'The genie is out of the bottle': telehealth points way for Australia post pandemic

Last year, when plans were being developed to establish a “virtual hospital” in central Sydney, some clinicians were not convinced about the merits of using digital technologies to care for people in their homes. “Every department in our district has now been looking at how they can provide outpatient services more effectively, using telemedicine not just for patients in rural and remote areas, but also for those who live locally,” she says. The health sector has a long history of resisting reform, but RPA Virtual Hospital is an example of the pandemic driving innovations that otherwise may have taken years, if not decades, of incremental changes. Importantly, the developments are not only about policies, programs or technologies, but also reflect new relationships and ways of working that cross sectors andsystems, helping to break down some of the longstanding silos that have held back innovation. Staff at the Sydney Local Health District have done more than 14,000 hours of video conferencing since Covid-19 began, contributing to reduced travel, air pollution and greenhouse gas emissions. Dr Forbes McGain, an anaesthetist and intensive care physician in Melbourne who has a PhD in sustainable healthcare, is also watching the pandemic’s impact on healthcare’s greenhouse gas emissions, saying it has created a “mountain of waste” of single-use gloves and gowns. This would be an example of more environmentally sustainable practices increasing the resilience and security of healthcare systems while also boosting local employment. Dr Chris Bollen, a GP in Adelaide who cares for many elderly people living in their own homes, has spent much time recently teaching patients to use FaceTime and other digital platforms. He is excited by the potential for telehealth to help support older people to live independently, and more generally to improve access to care, and to drive more proactive engagement withpatients, especially those with chronic health conditions. He expects it may also encourage more to support the concept of patients enrolling with a specific practice, to enable more systematic and safer management of their care. At Cohealth, a community health organisation in Melbourne, chief executive Nicole Bartholomeusz is also keen to see the measures continue. She has been surprised by the strong demand for telehealth consultations, especially as her organisation looks after many people dealing with poverty and complex, chronic health issues. The pandemic has also sped up a long-awaited shift to electronic prescribing, and Tasmanian pharmacist Shane Jackson is enthusiastic about the benefits, including “a wave of patient empowerment”. “It is very difficult to introduce something that people and clinicians really like and then take it completely off the table.” Wells also hopes that wider primary healthcare reform will be a legacy of the pandemic. “We’ve got to stop the incrementalism.” The report notes that “the use of episodic payments would create greater freedom for primary healthcare services to take a long-term, whole person and population health perspective that moves away from funding on the basis of single consultations or visits – an approach that can better meet the needs of people with chronic and complex conditions”. In the remote Western Australian town of Broome, Kimberley Aboriginal Medical Services (KAMS) has developed a reputation as a source of reliable information for all local residents, according to chief operating officer Rob McPhee. The way KAMS shared information and resources transparently helped to build trust with other services, as well as the wider community, and heexpects these positive connections to endure with benefits into the future. KAMS was also quick to adopt telehealth, for medical, mental health and social and emotional wellbeing services, and the uptake from clinicians and patients has been enthusiastic. While it is too early to know whether pandemic disruption will bring opportunities to address these determinants more effectively by promoting health in all policies, Dr Teresa Anderson is optimistic some of the positive lessons for healthcare will carry forward.