Digital health on fast forward

Covid-19 has accelerated the uptake of a variety of virtual care services, not least of which where it all began: the telehealth phone call between patient and practitioner.

By Michaela Sheahan, Senior Researcher

As the influence of tech on our lives expands, so too does the reach of digital health – from video check-ups to home-based heart monitors, from skeletal robotics to remote surgery.

With the help of the Centre for Online Health, Centre for Health Services Research at The University of Queensland, Hassell is investigating implications of increased digital healthcare delivery on hospital design. How can we take advantage of this significant change in healthcare delivery to design places and spaces that support individual wellbeing and maintain human connections between clinicians and patients?

In the midst of dealing with infection control issues and community anxiety about Covid-19 through the early months of 2020, Australian healthcare providers delivered the long-anticipated widespread uptake of telehealth consultations.

Between March and May 2020, health practitioners made more than seven million government-funded virtual consultations with patients. Over 90 per cent happened on the phone. (1)

While GPs conducted most of these, hospital telehealth services also grew, as well as allied health, mental health, specialist and nurse practitioner consultations. Similar patterns were experienced around the world.

According to the New York Times, one London-based practitioner declared, ​“We’ve had ten years of change in one week.” Frost & Sullivan report that demand for telehealth has grown by over 60 per cent in the US in 2020 alone.

What’s to be gained from this significant, and potentially sustained shift in service delivery? Well, as chronic disease and an ageing population increase pressure on hospital space and staff, systems are beginning to show the strain. Staff burnout, bed shortages and stretched emergency departments are common in hospital systems around the world.

What if we could sustain lower numbers of patients fronting up to hospitals in the first place, and then give that space to those that really need it? It sounds simple, but of course, health systems are complex, risk averse and too important to fail. The pandemic is a real time experiment to show where change can be made safely and effectively.

Research shows that despite unfounded fears of compromising confidentiality, safety and patient-doctor relationships, telehealth models can deliver lower mortality and hospitalisation rates across a range of patient groups. These include the elderly, frail and people with chronic illnesses such as heart disease, diabetes and stroke rehabilitation. (2)

A survey of telehealth patients this year also shows that patients are a lot less reluctant to use, and more satisfied with, the service than might have been expected. (1)

It’s safe to say we can anticipate significant change in the long term in how services are delivered to these patient groups, and perhaps others, including cancer care, mental and allied health services.

At Sydney’s Royal Prince Alfred Hospital, the RPA virtual space opened (fortuitously) in February 2020 intending to treat palliative care and cystic fibrosis patients. The program allows patients to communicate on a borrowed smart device (and remote monitoring equipment) with nurses and other clinicians located in a central 24-hour hub. The hub quickly flicked the switch to Covid-19 care, allowing patients who were isolating but did not require hospitalisation to remain connected to the hospital in case of deterioration. (3)

Hospitals in the UK also successfully adopted this virtual ward approach when Covid-19 infections were rising dramatically. In Watford, the West Hertfordshire Hospitals NHS Trust set up a virtual hospital that has since managed over 1200 patients at home and saved over 300 bed days in one three-week period. It has been so successful the Trust wants to continue the system after Covid-19, initially for respiratory patients but potentially across other groups too. (4) Similar virtual care systems have also operated well in Manchester, Reading, and countless other hospitals around the world.

It’s not only patients who are protected with this model. At the Shoalhaven Cancer Care facility south of Sydney, the normal model of conducting multidisciplinary team meetings with a room full of doctors potentially risked service provision if just one of the clinicians was infected with Covid-19. (5) So, for now at least, instead of meeting together in the conference room of the facility as they normally would, these teams of clinicians meet virtually to ensure continuity of both care and workforce. Perhaps in the future, fewer large meeting areas will be required in these types of settings.

While increased virtual care services like these will alter healthcare environments after this global calamity, there are other facility design changes afoot, too. 

In the mountain of studies and opinions published to date about Covid-19, proposed areas of hospital design slated for change also include (6):

• Surge capacity/​flexible design for emergency situations (infectious disease, disasters or otherwise)
• Patient journey changes for infection control, including circulation paths and separation of different patient cohorts
• Emphasis on community-based care settings
• Less space for outpatient consultations as telehealth services increase
• Less space for administration as working from home options increase
• More space for storage, with less emphasis on ​‘just-in-time’ provisioning
• More space for technology, including robots, remote monitoring equipment and patient-use devices in bedrooms

While the virus rages on across the world, it is too early to tell which areas of design will change and how. 

In some health systems and locations, some things won’t change at all, and others will develop incrementally. It might be that there’s not more or less space overall, but that the balance of clinical to non-clinical spaces shifts.

Our work with The University of Queensland will help us understand what some of the shifts in virtual care models might be, and how health facilities can continue to support efficient, effective and high quality care.