are today and where we need to go in the future.
THE POSSIBILITIES OF TELEHEALTH
The alarm clock rings. It’s 7 am and Raquel gets up. The first thing she does is to check her glucose level on the digital sensor she has at home. Raquel has Type 1 diabetes and today she has a follow-up teleconsultation with her doctor. She has a video call at 8 am with her doctor and they comment on the factors that the system has been registering. The doctor has access to them. It is a routine appointment and, therefore, brief. The consultation ends soon and Raquel leaves home to go straight to work.
Raquel does not exist, but she could actually exist in any town or city in Spain. Providing remote health services is already a reality for thousands of patients. It provides comfort and avoids travel (saving time, money and reducing one’s carbon footprint). It also facilitates and shortens the time to access the healthcare system, improving patient care and allowing anticipation and response capacity.
During the COVID-19 pandemic, telehealth has prevented crowds in health centers and has accelerated the access to the system through new digital tools or simply the telephone. In addition, it is a powerful tool to empower the patient and train them in their health management.
As for the system, telehealth also reduces costs, waiting lists and improves the quality of assistance, as well as ensuring good communication between all health professionals.
THE REALITY OF TELEHEALTH TODAY
However, despite all the benefits that telehealth can bring, the reality today in Spain is far from ideal. The pressure of the pandemic has led health centers to implement telehealth abruptly and disorderly, without being able to design a proper implementation strategy.
In some health centers, teleconsultation has been imposed on all patients, regardless of their profile or pathology, leading to reluctance from patients and difficulties when communicating with them remotely.
In addition, health centers have encountered a significant lack of resources -such as the need for telephones, headsets, microphones or webcams- and all kinds of management and connection problems due to a lack of coordination, information and training of both patients and healthcare professionals. Not to mention the lack of awareness that still exists among many patients, who cannot get their head around the idea of a phone call with the professional as a medical consultation.
THE CHALLENGES OF TELEHEALTH
For this reason, it is now crucial to stop and reflect in order to take a step further and offer a high-quality telehealth experience. To do this, it will be key to analyze what is working well and what needs to be improved. It is the only way to understand the needs that still exist today and continue moving in the right direction:
- Understand when telehealth is appropriate and when it is not. To do this, it is necessary to know the patient well and to ask them what they need. Which consultations can be remote and which not? What pathologies can be followed from far away and which ones need human interaction? Can a patient with cancer discuss their next treatment with the doctor through a screen? Does a pregnant woman want to do the antepartum classes using Zoom?
- Provide key resources to enable telehealth, ranging from technology (the computer system, computers, cameras, microphones), to adequate spaces for its practice (quiet rooms that allow confidentiality) or the necessary staff to do the adequate monitoring of patients remotely. Although centers are making an effort, there is still a long way to go.
- Design the new teleconsultation experience, since it cannot be approached in the same way as a face-to-face consultation. The patient needs the professional to make up for the lack of closeness with the appropriate attitude, as well as using new tools that allow them to share information easily, as if they were both in the same place.
- Promote the training and education of the main actors involved, mainly doctors and patients. And beyond the practical learning, change management will be important -still very present among patients, as well as professionals.
- Ensure the regulation and protocolization of telehealth to protect confidentiality and the exchange of data. In this sense, it will also be important to train professionals and patients in the rights and responsibilities they have to preserve data security.
- Communicate the advantages of telehealth to citizens so they know this possibility exists, and they normalize its use. Institutional campaigns are key to advocate for its benefits.
In conclusion, telehealth is in a fairly incipient phase in Spain today. This is how the results of the Fenin “Digital Maturity Study” describe it, stating that maturity in health services is low. According to the study, telehealth implementation in Spain only reaches 31.7% of the aspects analyzed in 4 key areas: IT infrastructure, availability of tools, patient empowerment and data analysis.
To change these results, a global telehealth strategy will be necessary in order to guide all the actors in the correct implementation and to allow them to continue moving in the right direction.
 Estudio Fenin de Madurez Digital en Salud. Disponible en: https://www.fenin.es/documents/document/778