Virtual first telehealth – empowering patients

With unprecedented levels of demand and critical healthcare workforce shortages, Australia needs to embrace the next level of virtual care, not restrict it. The health system needs to pivot to an omni-channel service capability that includes synchronous and asynchronous virtual care to meet patient needs, support and improve health care practitioner utilisation, and enable virtual first care models.

Asynchronous telehealth refers to a service mode where there may be a non-real time interaction between a patient and practitioner. Most commonly, this is a means of text based online clinical data collection where the patient completes structured clinical questions, which are then reviewed, assessed, and utilised by the treating practitioner to provide care. Developing capabilities utilise technologies such as SMS, text, chat and AI. Asynchronous care models allow more convenient and efficient virtual health interactions by three main means.

Asynchronous telehealth augments traditional primary care models, increasing access to equitable and affordable primary care.

First, asynchronous telehealth empowers consumers with patient centric self-service. They can initiate a care interaction when it is needed, remotely, from their own device. This significantly increases access to care particularly for communities that have limited access to timely face to face primary care services. For patients that have the common experience of their local GP being booked out for weeks, it breaks down this barrier, allowing them to take control of their own health by initiating care whenever and wherever it is needed. Asynchronous interactions are more culturally sensitive and accessible for vulnerable groups such as patients with disabilities, from linguistically diverse backgrounds, victims of domestic violence or the LBGTQI+ community.  Due to the efficiency of the interaction, prices are much more affordable than a video visit or face to face visit – approximately 50% of the average out of pocket gap with traditional GP services with no cost to Medicare.

Virtual care is more efficient – improving access, empowering patients, reducing costs.

Second is the impact on provider efficiency and utilisation. Since no scheduling is involved, providers can complete online requests when it fits into their scheduling, such as in between face-to-face visits or after hours. A doctor can review an online clinical request efficiently and decide on the next steps in the clinical assessment. They triage the request based on the clinical information received. Often the structured clinical data received in the online clinical request is as rich or richer than a typical short face to face consultation. This is because the patient has had the time to review the structured clinical questions in the comfort and safety of their own home, refer to their medication list or previous medical records when providing answers or seek the help of a carer or family member. It takes the pressure off patients that have only previously had the option of a 10 minute time pressured face to face consultation. The result is that for stable medical conditions, such as a prescription renewal of regular medication, the structured data may be sufficient to provide initial care or lead to an efficient text-based interaction with the patient to clarify dosages, indications, and side effects to safely prescribe a limited amount of medication. This care interaction enables accessible care in between regular GP face to face appointments and stops patients from presenting unnecessarily to emergency departments for non-urgent issues.

Thirdly, asynchronous healthcare augments other forms of doctor-patient communication to enhance practitioner efficiency. Often online requests for assistance may lead to the doctor undertaking an extended text, phone or video consultation with the patient. Doctors utilise the structured clinical data to efficiently make a clinical decision about the best modality for further communication. Digital consults may start as an online questionnaire leading to a doctor making a decision to send a video link to complete the assessment. For example, to examine a sick child or a rash. Other medical conditions can be safely completed with a telephone call.  Doctors utilise their professional judgement about the modality of communication. The result is that asynchronous telehealth coupled with real-time SMS, phone or video consultation, dramatically increases efficiency for practitioners, meaning more people can receive care per doctor consultation hour – and it’s just as effective. A systematic review evaluating the efficacy of asynchronous telehealth as compared to conventional clinical visits undertaken by Nguyen et al concluded that asynchronous care ‘may provide clinical outcomes that are comparable to those provided by in-person care and reduce health care costs’1

There is a pressing and undeniable public demand for efficient online primary care models capable of utilizing asynchronous text-based telehealth, in addition to telephone and video consultations, within a virtual-first framework. Doctors should be trusted to exercise their professional judgment in determining the proper use of communication technologies for clinical assessment. Patients deserve easy and efficient access to doctors, along with the freedom to select the communication mode that best suits their personal and cultural preferences. It is crucial to promptly implement these solutions to ensure more patients receive timely evaluations by doctors, enabling diagnoses and medication prescriptions beyond standard GP practice hours. This will help alleviate the lengthy, unnecessary wait times at the nation’s overwhelmed general practices and emergency departments.

1. Impact of Asynchronous Electronic Communication–Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review. Oliver T Nguyen, BS,^1,2Amir Alishahi Tabriz, MD, MPH, PhD,^3,4 Jinhai Huo, MD, MSPH, PhD,¹ Karim Hanna, MD,⁵ Christopher M Shea, MA, MPA, PhD,⁶ and Kea Turner, MPH, MA, PhD J Med Internet Res. 2021 May; 23(5): e27531., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135030/