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The rise of virtual care: Implications for consumers and providers, now and into the future

Updated: Feb 4

In this blogpost, Emerson Health consultant Sebastian Isabel explores the rise of virtual care, including some of the reasons for the recent increase in virtual care adoption and the implications this has for consumers and providers, now and into the future.

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As we enter 2022 with the hope of fewer restrictions and greater freedoms, we recognise that there has been a seismic shift in the accessibility and delivery of healthcare during the pandemic. Virtual care has quickly normalised as a standard modality of care delivery, and for many Australians, there is an expectation that they will continue to access healthcare virtually into the future. In this blog, we first consider what virtual care is before exploring the implications of the recent rise of virtual care, now and into the future.


What do we mean by 'virtual care'?


“Virtual care is any interaction between a patient and clinician, or between clinicians, occurring remotely with the use of information technologies.”


NSW Health Virtual Care Strategy (2022) defines virtual care as “...any interaction between a patient and clinician, or between clinicians, occurring remotely with the use of information technologies.”


The term ‘virtual care’ is often used synonymously with ‘telehealth’ however, since technology has evolved, so too has our terminology. ‘Telehealth’ services are increasingly being referred to as ‘virtual care’ to better reflect the broader range of technologies incorporated into the delivery of health services. The Agency of Clinical Innovation (ACI) lists the following ways virtual care can be delivered (ACI, 2021):

While we have seen a rapid rise in the adoption of virtual care recently, it is worth acknowledging that virtual care has a long history, dating back to the 19th century with the invention of the telegraph, which played an important role in telemedicine at the time (Eikelboom, 2012). Since these early inception days, and in particular over the past two-years, virtual care adoption has rapidly increased. In fact, the number of requested Medicare items for telehealth services in Australia rose from about 20,000 in February 2020, to almost 6 million in April and May 2020.


What led to the recent rise of virtual care?


There are a number of factors that have contributed to the recent rise of virtual care including the COVID-19 pandemic, increased consumer and provider willingness to use virtual care, and regulatory changes. Let’s unpack these a little further.


COVID-19

You don’t need to stretch your imagination too far to be able to connect the dots between the COVID-19 pandemic and the rapid rise in virtual care over the past two years. As travel restrictions were enforced and in-person clinic and hospital visits were minimised, moving as many cases as possible to virtual modalities became an appropriate solution to maintaining healthcare accessibility without compromising personal safety.


In New South Wales, virtual General Practitioner (GP) consultations made up nearly 30% of weekly GP consultations in 2020 (Macquarie University, 2021). This is a vast contrast to before the pandemic, where virtual care accounted for only 0.1% of all federally-funded attendances in Australia (Medicare Australia Statistics).


Increased willingness to use virtual care

We have seen a shift in consumer and provider willingness to access healthcare through virtual modalities, and across different domains, such as medical, allied health and mental health. While a large proportion of virtual care adoption was born out of necessity, for many consumers, particularly in rural or remote areas, virtual care provides clear cost and time benefits. As well as for many healthcare providers who have the opportunity to effectively deliver care virtually and reduce any potentially unnecessary exposure.


Regulatory changes enabling greater access and reimbursement

Prior to the pandemic, financial constraints contributed to the reduced uptake of virtual care, as it was not funded by government health schemes unless delivered to rural or remote settings. However, this has since changed, with Australia’s Medicare Benefits Scheme expanded to include telemedicine services to everyone (MBS Online, 2021).


What does this mean for consumers and providers?


For consumers


Increased accessibility and choice

A large proportion of GP attendances, such as prescription renewal, referral renewals and some follow-ups do not require physical examination, thus are well-suited to virtual care consultations. This coincides with the 2018 Medical Australia Statistics that 80% of federally-funded GP services in Australia were consultations that ran for less than 15 minutes.


Access for rural and remote communities have also seen significant benefit from advances in virtual care. For every 100,00 rural patients in Australia, there are only 22 specialists available (AIHW, 2017). These patients can endure longer appointment commutes, travel expenses, time away from home and delays between appointments. Virtual care offers improved access to specialists regardless of location as well as reduced costs.


Barriers

While the benefits of virtual care are well documented, for some, virtual care may still be perceived as a substandard form of care or a substitute to in-person care. It is acknowledged that virtual care is not an appropriate mode of delivery for all care settings, models and consumers. Rather, it can be an effective mode of delivery where appropriate and often a mixed modality approach of face-to-face and telehealth can be incorporated.


For providers


Development of new skills and capabilities in virtual care delivery

Advances in technology that lead to new ways of working inevitably lead to the need for new skills and capabilities to match the changing environment. For healthcare workers, this includes the development of new skills and capabilities in virtual care delivery. Below are some of the key skills identified that support virtual care success for healthcare providers.

  • Interpersonal skills: verbal communication, non-verbal communication, consumer-provider relationships

  • Digital literacy: skills to navigate digital tools, awareness and knowledge of digital security and digital health ethics

  • Change management: systematic approach to dealing with the transition or transformation of an organisation's goals, processes or technologies

  • Data analytics: critically appraise information and data, quality improvement, service planning and delivery

  • Health information management: knowing where to find information, translatingdata into insights for patients, digital skills in project and change management

  • Patient focus: patient-centred service provision, patient empowerment, patient ehealth literacy

  • Professionalism: ethical use of information, management and leadership


What does this mean for the future?


Enhanced collaborative engagement and outcomes

Virtual care enables patients, clinicians and health care services to connect with each other through a variety of channels based on their communication and interaction preferences, which in turn, provides one of the most compelling reasons for the future of virtual care - improved health outcomes. Studies have shown that virtual care can lead to a 14% reduction in the length of hospital stays and remote monitoring can cut readmission rates (O’Connor et al., 2016).


Dedicated virtual care workforce positions

Many people and roles are involved in the delivery of virtual care, with workforce changes required to further support delivery of virtual care into the future. The breadth and scope of these roles will continue to expand, however can include:


  • Frontline clinicians: who may use telephone or video conferencing to assess and deliver care to consumers; and other clinicians who provide implementation assistance and training to support virtual care

  • Administration officers: who may book, schedule and manage the flow of virtual appointments

  • Virtual care managers: who support planning, implementation, workforce adoption and management of digital technologies and new models of care

  • Virtual concierge: who act as a conduit between the service and the consumer, helping them to access care and navigate the virtual platforms

  • Virtual champions: who act as change champions or subject matter experts


While many of these roles may already exist in the workforce, it is believed that a balance between uplifting capabilities within the existing workforce and the augmentation of current or development of new roles is required to support ongoing adoption and application of virtual care.


Greater access to virtual care training at undergraduate and professional level

Currently there are six universities in Australia that offer digital health courses, however there is acknowledgment that greater access to virtual care training is required, both at the undergraduate and professional level. Formal training on telehealth clinical application, communication, etiquette, data management and patient safety, just to name a few, are required to further support the health workforce in the delivery of virtual care.


Greater availability of VC resources

Greater access to dedicated virtual care resources is also required to assist in delivery, such as virtual care etiquette guides, online models on safety/confidentiality and frameworks on professionalism when delivering virtual care.


While we hope we’ll stop seeing new COVID-19 variants and we’ll be able to enjoy the freedoms of travel more readily, one thing we are confident will stay in a post-pandemic world is virtual care. While work is still required in the areas of training, promotion, workforce, system governance and leadership, the future of virtual care and the positive health outcomes it can enable looks promising.


Emerson Health has been fortunate to work on numerous projects in the virtual care space and we’d love to hear of your experiences and thoughts on the future of this care delivery modality. For more information and to keep up to date with our regular blog posts, be sure to follow us on LinkedIn.



References


About virtual care. (2021, October 20). Agency for Clinical Innovation. Retrieved December 8, 2021, from https://aci.health.nsw.gov.au/statewide-programs/virtual-care/about


Eikelboom RH. The telegraph and the beginnings of telemedicine in Australia. Stud Health Technol Inform. 2012;182:67-72. PMID: 23138081


O'Connor M, Asdornwised U, Dempsey ML, et al. Using Telehealth to Reduce All-Cause 30-Day Hospital Readmissions among Heart Failure Patients Receiving Skilled Home Health Services. Appl Clin Inform. 2016;7(2):238-247. Published 2016 Apr 20. doi:10.4338/ACI-2015-11-SOA-0157


Macquarie University, Telehealth is here to say as patients phone their GPs in droves. [Online] 2021. https://lighthouse.mq.edu.au/article/january-2021/telehealth-is-here-to-stay-as-patients-phone-their-gps-in-droves


MBS Online, COVID-19 Temporary MBS Telehealth Services. [Online] 2021

http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TempBB


NSW Health. (2022, February). NSW Virtual Care Strategy 2021–2026 - Virtual care. Retrieved February 4, 2022, from https://www.health.nsw.gov.au/virtualcare/Pages/nsw-health-virtual-care-strategy-feb-2022.aspx


Services Australia (2020) Medicare item reports Canberra, Australia: Australian Government

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