Telehealth is nothing new. Derived from the Greek word for “far”, telehealth has been around since the invention of the telephone. Since then, thousands of innovative technology-enabled remote-care solutions have been invented and registered around the world, with national healthcare systems and large providers starting to develop targeted digital strategies in the early 2000s.
This strategic shift toward telehealth approaches saw providers move 5-10 per cent of their consultations to virtual platforms. Early adopters were quick to recognise the benefits of telehealth solutions: an immediate improvement in patient access, particularly in rural areas; a reduced burden on hospitals; and greater multi-disciplinary cooperation between remote healthcare professionals.
However, up until 2020, the speed of technology uptake was held back by several factors, such as the slow development of reimbursement solutions, and the lack of research into the safety and efficacy of telehealth interventions. Uptake was limited by slow provider adoption, the nascent regulatory framework, and by the significant investment required to make telehealth solutions work. In addition, patients themselves were still unfamiliar with telehealth, and many lacked the access to the infrastructure needed to support it.
Now, 2020 marks a critical turning point for the telecare industry. As the COVID-19 pandemic has spread around the world, telehealth has come to the fore as an intuitive solution for outpatient care. Providers, payers, and regulators have joined forces to ramp up capacity, expand the range of services they offer, and deliver them to the population. Many providers have even set up fully remote treatment pathways for chronic conditions, covering the entire healthcare journey from teleconsultation, to home visits by a phlebotomist, to e-prescription and home delivery of medication and home care interventions.
The benefits and risks of telehealth
Healthcare systems around the world are working hard to improve access to high-quality care for everybody—no matter where they live. Telehealth has unrivalled potential to deliver on this goal—a patient with a smartphone can access the right specialist in the right time. By using the latest digitally enabled solutions, providers can build remote treatment pathways for all major conditions, admitting the patient to healthcare facilities for hospital interventions alone, like surgery or complex diagnostics.
Another key benefit of telehealth is its potential to reduce overall care costs by enabling early diagnosis and prevention; faster discharge of patients as they can receive their continuous care at home, e.g. remote physiotherapy; and better utilisation of specialists. But scaling up telehealth solutions too rapidly can represent a tangible risk if it’s not supported by the appropriate evaluation of outcomes and the creation of evidence-based care telehealth pathways. Without robust clinical studies, we can’t know for sure if remote interventions are safe and of the same quality as face-to-face ones. The efficacy of traditional pathways is backed by decades of research, but when it comes to telehealth, that evidence is only just beginning to emerge. In 2020, the forced ramp-up of remote healthcare during the COVID-19 pandemic will shift that balance.
Another major risk comes from the patient side: after all, the significant effort expended in rolling out telehealth services would go to waste if patients lacked confidence in their safety or lacked access to the right devices and tools to use those services in the first place. And this would jeopardise adherence to treatment regimes, putting successful outcomes under threat as a result.
Building a sustainable telehealth ecosystem
In order to be truly sustainable, telehealth systems should be based on five key pillars:
- Evidence-based telehealth pathways. Existing clinical guidelines and treatment standards have been written with traditional care in mind. Providers need to optimise digital interventions and define their role in treatment pathways. This means they must pinpoint which procedures need to be digitalised, identify the patients that this applies to, and determine the best way to achieve this goal. This approach would also help to increase the adoption of telehealth solutions by medical professionals.
- Robust regulatory framework. Telehealth is still evolving, so an open dialogue between providers and regulators is paramount. For some of the decisions, multiple authorities need to be involved; for example, around healthcare professional certification, e-prescription, home medication delivery. Therefore, it’s very important to have a comprehensive legal framework to ensure telehealth services are both safe and effective. In addition, countries may consider a set of policies encouraging innovation and entrepreneurship to facilitate the development of local solutions.
- Reimbursement of telehealth services. For most countries, the majority of healthcare costs are paid for by national payers and insurance companies, with out-of-pocket spend ranging from 10-20 per cent. This means that patient demand is often curbed by the extent to which telehealth solutions are covered by their insurance.
- Investment in infrastructure. Successfully ramping up virtual care infrastructure takes significant investment. Providers have been seeking additional government funding from initiatives like the Telehealth Network Grant Program in the U.S., which was granted US$29 million under the administration’s Coronavirus Aid, Relief, and Economic Security (CARES) Act.
- Patient adoption. Patient experience has a significant impact on adoption, so it’s vital to ensure that designs are user-friendly, compatible with different types of technology, and backed up by qualified customer support.
What’s next for telehealth in the GCC?
The telehealth journey was already well underway in the GCC long before COVID-19 came into the equation. For example, KSA had developed an e-Health Strategy in 2010; in 2017, Dubai Healthcare Authority issued Administrative Decision Number 30 to regulate the provision of telehealth services. Since then, both the KSA and UAE have seen an increase in telehealth services. The fundamental ecosystem—including legal frameworks, essential regulations, and key solutions—was in place by the time the pandemic started. But telehealth solutions often covered just select interventions rather than full pathways, with some still in the development phase. Meanwhile, reimbursement models were still in the refinement stage—in common with those of other developed health systems at the time. The COVID-19 pandemic has led to a spike in the adoption of the technology, and an increased focus by providers and regulators on fast-tracking the shift from traditional care to telehealth.
As communities are settling into the “new normal”, GCC countries are reflecting on the future of virtual care. The results achieved to date have been very positive. But to capture the full potential of telehealth, we’ve identified some immediate actions that would enable transformation and accelerate adoption:
National public providers in the GCC, supported by government authorities, could establish a process of knowledge-sharing related to the development of digitally enabled treatment pathways for the key conditions. Ideally, Centres of Excellence should be created, with a remit to focus on researching the outcomes and publishing the supporting evidence. Patient education and patient-centred telehealth pathway design would accelerate the rate of adoption and encourage patients to stick with telehealth, rather than going back to a traditional care model in the future.
To ensure maximum coordination between authorities, providers and tech firms, National Committees and non-government organisations could take a coordination role, ensuring safety and efficacy of care and encouraging local tech entrepreneurship.
Using the latest scientific evidence, healthcare systems could facilitate the inclusion of digital interventions for the most common medical conditions into the national treatment guidelines.
National payers and private insurance companies should continue working closely with providers to identify economically viable technologies, evaluate their true financial value, and develop permanent payment models.
We are now entering a new era for telehealth—one that will create fresh challenges and opportunities for healthcare systems and patients around the world. And we have every reason to believe that new technology will help bring safe, equitable, value-based care to the population. Based on its positive progress so far, the GCC region is well placed to claim a strong leadership position at the forefront of this growing movement.